Benign Prostatic Hyperplasia and Complementary and Integrative Approaches: What the Science Says
Clinical Guidelines, Scientific Literature, Info for Patients:
Benign Prostatic Hyperplasia and Complementary and Integrative Approaches
There is limited evidence that acupuncture may be beneficial for benign prostatic hyperplasia (BPH) symptoms in the short-term; however, more rigorous studies with longer follow-up times are needed before definite conclusions can be drawn.
What Does the Research Show?
- A 2017 systematic review and meta-analysis of 8 randomized controlled trials involving a total of 661 men with BPH found statistically significant changes in favor of acupuncture in moderate-to-severe BPH symptoms with respect to short-term follow-up endpoints. However, the authors of the review noted that the clinical significance of these changes needs to be tested by further studies with rigorous designs and longer follow-up times.
- A 2013 randomized controlled trial in 100 men with moderate-to-severe BPH examined the effects of electroacupuncture on specific acupoints compared to non-acupoints and found that electroacupuncture at a specific acupoint (BL 33) had better effects on the International Prostate Symptoms Score, but there was no difference on post-void residual urine and maximum urinary flow rate as compared with non-acupoint electroacupuncture. The findings suggest that electroacupuncture may be helpful in improving a patient’s quality of life and that electroacupuncture at a specific acupoint may have better therapeutic effects than non-acupoints for BPH.
- Relatively few complications from the use of acupuncture have been reported. Still, complications have resulted from inadequate sterilization of needles and from improper delivery of treatments.
- Practitioners should use a new set of disposable needles taken from a sealed package for each patient and should swab treatment sites with alcohol or another disinfectant before inserting needles. When not delivered properly, acupuncture can cause serious adverse effects, including infections and punctured organs.
There isn’t sufficient evidence to support the use of lycopene for the prevention or treatment of BPH.
What Does the Research Show?
- A 2012 systematic review of eight randomized controlled trials concluded that given the limited number of studies published and their varying quality, it is not possible to support or refute the use of lycopene for the prevention or treatment of BPH or prostate cancer.
- There isn’t adequate data on the safety of lycopene supplements. Lycopene may cause several adverse effects including hypotension and gastrointestinal problems and may increase the risk of bleeding.
Pygeum africanum, also known as the African plum tree, is an evergreen tree native to the Central and South American mountains, the Madagascar and Comoros islands, and the Gulf of Guinea. Extracts from the bark of the tree have traditionally been used for inflammation, kidney diseases, urinary problems, prostate gland inflammation, and other uses. There is some limited evidence that Pygeum africanum may improve some symptoms of BPH, including urinary symptoms, flow parameters, spermogram, and quality of life.
What Does the Research Show?
- A 2015 review of clinical studies of several phytotherapeutic agents, including Pygeum africanum, found some evidence of improved urinary symptoms, flow parameters, spermogram, and quality of life. However, these studies were of short duration, performed on small groups of patients, and had varied evaluation methods and varied formulations. In spite of these limitations, a 2002 meta-analysis indicated that Pygeum africanum is more effective than placebo in relieving BPH-related symptoms.
- A 2002 Cochrane review of 18 randomized controlled trials involving 1,562 men with BPH concluded that a standardized preparation of Pygeum africanum may be a useful treatment option for men with lower urinary symptoms consistent with BPH. However, the studies included in the review were small in size, were of short duration, and used varied doses and preparations of the extract.
- Clinical studies have concluded that Pygeum africanum is generally well-tolerated with mild adverse effects such as diarrhea, nausea, constipation, and headache.
Saw palmetto (Serenoa repens)
Although several small studies have suggested modest benefit of saw palmetto for treating symptoms of BPH, a large study evaluating high doses of saw palmetto and a Cochrane review found that saw palmetto was not more effective than placebo for treatment of urinary symptoms related to BPH. However, a recent systematic review and meta-analysis found that Serenoa repens had the same effect as tamsulosin in treating BPH in terms of International Prostate Symptom Score, quality of life, maximum flow rate, postvoid residual volume, and prostate-specific antigen, with the exception of prostate volume. A single randomized controlled trial showed combination therapy of saw palmetto plus lycopene, selenium, and tamsulosin was more effective than single therapies alone.
What Does the Research Show?
- A 2012 Cochrane review of 32 randomized controlled trials involving 5,666 men with BPH found that Serenoa repens, at 2 and 3 times the usual dose, provides no improvement in urinary flow measures or prostate size in men with lower urinary tract symptoms consistent with BPH.
- A 2020 systematic review and meta-analysis involving 1,080 participants examined the effects of Serenoa repens (320 mg daily) with tamsulosin (0.4 mg daily) for BPH. The reviewers found that after at least the 6-month treatment cycle, Serenoa repens had the same effect as tamsulosin in treating BPH in terms of International Prostate Symptom Score, quality of life, maximum flow rate, postvoid residual volume, and prostate-specific antigen, with the exception of prostate volume; however, tamulosin had a greater improvement in prostate volume compared with Serenoa repens.
- A 2011 double-blind, placebo-controlled, randomized trial in 369 older men demonstrated that saw palmetto extract administered at up to 3 times the standard daily dose (320 mg) did not reduce the urinary symptoms associated with BPH more than placebo. In addition, a 2009 Cochrane review of nine trials concluded that saw palmetto has not been shown to be more effective than placebo for this use.
- A 2014 randomized trial of 225 men with lower urinary tract symptoms and BPH examined the efficacy and tolerability of combination therapy between saw palmetto, lycopene, and selenium plus tamsulosin versus single therapies. The findings suggest that a combination therapy of saw palmetto, lycopene, selenium, and tamsulosin is more effective than single therapies in improving the International Prostate Symptom Score and increasing maximum urinary flow rate. It was noted that after 6 months of treatment, the combination therapy significantly improved symptom scores compared with single therapy, and from 6 to 12 months, combination therapy demonstrated significant improvement in urine flow rate compared to tamsulosin alone. There were no reported treatment-related adverse events associated with combination therapy.
- Saw palmetto appears to be well-tolerated by most users. It may cause mild side effects, including stomach discomfort.
Urtica dioica, also known as stinging nettle, is a plant that grows in humid and temperate climates all over the world. The roots of Urtica dioica have been used for urination disorders associated with BPH, as well as for joint problems, as a diuretic, and as an astringent. There is some limited evidence that Urtica dioica may improve some symptoms of BPH, including lower urinary tract symptoms. There is also some limited evidence that Urtica dioica and saw palmetto (Serenoa repens) may be efficacious for lower urinary tract symptoms associated with BPH.
What Does the Research Show?
- A 2005 double-blind, placebo-controlled, randomized trial of Urtica dioica for treatment of BPH in 620 patients found significant improvement in International Prostate Symptom Score (IPSS), maximum urinary flow rate, and relief of lower urinary tract symptoms compared with placebo, over 6 months of treatment. These improvements were also maintained after 18 months of treatment.
- Other studies have examined the effects of a combination of Serenoa repens and Urtica dioica. A 2007 randomized controlled trial in 257 patients with moderate and severe symptoms of BPH found that the combination treatment over the course of 6 months was superior to placebo for attenuation of inflammatory and obstructive symptoms. Another study in Germany compared the effects of the same combination to tamsulosin in 140 men for 15 months and found both treatments to be efficacious for lower urinary tract symptoms caused by BPH.
- Urtica dioica seems to be generally well-tolerated in clinical trials and may produce mild gastrointestinal effects.
- A 2015 review noted that Urtica dioica contains tannins, which can interact with a concomitant intake of iron, causing a reduction of the effects in patients who need iron supplements.
- Allkanjari O, Vitalone A. What do we know about phytotherapy of benign prostatic hyperplasia? Life Sciences. 2015;126:42-56.
- Barry MJ, Meleth S, Lee JY, et al. Effect of increasing doses of saw palmetto extract on lower urinary tract symptoms: a randomized trial. JAMA. 2011;306(12):1344-1351.
- Cai T, Cui Y, Yu S, et al. Comparison of Serenoa repens with tamsulosin in the treatment of benign prostatic hyperplasia: a systematic review and meta-analysis. American Journal of Men’s Health. 2020;14(2):1557988320905407.
- Engelmann U, Walther C, Bondarenko B, et al. Efficacy and safety of a combination of sabal and urtica extract in lower urinary tract symptoms. A randomized, double-blind study versus tamsulosin. Arzneimittel-Forschung. 2006;56(3):222-229.
- Fagelman E, Lowe FC. Herbal medications in the treatment of benign prostatic hyperplasia. The Urologic Clinics of North America. 2002;29(1):23-29.
- Ilic D, Misso M. Lycopene for the prevention and treatment of benign prostatic hyperplasia and prostate cancer: a systematic review. Maturitas. 2012;72(4):269-276.
- Lopatkin N, Sivkov A, Schläfke S, et al. Efficacy and safety of a combination of Sabal and Urtica extract in lower urinary tract symptoms—long-term follow-up of a placebo-controlled, double-blind, multicenter trial. International Urology and Nephrology. 2007;39(4):1137-1146.
- Morgia G, Russo GI, Voce S, et al. Serenoa repens, lycopene and selenium versus tamsulosin for the treatment of LUTS/BPH. An Italian multicenter double-blinded randomized study between single or combination therapy (PROCOMB trial). Prostate. 2014;74(15):1471-1480.
- Safarinejad MR. Urtica dioica for treatment of benign prostatic hyperplasia: a prospective, randomized, double-blind, placebo-controlled, crossover study. Journal of Herbal Pharmacotherapy. 2005;5(4):1-11.
- Tacklind J, MacDonald R, Rutks I, et al. Serenoa repens for benign prostatic hyperplasia. Cochrane Database of Systematic Reviews. 2012;12(12):CD001423.
- Wang Y, Liu B, Yu, J, et al. Electroacupuncture for moderate and severe benign prostatic hyperplasia: a randomized controlled trial. PLoS One. 2013;8(4):e59449.
- Wilt TJ, Ishani A. Pygeum africanum for benign prostatic hyperplasia. Cochrane Database of Systematic Reviews. 2002;1998(1):CD001044.
- Zhang W, Ma L, Bauer BA, et al. Acupuncture for benign prostatic hyperplasia: a systematic review and meta-analysis. PLoS One. 2017;12(4):e0174586.
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