Benign Prostatic Hyperplasia (BPH)

BPH Overview:

BPH is a progressive, benign, enlargement of the prostate gland. As the prostate enlarges, urine flow from the bladder is gradually decreased. It is age-related, and common.

The prostate gland surrounds the urethra, which is why an enlargement of this gland causes classic symptoms of urinary obstruction.

 

Aetiology:

BPH is a non-cancerous swelling of the prostate gland. When it becomes swollen, symptoms including dysuria, poor urine flow, sensation of incomplete emptying, dribbling, and frequent urges to urinate are common.

Roughly 50% of men over the age of 60 are believed to be suffering from BPH.

Due to urinary obstruction, BPH can lead to an increased chance of urinary tract infection. In some cases, especially in combination with heavy alcohol use, the prostate can become so swollen that urine flow is blocked completely, which is a medical emergency and needs immediate catheterisation to correct.

It is not fully understood what causes BPH, however, there are several popular theories:

Androgen Deficiency

An older theory involves the role of androgens (both testosterone and dihydrotestosterone) causing a gradual increase in prostate size with age.

Female Hormone Ration

Another theory involves the ratio of the male androgens and female oestrogens.

Inflammation

Inflammation is another mechanism, either through systemic inflammation from infection or autoimmune conditions.

Hyperinsulinemia

High circulating insulin triggering prostate growth. This would explain the common link between people with BPH and insulin resistance.

 
anatomy of the prostate
 

Risk Factors:  

  • Old age
  • Sex (Male)
  • Smoking
  • Ethnicity
  • Dietary fat consumption
  • Hormonal dysfunctions
 

Symptoms:

Dysuria

Urinary frequency

Dribbling

Sensation of incomplete emptying

Poor urine flow

Urinary tract infections

Acute Anuria

Painful urination

 

Diagnostic Considerations:

  • MSU

  • Prostate specific antigen (PSA) test

    • Used to screen for prostate cancer
    • Greater than 10.0 ug/L (indicate high probability for prostate cancer)
    • 40.0 ug/L to 10.0 ug/L (may indicate BPH, prostatitis or prostate cancer)
  • Screens for prostate cancer

  • Biopsy

    • Needle biopsy of the prostate gland
  • Cystoscopy

    • Fiberoptic visualisation of the bladder
  • Transrectal ultrasound

  • Digital rectal exam (DRE)

    • Insertion of a finger into the male rectum to palpate rectum and prostate
  • Testosterone Testing

    • Free testosterone
    • Total testosterone
    • Sex hormone binding globulin (SHBG)
    • Free androgen index (from total testosterone and SHBG)
    • Dihydrotestosterone.
  • Prolactin Testing

    • Reference ranges:
      • Female: <750 data-preserve-html-node="true" mU/L
      • Male: 150-500 mU/L
  • Salivary Hormone Testing

    • Testosterone (TT)
    • Oestradiol (E2)
    • DHEA-S
    • Cortisol
 

Hormone Testing Interpretation:

High LevelsLow Levels2
high prescribed hormone dosingLow endogenous hormone production
high endogenous hormone productionLow metabolic funcitoning (thyroid, stress, adrenal, exhaustion)
Adrenal imbalanceInability to synthesize hormones
Thyroid imbalanceNormal decrease with age
Poor liver detoxificationPoor diet (low in fat or protein)
 

Therapeutic Aims:

1. Reduce The Conversion Of Testosterone To DHT via 5-alpha-reductase Inhibition

  • Antiprostatic Herbs (Sernoa repens, Urtica dioica, Epilobium spp., Pygeum africanum)

2. Reduce The Conversion Of Testosterone To Estradiol Via The Inhibition Of The Aromatase Pathway

  • Antiprostatic Herbs (Sernoa repens, Urtica dioica, Pygeum africanum)

3. Reduce SHBG Levels

  • Antiprostatic Herbs (Sernoa repens, Urtica dioica, Epilobium spp., Pygeum africanum)

4. Provide Antiproliferative Effects

  • Antiproliferatives ()

5. Reduce Inflammation

  • Antinflammatories (Crataeva nurvala, Agathosmabetulina, Pygeum africanum, Serenoa repens)
  • Antioxidants ()

6. Improve Bladder Tone

  • Bladder Tonics (Crataeva nurvala)

7. Control Infection (If Applicable)

  • Urinary Antiseptics (Agathosma betulina, Vaccinium oxycoccos)
  • Immunomodulators (Andrographis spp., Echinaceae purpurea)

8. Alleviate Excess Sympathetic Nervous Tone/LUTS

  • Antispasmodics (Viburnum opulus, Corydalis yanhusuo, Dioscorea spp., Valerian officinalis, Piper methysticum)
 

Differential Diagnosis:

  • Prostatitis
  • Prostate cancer
  • Urinary stones
 

Cautions:

Consider the possibility of prostate cancer, test PSA.

 

Herbs For Benign Prostatic Hyperplasia:

Other Herbs:

  • Pygeum africana
  • Crataeva nurvala
  • Epilobium parviflorum
  • Trifolium pratense
  • Curcuma longa

Nutritional Considerations:

  • Quercetin, often combined with bromelain
  • Beta sitosterol
  • Zinc
  • Selenium
  • Essential fatty acids
  • Antioxidants Vitamins A, C, & E
  • Amino acids
    • Glycine
    • Alanine
 

BPH Formula

Herb Name Ratio Amount in mL
Serenoa repens 1:2 40 mL
Urtica dioica (root) 1:2 30 mL
Crataeva nurvala 1:2 40 mL
Total 110 mL

Author:

Justin Cooke

The Sunlight Experiment

Updated: June 2018


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References:

  1. Bone, K., & Mills, S. (2013). Principles and Practice of Phytotherapy-E-Book: Modern Herbal Medicine. Elsevier Health Sciences.