Benign Prostatic Hyperpasia

Wednesday June 22, 2016


The development of BPH is thought to be driven by a lifetime of exposure to the testosterone metabolite, dihydrotestosterone (DHT), and possibly estrogen (1). In men, estrogen is produced by the enzyme aromatase, which is present in fat cells (1). As a result, obesity is associated with higher risk of BPH. On the other hand, prostatic cells convert testosterone to the more potent metabolite, DHT.


In BPH, the enlarged prostate compresses the bladder and the urethra (the “pee tube”), resulting in classic BPH symptoms. Therefore, treatments generally focus on decreasing prostate size and decreasing bladder irritability. The most common medication used to treat BPH is finasteride, which inhibits the conversion of testosterone to DHT; however unpleasant side effects such as erectile dysfunction affect up to 9% of men who take this drug (3). Newer research suggests that more serious side effects may also be associated with finasteride, including higher risk of more aggressive types of prostate cancer as well as depression (4). Researchers emphasize the importance of patients being adequately informed as to these risks when prescribed their medication (4).


Several natural agents have been shown to be highly effective in reducing symptoms of BPH.  Saw palmetto (Serenoa repens) has been very well studied for its effects on BPH (5). A systematic review including 18 randomized trials concluded that “S repens improves urologic symptoms and flow measures. Compared with finasteride, S repens produces similar improvement in urinary tract symptoms and urinary flow and was associated with fewer adverse treatment events” (5), a strong statement indeed from the Journal of the American Medical Association. Beta-sitosterols are another plant derived agent that has been shown to improve BPH, likely through effects on modulating hormones and inflammation (6). In another study, stinging nettle (Urtica dioica) was shown to improve lower urinary tract symptoms in 81% of patients, compared to only 16% in the placebo group (7). This was accompanied by a modest decrease in prostate size.


Traditionally, BPH has been considered a distinct and separate entity from prostate cancer. Newer data, however, has illustrated several similarities between these two chronic conditions affecting the prostate. Most important is the observation that both of these conditions are fueled by DHT, estrogen, and the presence of inflammation in the prostate; both conditions also respond to treatment with anti-hormonal agents (8). Studies show that men with BPH are at elevated risk of developing prostate cancer (8). Additionally, men with BPH who have high inflammatory activity are at highest risk of having BPH progression and complications (9); on the other hand, chronic inflammatory lesions of the prostate have been considered a precursor to prostate cancer (9).


Given this new association and common inflammatory cause, there is a strong basis to utilize agents with proven benefit in BPH as treatment for preventing and treating prostate cancer.


Consult with a licensed naturopathic doctor to determine the most appropriate treatments for you.



1. Patel ND, Parsons JK. Epidemiology and etiology of benign prostatic hyperplasia and bladder outlet obstruction. Indian J Urol. 2014 Apr;30(2):170-6.

2. Chang RT, Kirby R, Challacombe BJ. Is there a link between BPH and prostate cancer? Practitioner. 2012 Apr;256(1750):13-6, 2.

3. Gur S, Kadowitz PJ, Hellstrom WJ. Effects of 5-alpha reductase inhibitors on erectile function, sexual desire and ejaculation. Expert Opin Drug Saf. 2013 Jan;12(1):81-90.

4. Traish AM, Mulgaonkar A, Giordano N. The dark side of 5α-reductase inhibitors'

therapy: sexual dysfunction, high Gleason grade prostate cancer and depression.

Korean J Urol. 2014 Jun;55(6):367-79.

5. Wilt TJ, Ishani A, Stark G, MacDonald R, Lau J, Mulrow C. Saw palmetto extracts for treatment of benign prostatic hyperplasia: a systematic review. JAMA. 1998 Nov 11;280(18):1604-9.

6. Wilt T, Ishani A, MacDonald R, Stark G, Mulrow C, Lau J. Beta-sitosterols for benign prostatic hyperplasia. Cochrane Database Syst Rev. 2000;(2):CD001043.

7. Safarinejad MR. Urtica dioica for treatment of benign prostatic hyperplasia: a prospective, randomized, double-blind, placebo-controlled, crossover study. J Herb Pharmacother. 2005;5(4):1-11.

8. Ørsted DD, Bojesen SE. The link between benign prostatic hyperplasia and prostate cancer. Nat Rev Urol. 2013 Jan;10(1):49-54.

9. Sciarra A, Di Silverio F, Salciccia S, Autran Gomez AM, Gentilucci A, Gentile V. Inflammation and chronic prostatic diseases: evidence for a link? Eur Urol. 2007 Oct;52(4):964-72.