We are faced with many questions regarding the use of herbs, natural, and alternative treatments in our practice. Therefore, we decided to create the concise information below solely for your education and awareness.  The references are listed for your review as well. Majority of the information is derived from 2005 EBSCO Publishing. Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.

Benign Prostatic Hyperplasia

Most men show signs of prostatic enlargement as they age. Symptoms include difficulty in starting urination, a diminished force of urinary stream, a sensation of fullness in the bladder after urination, and the need to urinate many times at night. It is important to discuss your symptoms with your physician and rule out prostate cancer prior to starting any therapy.

Saw Palmetto

The best-documented herbal treatment for BPH is the oil of the berry of the saw palmetto tree. There are some data in the literature supporting the benefits of Saw Palmetto over placebo. A 52-week, double-blind study of 811 men compared saw palmetto to a standard drug for BPH in another class: the alpha-blocker tamsulosin.[1] Once again, both treatments proved equally effective. However, saw palmetto caused fewer side effects than the drug. In addition, the herb caused some prostate shrinkage, while the drug allowed a slight prostate enlargement. However, in the most recent and perhaps best-designed of these studies, a 1-year trial of 225 men, saw palmetto product failed to prove more effective than placebo.[2]

Although there are many theories about how saw palmetto works, none have been conclusively established.

 Pygeum

The pygeum tree is a tall evergreen native to central and southern Africa. Its bark has been used since ancient times for urinary problems. The best of these trials was conducted at 8 sites in Europe and included 263 men between 50 to 85 years of age.[3] Participants received 50 mg of a pygeum extract or placebo twice daily. The results showed significant improvements in various measures of BPH severity.

We don't really know how pygeum works. It is thought to reduce inflammation in the prostate and to inhibit prostate growth factors, substances implicated in inappropriate prostate enlargement. We don't know whether pygeum can reduce the need for prostate surgery or whether it affects PSA levels.

Cancer Prevention (Reducing the Risk)

Cancer is believed to begin with a mutation in a single cell. Several mutations in a row are necessary to create all the characteristic features of cancer. Usually, cells have a self-destruct mechanism that causes them to die when their DNA is damaged by mutation. However, in developing cancer cells, something interferes with the self-destruct sequence. The rate of cancerous mutations is increased by exposure to carcinogenic substances. Cigarette smoke is a powerful carcinogen. Many carcinogens exist in the diet as well, even in fruits and vegetables.

Only a few supplements have any evidence from double-blind trials to support their potential usefulness for cancer prevention, and even that evidence is weak. For all other supplements, supporting evidence is limited to observational studies, as well as preliminary evidence from animal and test tube studies.

Vitamin E

The results of observational trials have been mixed, but on balance, they suggest that high intake of vitamin E is associated with reduced risk of many forms of cancer, including stomach, mouth, colon, throat, laryngeal, lung, liver, and prostate cancer. The randomized control trials do not support these findings.[4]

The one positive note came in a double-blind study of 29,133 smokers. Those who were given 50 mg of synthetic vitamin E (dl-alpha-tocopherol) daily for 5 to 8 years showed a 32% reduction in the incidence of prostate cancer and a 41% drop in prostate cancer deaths.[5] Surprisingly, results were seen soon after the beginning of supplementation. This was unexpected because prostate cancer grows very slowly. A cancer that shows up in the prostate today actually started to develop many years ago. The fact that vitamin E almost immediately lowered the incidence of prostate cancer suggests that it may somehow block one of the last steps in the development of detectable prostate cancer.

Selenium

One double-blind study found some evidence that selenium supplements might help prevent cancer even in the absence of severe deficiency.[6] The study actually designed to detect selenium's effects on skin cancer. It followed 1,312 individuals, half of whom were given 200 mcg of selenium daily. People participating in the study were not deficient in selenium. The participants were treated for an average of 2.8 years and were followed for about 6 years. Although no significant effect on skin cancer was found, the researchers were startled when the results showed that people taking selenium had a 50% reduction in overall cancer deaths and significant decreases in cancer of the lung (40%), colon (50%), and prostate (66%). The findings were so remarkable that the researchers felt obliged to break the blind and allow all the participants to take selenium.

Mixed Antioxidants

A large double-blind, placebo-controlled study evaluated the potential overall cancer preventive benefits of a low-dose combination antioxidant supplement providing 120 mg of ascorbic acid, 30 mg of vitamin E, 6 mg of beta-carotene, 100 mcg of selenium, and 20 mg of zinc taken daily for about 7.5 years.[7] The results as a whole failed to show benefit. Finally, antioxidants in high or low doses are probably not helpful in healthy people with good nutrition. [8] 

Beta-carotene

The story of beta-carotene (found in fruit and vegetable) and cancer is full of contradictions. The anticancer bubble burst for beta-carotene in 1994 with the results of the Alpha-Tocopherol, Beta-carotene (ATBC) study.[9] These results showed that beta-carotene supplements did not prevent lung cancer, but actually increased the risk of getting it by 18%. This trial followed 29,133 male smokers in Finland who took supplements of about 50 IU of vitamin E (alpha-tocopherol), 20 mg of beta-carotene (more than 10 times the amount necessary to provide the daily requirement of vitamin A), both, or placebo daily for 5 to 8 years. (In contrast, vitamin E was found to reduce the risk of cancer, especially prostate cancer.)

In January 1996, researchers monitoring the Beta-carotene and Retinol Efficacy Trial (CARET) confirmed the prior bad news with more of their own: The beta-carotene group had 46% more cases of lung cancer deaths.[10] This study involved smokers, former smokers, and workers exposed to asbestos. Alarmed, the National Cancer Institute ended the $42 million CARET trial 21 months before it was planned to end.

Lycopene (Tomatoes)

Lycopene, a carotenoid like beta-carotene, is found in high levels in tomatoes and pink grapefruit. In another study, 47,894 men were followed for 4 years in an observational study looking for influences on prostate cancer.[11]Their diets were evaluated on the basis of how often they ate fruits, vegetables, and foods containing fruits and vegetables. High levels of tomatoes, tomato sauce, and pizza in the diet were strongly connected to reduced incidence of prostate cancer. After an evaluation of known nutritional factors in these foods as compared to other foods, lycopene appeared to be the common denominator.

Vitamin C

Observational studies have also linked higher vitamin C in the diet with reduced risk of cancers of the colon, esophagus, larynx, bladder, cervix, rectum, breast, and perhaps lung.However, dietary vitamin C intake does not appear to be associated with reduced rate of prostate cancer.[12]

Green Tea

Both green tea and black tea come from the plant Camellia sinensis , which has been cultivated in China for centuries. The key difference between the two is in preparation. For black tea, the leaves are allowed to oxidize, green tea is made by lightly steaming the freshly cut leaf, a process that prevents oxidation and possibly preserves more of the therapeutic effects.  However, results from observational studies in humans have not been so clear-cut—some have found evidence of a protective effect, and others have not.[13]

Soy

In many animal studies, soybeans, soy protein, or other soy extracts decreased cancer risk, and observational studies in people have found suggestive associations between higher soy consumption and lower incidence of hormone-related cancers such as prostate, breast, and uterine cancer.

Soybeans provide estrogen-like compounds (isoflavones) binding to the same sites in the body as estrogen, occupying these sites and keeping natural estrogen away. Estrogen stimulates certain forms of cancer, but soy isoflavones exert a milder estrogen-like effect that may not stimulate cancer as much as natural estrogen. This could help protect against cancer.

Men have very low levels of circulating estrogen, so the net effect of increased soy consumption might be to increase estrogen-like activity in the body. Since real estrogen is used as a treatment to suppress prostate cancer, it has been hypothesized that the mild estrogen-like activity of isoflavones has a similar effect. There are also indications that isoflavones might decrease testosterone levels, and alter ratios of certain forms of estrogen, both of which would be expected to provide benefit. In one double-blind study, men with early prostate cancer were given either isoflavones or placebo, and their PSA levels were monitored. The results did show that use of isoflavones (60 mg daily) slightly reduces PSA levels. [14]  

Erectile Dysfunction (Impotence)

Impotence, or erectile dysfunction, is the inability to achieve an erection. Impotence may occur for any of at least 15 possible causes, including diabetes, drug side effects, pituitary tumors, hardening of the arteries, high blood pressure, hormonal imbalances, and psychological factors. A few of these conditions respond to specific treatment. For example, if a blood pressure drug is causing impotence, the best approach is to change drugs. If a pituitary tumor is secreting the hormone prolactin, treating that tumor may result in immediate improvement. However, in most cases, conventional treatment of impotence is nonspecific.

The drugs Viagra and Cialis have revolutionized treatment for erectile dysfunction. These medications work by increasing tissue sensitivity to the blood-vessel-dilating substance nitric oxide (NO) in the penis. Older methods include mechanical devices that utilize a vacuum to produce an erection, drugs for self-injection, and implantation of penile prostheses.

Korean Red Ginseng

Two double-blind, placebo-controlled trials, involving a total of about 135 people, have found evidence that Korean red ginseng may improve erectile function.[15],[16] In the better of the two trials, Hong et al, 45  participants received either placebo or Korean red ginseng at a dose of 900 mg 3 times daily for 8 weeks. After a 1-week period of no treatment, the two groups were switched. The results indicate that while using Korean red ginseng men experienced significantly better sexual function than while they were taking placebo.

 L-Arginine

The substance nitric oxide (NO) plays a role in the development of an erection. Dugs like Viagra increase the body's sensitivity to the natural rise in NO that occurs with sexual stimulation. A simpler approach might be to raise NO levels, and one way to accomplish this involves use of the amino acid L-arginine. Oral arginine supplements may increase nitric oxide levels in the penis and elsewhere. Based on this, L-arginine has been advertised as "natural Viagra." However, there is as yet little evidence that it works.

The main support for the use of arginine in erectile dysfunction comes from a small double-blind trial in which 50 men with erectile dysfunction received either 5 g of L-arginine or placebo daily for 6 weeks.[17] More men in the treated group experienced improvement in sexual performance than in the placebo group.

A double-blind crossover study of 32 men found no benefit with 1,500 mg of arginine given daily for 17 days; the much smaller dose and shorter course of treatment may explain the discrepancy between these two trials. [18]

 Carnitine

 In a 6-month, double-blind trial of 120 men, average age 66, carnitine (propionyl-l-carnitine 2 g/day plus acetyl-l-carnitine 2 g/day) and testosterone (testosterone undecanoate 160 mg/day) were separately compared to placebo.[19]The results indicated that both carnitine and testosterone improve erectile function; however, while testosterone significantly increased prostate volume, carnitine did not.

Another double-blind, placebo-controlled study found that propionyl-l-carnitine at 2 g/day enhanced the effectiveness of sildenafil (Viagra) in 40 men with diabetes who had previously failed to respond to sildenafil on at least eight occasions.[20]