Benign Prostatic Hyperplasia (BPH)

Benign prostatic hyperplasia or “BPH” is a condition which causes the prostate gland to enlarge, and this can often lead to bothersome urinary symptoms.

Frequently Asked Questions

  • 1What is benign prostatic hyperplasia? .
  • 2What are the symptoms of BPH?
  • 3What are the causes of BPH?
  • 4What are the additional causes of BPH?
  • 5Why is it important to measure PSA levels in all men over the age of 40?
  • 6What is the conventional treatment for for BPH?
  • 7What are the risks and complications of BPH and its management?
  • 8What are the risks and management of BPH?
  • 9What neutraceuticals will be recommended?
  • 10Why should one not self-medicate?
  • 11How do I get started?
  • 12How do we treat this at Health Renewal?
  • 13Health Renewal's 10 Inspiring Quotes For Healthy Living:

Benign prostatic hyperplasia or “BPH” is a condition which causes the prostate gland to enlarge, and this can often lead to bothersome urinary symptoms. BPH primarily affects older men: only about 25% of men in their 40s have BPH, but this statistic increases to more than 80% between the ages of 70 and 79

Benign prostatic hyperplasia can cause various significant urinary symptoms which are bothersome to men. In fact, due to the enlarged prostate more than 50% of men in their 60s, and approximately 90% of men over the age of 80, have a form lower urinary tract obstruction. This obstruction causes symptoms such as a weak urinary stream, urinary hesitancy (delay in initiating urination), involuntary cessation of urination, straining to void, and a feeling of incomplete emptying of the bladder. The bladder can also be affected as the urethra ( the “tube” through which urine leaves the body) becomes obstructed. This added complication may result in increased urinary frequency (or a sense of urgency), the need to urinate during the night, bladder pain, painful urination, and/or incontinence.

The development of BPH is a multifactorial process, indicating there is more than one attributing factor. As men age, the cell growth of the prostate gland becomes less well controlled by cell signaling activity. Additionally, the cells in the prostate become less responsive to signals that induce apoptosis or “programmed cell death”. This results in an overabundance of cells in the prostate, also known as prostate hyperplasia. This breakdown in cellular regulation that occurs within the aging man allows prostate cells to proliferate and promote the formation of additional tissue. This additional tissue is smooth muscle, which tends to increase the overall muscle tone of the prostate gland, and will ultimately contribute to blockage of the urinary tract.

The sex hormones (both male & female) exert significant influence over BPH development and progression. While many men are aware of a pro-growth role of a testosterone metabolite called DHT (dihydrotestosterone) in prostatic hyperplasia, few know that estrogen may also contribute to BPH. In ageing men there is an increased level of activity of an enzyme called aromatase. This enzyme has the function of converting testosterone into oestrogen. As a result, if too much oestrogen is produced a hormonal imbalance occurs which can contribute to the formation of BPH in ageing men. Additionally, if an individual has high levels of insulin-like growth factors and inflammatory markers (such as C-reactive protein) it can also be a contributing factor to BPH formation.

Health Renewal advocates the use of PSA screening to prevent prostate cancer deaths, with an important caveat– PSA results should be tracked and monitored over time (ie, PSA velocity) with less emphasis being placed on individual test results. Health Renewal issues a cautionary advisory whenever PSA levels exceed 1.0 ug/L. A level of say 1.4 should be closely followed with PSA blood tests every 6-12 months to carefully track any consistent increase indicative of an early stage prostate tumor that may be treatable with lifestyle changes and medications with low side effect profiles.

Conventional BPH treatments typically depend on the severity of the patient’s symptoms. In men with mild or asymptomatic BPH, watchful waiting is appropriate, which includes an annual physical examination.

Pharmacologic Treatment can be employed for men who have moderate-to-severe (AUASI score ≥ 8) and/or bothersome symptoms after consideration of the risks and benefits. These patients ill be referred o a urologist or further evaluation and treatment . Currently, four different classes of medications and/or surgery are used to treat BPH.

α1-adrenergic receptor blockers eg Flomax

5α-reductase inhibitors eg Proscar. Medications in the 5-α-reductase inhibitor class block the conversion of testosterone to dihydrotestosterone, helping to shrink the prostate and prevent further growth.

Antimuscarinics. Pharmacologic blockade of these receptors decreases the incidence of overactive-bladder symptoms of BPH

Phosphodiesterase-5 Inhibitors Eg Viagra. Men with lower urinary tract symptoms sometimes experience erectile dysfunction, which has led some researchers to speculate that the two symptoms may be linked . Phosphodiesterase inhibitors are used to treat erectile dysfunction, but may also relieve lower urinary tract symptoms in men with BPH.

Surgery. BPH can also be treated surgically. The purpose of surgery is to either remove the prostate or reduce its size, thereby relieving the lower urinary tract symptoms.

Two minimally invasive treatments — transurethral needle ablation of the prostate and transurethral microwave thermotherapy— have been developed to treat BPH, although there is some uncertainty regarding which patients will respond well, and more studies need to be done to evaluate the effectiveness of these treatments. More invasive procedures can be used for patients with moderate-to-severe symptoms of BPH, particularly for patients who have not responded to pharmacologic therapy.

Transurethral protastectomy (TURP), a procedure in which the prostate is endoscopically removed, is the benchmark surgical therapy for BPH Men with very large prostates may benefit from an open prostatectomy, in which the entire prostate is removed, but this treatment can result in significant blood loss, incontinence, impotency, pain, and longer hospital stays (McVary 2011).

Transurethral laser therapy is another surgical option that is gaining momentum. This treatment option may reduce the length of stay in the hospital, although more information regarding the safety of this therapy is needed (McVary 2011). The adoption of laser-based operations for BPH has led to more cases of BPH being treated surgically.

Intraprostatic botulinium toxin injections an emerging BPH therapy. Botulinum toxin is a bacteria-derived neurotoxin that relaxes muscles by preventing certain neurotransmitter (acetylcholine) signals. Since lower urinary tract symptoms are attributable in part to excessive smooth muscle contraction around the bladder and prostate in men, scientists have hypothesized that injecting botulin toxin directly into the prostate may relax those muscles and relive some urinary symptoms.

In a preliminary trial, 10 men with lower urinary tract symptoms suggestive of BPH received intra-prostatic injections of botulinum toxin. Significant improvements were noted, including a nearly 50% reduction of urinary symptoms assessed by a standardized assessment, a significant reduction in PSA levels and prostate volume, and a 42% reduction in frequency of nighttime urination. The investigators in this study concluded that “ntraprostatic injection of Botulinum-A may be an effective and safe treatment for symptomatic BPH in selected patients whose medical treatment has faced failure and are poor surgical candidates” (Hamidi Madani 2012). Another similarly designed study on 10 men with BPH demonstrated similar efficacy: “Intraprostatic [purified botulinum neurotoxin] injection induces prostate shrinkage and is effective in men with BPH” (Yokoyama 2012). A slightly larger study (34 men with BPH who failed medical treatment) published in September 2012 reported very similar findings (Arnouk 2012).

Soy Isoflavones. If an individual has a risk, or history of, oestrogen dependent cancers he/she should consult a healthcare professional before beginning a soy regimen, and then monitor it closely is the choice is made to continue with treatment.

Fish oil. If an individual is on chronic anti-coagulant or anti-platelet medications, or has a bleeding disorder, it is imperative to consult a healthcare provider before taking this product. Please do not self-medicate.

Gamma-linolenic acid (GLA.) If an individual is on chronic anti-coagulant or anti-platelet medications, or has a bleeding disorder, it is imperative to consult a healthcare provider before taking this product. Please do not self-medicate.

Selenium. If an individual is on chronic anti-coagulant or anti-platelet medications, or has a bleeding disorder, it is imperative to consult a healthcare provider before taking this product. Please do not self-medicate.

Garlic extract. Garlic taken on an empty stomach may cause irritation, therefore take this supplement with (or after) meals.

Nutroceuticals are products derived from food sources that have extra health benefits. It is clear that nutritional therapy plays a vital role in the management of PMS. It is a simple and effective approach in comparison to conventional medicine, without any side effects and will be prescribed and monitored by your Health Renewal Doctor.

  • ’Natural’ progesterones derived from yams can be substituted with the synthetic progestin versions. These are considered safer alternatives with good reduction of PMS symptoms.
  • Phytoestrogens, derived from plants, are estrogen like compounds, which are effective in relieving PMS symptoms.
  • Calcium and vitamin D3 , when used in combination, have shown to cause a reduction in PMS related symptoms in over 48% of cases.
  • Magnesium: Owing to magnesium deficiency being a possible cause of premenstrual symptoms, the supplementation with magnesium may be indicated.
  • Zinc: Women suffering with PMS have found to have lower than normal levels of Zinc during the luteal phase. Hence supplementation is helpful to normalize levels.
  • Vitamin B6 is found to be particularly helpful for those suffering with mood related premenstrual symptoms.
  • Vitex: Extracts of the fruits of the chaste tree (Vitex agnus castus) are widely used to treat PMS symptoms, especially breast tenderness. One German study showed that more than 50% of women experienced a reduction in PMS-related symptoms after using Vitex supplementation. Its efficacy has even been compared to fluoxetine (Prozac).
  • Ginkgo biloba: This supplement has shown great results in reducing anxiety, headaches and fluid retention symptoms associated with PMS.
  • Vitamin E: This vitamin is a powerful antioxidant and free radical scavenger, it also yields significant improvement in physical symptoms of PMS.
  • Theanine: This is a unique amino acid found in tea, and can lessen the effects of PMS. It is found in high quantities in green tea and may increase dopamine levels in the brain, which causes relaxation without drowsiness, thus relieving anxiety and stress.
  • Serotonin modulators: Tryptophan, a precursor of serotonin, is used to increase the amount of serotonin available in the brain. It has been shown to hugely reduce the PMS symptoms when taken during the luteal phase. 5-hydroxytryptophan, which is a direct serotonin precursor, is beneficial in the treatment of depression.
  • St John’s Wort is another natural antidepressant which has shown promise in managing more mood related symptoms of PMS.
  • Omega 3 fatty acids: This fatty acid is found in fish products and is particularly helpful in increasing the amount of anti-inflammatory prostaglandins while suppressing the pro-inflammatory ones. Thus it is particularly helpful with alleviating cramping associated with PMS.
  • Gamma-Linoleic acid (GLA) is found to be lower in women with PMS so supplementation can be beneficial. GLA can be found in Evening Primrose oil and Borage seed oil.

Treatment of BPH with plant-derived compounds dates back to the 15th century BC in Egypt.

Saw palmetto extract also known as Seronoa repens (S. repens) or Sabal serrulata (S. serrulata), is the most widely used phytotherapeutic treatment for BPH . It has been documented as a treatment for swollen prostate glands since the 1800s ). Saw palmetto has been found to be effective in treating the lower urinary tract symptoms of BPH. Evidence suggests that saw palmetto has similar efficacy to finasteride and tamsulosin, two medications used to treat BPH . Saw palmetto extract appears to inhibit the activity of the 5α-reductase enzyme. It may also have anti-inflammatory properties and a tendency to promote apoptosis of prostate cells . Saw palmetto has not been reported to cause any significant side effects. Saw palmetto is rich in phytosterols, including beta-sitosterol (see below), and this may contribute to its therapeutic effects.

Beta sitosterol – Beta-sitosterol belongs to a family of plant-derived compounds chemically similar to cholesterol. These compounds are called phytosterols. The impact of human intake of phytosterols has been studied in a variety of contexts, including cardiovascular disease and cancer. A beneficial role for phytosterols, and beta-sitosterol in particular, in prostate conditions is supported by a considerable body of research in both laboratory and clinical settings. A comprehensive review of 4 studies comprising data on 519 men with BPH showed that beta-sitosterol improved urinary symptoms and flow measures.

Pygeum Africanum – Pygeum africanum (P. africanum), also known as African plum, is used as a treatment for BPH in Europe P. africanum may prevent the proliferation of cells within the prostate A review of studies examining the effects of African plum on BPH found that it provides moderate relief from urinary symptoms.

Urtica Dioica (“stinging nettle”) – Stinging nettle root extracts have shown effectiveness as natural therapeutics for BPH ). A study found that a combination of saw palmetto and 120 mg of stinging nettle extract was as effective as finasteride in the treatment of BPH; the herbal combination also had fewer side effects than finasteride. Another study showed that stinging nettle alone had beneficial effects in patients with symptomatic BPH. This finding is supported by animal studies showing that stinging nettle extract reduced the size of the prostate, weekly urine output, and PSA levels, perhaps by disrupting prostate cell growth.

Isoflavones and Lignans – Plant-derived compounds called isoflavones, which are abundant in soybeans, and lignans, which are abundant in flax and Norway spruce, modulate estrogen signaling in the human body via interaction with estrogen receptors. Thus, these compounds are sometimes classified as “phytoestrogens”. Isoflavones and lignans have been investigated for their anti-cancer effects, but their ability to affect hormone-responsive tissues appears to influence the prostate.

Evidence suggests that isoflavones may inhibit testosterone-mediated prostate cell growth These compounds were also shown to block the activity of 5α-reductase, the enzyme that converts testosterone to dihydrotestosterone (DHT), which promotes prostate growth One study suggested that men with BPH may have lower dietary intake of soy isoflavones than men with healthy prostates, as determined by lower prostate tissue concentrations of genistein, a potent isoflavone (Hong 2002). Genistein levels may also correlate with the size of the prostate in BPH: men with small-volume BPH have been found to have higher levels of genistein in their prostate tissue than men with large-volume BPH (Brossner 2004).Supplementation with soy isoflavones has been found to reduce PSA levels in men with prostate cancer In addition to preventing prostate cell proliferation, isoflavones may increase programmed cell death (ie, apoptosis) in low-to-moderate grade tumors from prostate cancer patients. Another study found that isoflavones are very well tolerated.

Lignans have also been evaluated as a treatment for BPH, and one study found that a flaxseed lignan extract reduced both BPH symptoms and the grade of lower urinary tract symptoms experienced by some patients.

Pumpkin Seed Oil – Pumpkin seeds (Curcurbita pepo) have been used in folk medicine as a treatment for urinary problems caused by an enlarged prostate (Tsai 2006). Compounds in pumpkin seeds may interfere with the action of dihydrotestosterone, which stimulates prostate cell growth (Gossell-Williams 2006). Studies in animal models of BPH have found that pumpkin seed oil blocks testosterone-mediated prostate growth (Gossell-Williams 2006, Abdel-Rahman 2006). Pumpkin seed oil’s effects were greater in animal models when the oil was combined with phytosterols Similar results have also been found in human studies. For example, one study found that pumpkin seed oil reduced BPH symptoms in Korean men and also improved their urinary flow rate. This study also found that a combination of pumpkin seed oil and saw palmetto reduced PSA levels (Hong 2009).

Lycopene – Lycopene is a carotenoid occurring abundantly in tomatoes. Men with higher lycopene levels in their blood, suggesting greater dietary lycopene consumption, are less likely to develop prostate cancer. One laboratory experiment found that lycopene inhibited the growth of normal human prostate cells. Another study suggested that lycopene supplementation may decrease the growth of prostate cancer.

Fatty Acids – Healthy fats, such as eicosapentaenoic acid (EPA), decosahexoaenoic acid (DHA), and gamma-linolenic acid (GLA), exhibit a wide range of beneficial effects on the human body and may support prostate health.

Flaxseed oil and fish oil are rich sources of essential fatty acids. A pilot study found that flaxseed supplementation, combined with a low-fat diet, lowered PSA levels in men who were scheduled to have a repeat prostate biopsy. This special diet also reduced the rate of prostate cell proliferation ). Another study found that the essential fatty acids gamma-linolenic acid (GLA) and eicosapentaenoic acid (EPA), and their metabolites, suppressed the activity of 5α-reductase.

Additional Support for BPH

Several other dietary constituents may also be able to protect against BPH, although more studies are needed.

  • Boswellia serrata
  • Selenium - Selenium is a mineral the body needs in small quantities; however, increased selenium intake may help prevent BPH
  • Garlic - Garlic has anti-inflammatory, anti-cancer, and antioxidant effects, all of which may help prevent the development of BPH and prostate cancer. Although its mechanism of action is not clear, several animal and cell culture studies have suggested that garlic may be beneficial for BPH. In addition, combining garlic with other foods beneficial for the prostate, such as olive oil and tomatoes, may enhance its effects.
  • Beta-carotene and vitamin C - Increased intake of beta-carotene and vitamin C is associated with a decreased risk of having BPH requiring surgical treatment.

For all health conditions, the nutraceuticals are individually tailored by the Health Renewal Doctor. The doctor will decide- based on your history, physical examination and blood tests what would be the best for you and your specific needs and/or deficiencies. It cannot be overemphasized that one must not self-medicate. Self-Medicating is done when a person takes prescription medication or nutraceuticals on their own without a doctor's supervision and/or consent. By not having a physical examination and blood testing done by a qualified and practising integrative medical practitioner, you could be not treating vital deficiencies or conditions such as elevated blood pressure, high sugar level, high stress levels (that can lead to adrenal burnout ) and high blood clotting factors that could lead to heart attacks and stroke. In addition, there is no single supplement prescribed to clients as there is no magic bullet that can support all the essential nutrients that one's body needs. Today's food is not functional and we need to supplement in order to maintain optimal bodily functions and nutrition.

Make an appointment to consult with your Health Renewal Doctor who is an integrative doctor and he/ she will assist you in determining your risk factors and how best to prevent any problems or conditions that you may be susceptible to.

The initial medical consultation at Health Renewal will be approximately 45 minutes. As this is a prolonged medical consultation, the initial consultation fee will be R975 which can be claimed back from your medical aid.

On arrival you will have to complete an in depth questionnaire before the consultation so please arrive 20 minutes before the time. During the 45 minute consultation your Health Renewal doctor will obtain a full medical history from you to determine your personal risk. A physical examination will be done after which he/she will decide which blood tests need to be requested from your local pathology laboratory. If you have a medical aid, these should be able to be claimed as well.
These results will then be analyzed by your Doctor and this will be discussed with you at your follow up appointment usually 2 weeks later. This will determine what abnormalities/ deficiencies exist and you will be advised on your treatment options. These options may range from prescription medications, nutraceuticals, bio-identical hormonal creams / tablets or alternatively to having bio-identical implants / pellets inserted. In office treatments such as carboxytherapy may also be recommended for certain conditions such as hair loss, erectile dysfunction, menopause or PMS. If you need to lose weight our Body Renewal Medical Weight loss program may be recommended.
All these recommendations will be summarized on a sheet / print out which you can take home with you . The nutraceuticals offered at Health Renewal are of superior quality (Solgar) and are not rancid nor contain Hg or PCB'S (which is very important for Omega3 EFA) and are free of gluten, preservatives, Wheat, Dairy, Soy, Yeast, Sugar, Artificial Flavor, Sweetener and Color. We have a great professional team made up of doctors, trained and registered nurses and therapists to support you at any time. An added bonus is that any nutraceuticals purchased will go towards loyalty points at any Skin, Body and Health Renewal branches.

Here are ten quotes from great thinkers to challenge, motivate and inspire us to exercise, eat right and live healthier lives:

1. Buddha (c. 563 BC to 483 BC) – a spiritual teacher from ancient India who founded Buddhism

To keep the body in good health is a duty, otherwise we shall not be able to keep our mind strong and clear.

2. Marcus Valerius Martialis (known in English as Martial) (circa 40 AD – 103 AD) – a Latin poet from Hispania (the Iberian Peninsula) best known for his twelve books of Epigrams

Life is not merely being alive, but being well.

3. Edward Smith-Stanley (1752-1834) – English statesman, three times Prime Minister of the United Kingdom

Those who do not find time for exercise will have to find time for illness.

4. Paul Dudley White (1886 – 1973) – an American physician and cardiologist

A vigorous five-mile walk will do more good for an unhappy but otherwise healthy adult than all the medicine and psychology in the world.

5. Henry Ward Beecher (1813 – 1887) – a prominent, Congregationalist clergyman, social reformer, abolitionist, and speaker

The body is like a piano, and happiness is like music. It is needful to have the instrument in good order.

6. James Leigh Hunt (1784 – 1859) – an English critic, essayist, poet and writer

The groundwork of all happiness is health.

7. Francois Rabelais (c. 1494 – 1553) – a major French Renaissance writer, doctor and Renaissance humanist

Without health, life is not life; it is only a state of languor and suffering.

8. Francis Bacon (1561 – 1626) – an English philosopher, statesman, scientist, lawyer, jurist and author

A healthy body is a guest-chamber for the soul; a sick body is a prison.

9. Persius (34 AD -62 AD) – a Roman poet and satirist of Etruscan origin

You pray for good health and a body that will be strong in old age. Good — but your rich foods block the gods’ answer and tie Jupiter’s hands.

10. Menander (ca. 342–291 BC) – Greek dramatist, the best-known representative of Athenian New Comedy

"Health and Intellect are the two great blessings in life"


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