Prostatic Diseases and Natural Medicines:

Dr-Nyarkotey.jpg

Dr. Raphael NyarkoteyObu: PhD(A.M)

The Urologist’s Role in Ghana

Dr. Mathew Y. Kyei and colleagues conducted a prospective study titled “Traditional medicines and alternative practice in the management of prostate diseases” published in the Ghana Med J 2017; 51(3): 128-137. The researchers are affiliated with the Department of Surgery, School of Medicine and Dentistry, College of Health Sciences, University of Ghana and The University of Health and Allied Health Sciences.

The conventional Urological researchers used Traditional Medicine samples from consecutive patients with either lower urinary symptoms (LUTS) presenting at the Urology Unit of the Korle Bu Teaching Hospital (KBTH) in Accra from January 2015 to June 2016 and had a prior treatment with traditional medicines, had the samples retrieved. Additionally, all the 58 licensed pharmaceutical shops in Okaishie, a whole sale and retail depot for medicines in the main business district of Accra, were visited and traditional medicines for the management of prostate diseases acquired.

The products constituent as labeled were documented and entered once on a proforma. This study was part of a study on the management of benign prostate hyperplasia at the KBTH approved by the Medical Directorate. The findings were analyzed and presented using descriptive statistics and presented as a table. The researchers revealed that eleven products were identified with the main indigenous medicinal plant identified being the root extract of Croton membranaceus. “This was the constituent in four products (Uro 500®, UR-Quick mixture®, Prostacure® and prostat®60). Although studies on the basic pharmacology and animal studies have confirmed its effect on the prostate, only one clinical study was identified. They further concluded that Croton membranaceus was the indigenous traditional medicine identified for relieving Lower Urinary Tract symptoms (LUTS) due toprostate disease. There is the need for empirical evidence on its efficacy in treating Prostate cancer” they said.

“There are both animal and human studies to support theeffectiveness of C.membranaceus in the management of some patients with lower urinary symptoms due to BPH. What remains to be elucidated is the population subgroup with lower urinary tract symptoms due to BPH in whom C. membranaceus will achieve satisfactory results with respect to good urine flow rates and acceptable post void residual urine volume levels. This will require a large study population to establish. While its medicinal significance has generated scientific interest in the plant there is real concern in relation to the longer-term availability of this indigenous plant in its natural habitat. The clinical effectiveness of C. membranaceus for the management of prostate cancer has not been established. There is therefore the need to carry out further studies to validate its use among traditional medical practitioners in Ghana in managing all prostate diseases including prostate cancer. Until this is done, efforts must be made to educate users of this plant product of the fact that symptoms of prostate cancer and BPH are often indistinguishable. Every effort must therefore be made at initial evaluation to ensure that those with possible underlying prostate cancer are referred for appropriate diagnosis, staging and treatment”.

I agreed 100% with them concerning their recommendations. This is because, it is difficult for patients to distinguish between prostate cancer and other prostate conditions as the symptoms are the same. The challenge with most of these herbal or alternative centers is how to differentiate between Prostate cancer and other prostate conditions; so they end up treating patients using the same product. Interestingly, by the time the patient realizes that the treatment is not working, the disease is at the advance stage. Sometimes, most of these herbal centers think that; once their medications given to their patients improves the urine flow or decreases the symptom, they have cure the patient from the disease.Others also believe that; once the prostate volumeshrunk, they have treated them. For the patient, your prostate size is not all that matters in the management of prostate conditions. This is because some patients with large prostate size do not even need treatment whilst those with small prostate size needs treatment.

Interestingly, Ghanaian Urologists have finally seen the light in using natural medicine formulated in Ghana with croton membranaceus and others for the management of patients with Benign Prostatic Hypertrophy. However, with prostate cancer, the researchers called for proper scientific research and referral pathway from herbal practitioners. This is the way to go! But the big question is” Would Ghanaian Urologists allowed their patients now to use natural remedy for their prostateenlargement for a while before considering surgery or conventional medicine for prostate enlargement? Would they prescribe some of these products for their patients based on this research from their camp?

One thing I have also observed is the misunderstanding of the usage of sawpalmetto for BPH which most physicians prescribe the recommended 320mg from the manufacturers. Sawpalmetto 320mg is ineffective for BPH; what has been proven effective is 640mg from Dr. Geo Espinoza perspective.

For the ordinary patients; there is one study in Ghana, conducted by Urologists you can use to buttress your point in using natural remedy for your BPH for a while and if no improvements, then you can see your Urologist for further treatment. I believe it is time for Conventional Urologists to extend their hands to practitioners in the field of Natural medicines who have vast knowledge in the field for collaboration. If the Conventional Urologists can do this; I tell you, there is hope for the men in Ghana in prostatic diseases management.

The Patient has right to make his informed decision on Treatments.

When a doctor tells you to make an informed decision; simply, he or she is saying do your own ‘homework’. “Interest in and use of complementary and alternative therapies, especially nutraceuticals, is high in prostate disease. These therapies have shown potential in benign prostatic hyperplasia (BPH), prostatitis, and prostate cancer. Some have produced results equal to or better than pharmaceuticals currently prescribed for BPH. In category III prostatitis, some nutraceuticals may offer relief to patients who get little from standard therapy. Because it is becoming apparent that inflammation may play a role in the progression of BPH and development of prostate cancer, nutraceuticals, which commonly have anti-inflammatory properties, may play a role. These therapies have also shown potential in prostate cancer treatment and prevention, especially those that also reduce cardiovascular events or risk. Nevertheless, uses of some nutraceuticals in prostate disease havehad less desirable consequences, showing lack of efficacy, adulteration, and/or severe side effects or drug interactions. By ensuring that these therapies undergo careful study for effectiveness, quality, and safety, urologists can look forward to adding them to their evidence-based armamentarium for prostate disease” Nickel et al 2008 in a study titled “Nutraceuticals in Prostate Disease: The Urologist’s Role” published in the Rev Urol. 2008 Summer; 10(3): 192–206.

In Ghana and Africa, more than 70% of men diagnosed with prostate disease use some complementary and alternative medical (CAM) therapy. Not only in Ghana, but I always received mails worldwide on men opting for alternative treatment for their Prostate health. It tells you that treatment is choice and no oneholds monopoly on treatment. Likewise, no single treatment is superior and the patient is the captain of his own ship and not the Doctor.No one also holds monopoly on what triggers diseases. Clearly, patients have embraced the concept, so conventional urologists managing prostate disease should be prepared to offer advice on the risks and benefits and play a role in ensuring that safe and effective therapies are developed. They can do this by working with experts in the field of Naturopathic Urology. Some of us in the field and research into Naturopathic Urology have conducted extensive research and knows what works and those natural remedies without scientific facts.

Ghanaian urologists have been slower than their European colleagues to understand and use these therapies. I quite remember sometimes ago, one Urologist called on the government in Ghana to prosecute those herbalcenterstreating prostate conditions; which I found ignoramus. The news was published in the Ghanaian ChronicleFrontPage..

You see, In Italy, for example, 50% of the medications used for benign prostatic hyperplasia (BPH) are phytotherapies, and in Germany and other European countries, phytotherapies are first-line treatment for mild-to-moderate benign prostatic hyperplasia/lower urinary tract symptoms (BPH/LUTS)Dreikorn K in a work titled “Complementary and alternative medicine in urology. BJU Int. 2005;96:1177–1184.

In most European countries, many phytotherapies must be prescribed. In Europe and, as of 2006, in Canada, new phytotherapies and nutraceuticals must undergo the same scrutiny and approval process as pharmaceuticals.

The best-studied CAM therapies for prostate disease include dietary modification; the phytotherapiesSerenoarepens (saw palmetto), Pygeumafricanum, phytosterols, rye pollen extract (eg, Cernilton®, Graminex LLC, Saginaw, MI), and others; and vitamins and minerals, such as vitamin E and selenium. Nevertheless, many of the studies are small, short, not randomized, and/or not placebo controlled. In addition, results can be difficult to measure, especially in preventive trials. In Ghana, only Croton Membranaceus have been studied on BPH. Interestingly, sawpalmetto is superior to Croton Membranaceus, even Hibiscus Sabdarriffa beats croton membranaceus for prostate health. In terms of prostate cancer, hibiscus sabdariffa has been studied a lot and even beats top brand green tea Matcha.

Ghanaian urologists’ reluctance to use these therapies stems not only from the lack of an evidence base for benefit, but also from concerns about safety and quality. Yes, sometimes, most of these herbal companies start pretty well but later employed manufacturing short cut resulting in efficacy challenges. Interestingly, today, lots of men complaining about products formulated with croton membranaceus on its ineffectiveness. The problem has to do with the plant inability to balance prostate hormones; hence manufactures needs to infuse this plant with other evidence based ingredient which have been shown to work to provide that kind of synergy. You cannot go to war with one soldier! Yes, croton membranaceus helps in improving the urine flow; it major drawback is balancing prostate hormones unlike sawpalmetto, smallwillow herb, Hibiscus Sabdariffa et al. What some herbal practitioners and formulators do not know is that; in handling prostate issues, three important things are to be considered: dealing with the urine flow, balancing prostate hormones and quality of life matters!

To you the patients never relied on any product with croton membranaceus for prostate cancer treatment. If you have been diagnosed with biopsy proven prostate cancer, croton membranaceus is a no go area. Always monitor it with your PSA.

 

The Challenges:

One thing you must also know is that , Because the Dietary Supplements Health and Education Act (DSHEA) of 1994 defined these products as dietary supplements, manufacturers do not have to demonstrate effectiveness to the Food and Drug Administration (FDA) before marketing, nor are the products subject to the premarket safety evaluations to which new food ingredients or pharmaceuticals are subject. Manufacturers are not required to demonstrate that the product contents match the labeling before marketing

In a study by Izzo AA and Ernst E titled “Interactions between herbal medicines and prescribed drugs: a systematic review” published in the Journal. Drugs.2001;61:2163–2175 revealed that The potential risks are significant. For example, St. John’s wort can interact with some 50% of prescription medications.

In another study titled “Analytical accuracy and reliability of commonly used nutritional supplements in prostate disease” by Feifer et al published in the J Urol. 2002 Jul; 168(1):150-4; discussion 154. According to the researchers, many nutraceuticals used in prostate disease contain concentrations of ingredients different from the advertised amount and contaminants. Because of such problems, the American Urological Association (AUA) now recommends that patients stop taking most nutraceuticals 2 to 3 weeks before undergoing any surgical or radiation procedure.

However, Ghanaian men have accepted it and it’s also appears to be with us; so what should we do? The AUA has taken steps to encourage careful study of supplements used for urologic problems. The urological community should continue to encourage regulation and work with manufacturers to provide not only quality control but also efficacy and safety data. Although it is easy to level charges at CAM, traditional medicine is guilty of many of the same faults. Urologists do not necessarily treat BPH or prostatitis pharmaceutically based only on objective parameters. In fact, “we typically treat these conditions empirically. Therapies recommended for prostate cancer prevention and treatment do not have controlled, randomized trials to back them, only anecdotal evidence and large series. The majority of randomized, controlled trials that have supported BPH or chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS) therapies are typically short—3 and 6 months in BPH and 6 and 12 weeks in CP/CPPS. Says Curtis et al 2008 in the Journal Reviews in Urology

And, although the FDA requires adequate safety data for marketing, estimated deaths for all adverse drug reactions and medication errors make these a leading cause of death (estimated to be the fifth leading cause of death in the United States)Starfield B. Is US health really the best in the world? JAMA. 2000;284:483–485 and CDC/NCHS National Vital Statistics System 2007, authors. Deaths, percent of total deaths, and death rates for the 15 leading causes of death: United States and each state, 1999–2003. [Accessed January 25, 2007].http://www.cdc.gov/nchs/datawh/statab/unpubd/mortabs_10.htm.

Clinical trials in prostate disease have taken urology to the forefront of CAM research. The urological community does need to proceed with more caution to avoid the kinds of problems that occurred with PC-SPES, a purported wonder herb (actually a concoction of various herbs) that had demonstrable benefit in prostate cancer treatment. After complications were reported, the product was found to be tainted with estrogens, warfarin, and indomethacin, was recalled from the market, and clinical trials were stopped. There are tremendous opportunities, however, in CAM for BPH, CP/CPPS, and prostate cancer, especially because emerging evidence indicates that prostate inflammation, which plays a role in some cases of CP/CPPS, may have a crucial role in the genesis and progression of BPH and prostate cancer. Kramer et al in a study titled “Is benign prostatic hyperplasia (BPH) an immune inflammatory disease”? Eur Urol. 2007;51:1202–1216 and also another study was published by Rohrmann et al. titled” Serum C-reactive protein concentration and lower urinary tract symptoms in older men in the Third National Health and Nutrition Examination Survey (NHANES III) in the Journal Prostate. 2005;62:27–33

 

BPH

To truly understand the benefits that may be derived from nutraceuticals in terms of BPH symptom improvement, one must be cognizant of the literature in regard to the results of medical intervention. With any of the recommended medical BPH therapies—alpha-blockers, 5-alpha-reductase inhibitors, or the combination—the International Prostate Symptom Score (IPSS) typically improves 3 to 6 points, but patients are not always satisfied with that improvement. For example, in the Hytrin Community Assessment Trial, it took at least a 4-point improvement for patients with the lowest baseline scores (10 to 15) to say they felt good and at least a 16-point improvement for those with the highest baseline scores (30 to 35) to say so. Clearly, medical therapy of BPH does not produce the result that surgery does, and patients many times demand more. At least from the patients’ standpoint, phytotherapies can play a role in achieving that result. The study was conducted by Roehrborn CG, Oesterling JE, Auerbach S, et al titled “The Hytrin Community Assessment Trial study: a one-year study of terazosin versus placebo in the treatment of men with symptomatic benign prostatic hyperplasia. HYCAT Investigator Group in the Journal Urology. 1996;47:159–168

 Another study conducted Sech SM, Montoya JD, Bernier PA, et al also titled “The so-called “placebo effect” in benign prostatic hyperplasia treatment trials represents partially a conditional regression to the mean induced by censoring in the journal Urology. 1998;51:242–250 postulated that all interventions for BPH/LUTS have a strong placebo effect, but that effect is not exclusively based on what is usually thought of as placebo phenomena—the white-coat effect, conditioning, expectations, and so on. Without therapy, BPH patients, in fact, are remarkably consistent in their flow rates and reporting of symptoms, as a 2-week lead-in study in a BPH/LUTS treatment trial showed.

Before selection and randomization, 150 patients were asked to come to the clinic twice within 2 weeks and complete the BPH symptom index questionnaire and undergo a flow-rate study each time. The correlation between the first and second measurements was very high.

These were unselected symptomatic patients, however, and not all symptomatic patients are typically included in clinical trials. Instead, patients are screened and entered into trials with a minimum threshold AUA Symptom Index (AUASI) or IPSS score, voided volume, or flow rate. The investigators found that setting a threshold symptom score did, indeed, affect the result. Patients tended to have a lower AUA/IPSS symptom score on a second measurement. The reason is regression to the mean, which is a trend in the direction opposite that of the restriction imposed by the selection process, with more regression (“improvement”) when thresholds are set higher. For example, setting an AUASI threshold at 7 points induced a regression of 1 point, setting it at 10 points induced a regression of 1.1 points, and setting it at 15 points induced a regression of 1.4 points. The regression effect was also apparent in the BPH Impact Index, voided volume, and peak urinary flow rate. Urologists need to keep this effect in mind when they evaluate clinical trials of BPH therapy, whether of pharmaceuticals or phytotherapies.

Phytotherapies used in BPH include extract of the berries of Serenoarepens (saw palmetto), Pygeumafricanum (from the bark of the African plum tree), pumpkin seed, rye pollen (also known under the brand name Cernilton), stinging nettle, South African star grass, and quercetin.

Often, the effects suggested for these phytotherapeutic agents mimic the activities of currently marketed pharmaceuticals. I shall bring to the public and the Urological community the best clinical evidence for the effectiveness of each of these phytotherapies.

 

Prostatitis

Prostatitis is common and a major clinical problem in Ghana especially in young men. Clemens et al titled “Prevalence of prostatitis-like symptoms in a managed care population “published in the J Urol. 2006;176:593–596, Mehik et al “Epidemiology of prostatitis in Finnish men: a population-based cross-sectional study. BJU Int. 2000;86:443–448, in Worldwide prevalence, depending on the definition, is from 5% to 14% of men. Based on a consensus conference, the National Institute of Diabetes and Digestive and Kidney Diseases developed a new classification system for prostatitis in a study published by Krieger JN et al titled “NIH Consensus definition and classification of prostatitis. JAMA. 1999;281:236–237.. Because the etiology is unclear, the new classification avoids etiologic expressions such as “nonbacterial prostatitis.

Category I

Alternative or phytotherapies should be actively discouraged for category I, acute bacterial prostatitis, which is a potentially life-threatening systemic infection. Cure rates are near 100% with antibiotics and appropriate supportive care.

 

Category II

Patients with category II prostatitis have recurrent episodes of bacterial urinary tract infection (UTI) by the same organism. Treatment usually involves long-term therapeutic or suppressive doses of antibiotics. In this category, complementary therapy can play a supportive role.

Prolonged antibiotic use can disrupt the normal gastrointestinal flora, and there is some evidence that probiotic formulations and lactobacilli culture-active yogurt can prevent or lessen gastrointestinal symptoms associated with antibiotic therapy. The study was published by Gionchetti et al titled” Probiotics in gastroenterology. CurrOpinGastroenterol. 2002;18:235–239.

There is also evidence that some probiotic treatments may lessen recurrent UTIs, at least in women. Two studies supported this: Heczko et al titled “Critical evaluation of probiotic activity of lactic acid bacteria and their effects”. J PhysiolPharmacol. 2006;57(suppl 9):5–12 and also Falagas et al titled “Probiotics for prevention of recurrent urinary tract infections in women: a review of the evidence from microbiological and clinical studies. Drugs. 2006;66:1253–1261.

If probiotics could lessen our antibiotic use in these patients, we could avoid the common and considerable side effects of long-term antibiotics. With quinolones, the risk of Achilles tendon rupture is high by van et al “ Increased risk of Achilles tendon rupture with quinolone antibacterial use, especially in elderly patients taking oral corticosteroids” in the journal Arch Intern Med. 2003;163:1801–1807

Zinc is known to be a component of antibacterial factor in seminal fluid, and early studies of chronic prostatitis showed reduced levels in semen in a study by Fair et al titled “antibacterial factor. Identity and significance.Urology. 1976;7:169–177, also Evliyaoglu Y and Kumbur H titled “Seminal plasma zinc analysis and bacteriological cultures in chronic staphylococcal prostatitis published in the .IntUrolNephrol. 1995;27:341–345.

According to research, Cranberry juice protect against UTIs by blocking adherence of Escherichia coli to the uroepithelial cells Di Martino et al “Reduction of Escherichia coli adherence to uroepithelial bladder cells after consumption of cranberry juice: a double-blind randomized placebo-controlled cross-over trial. World J Urol. 2006;24:21–27 and may reduce the biofilm load, Di Martino et al in a work titled” Effects of cranberry juice on uropathogenic Escherichia coli in vitro biofilm formation. J Chemother. 2005;17:563–565. In addition, dangerous interactions with warfarin have been reported by Aston JL, Lodolce AE, Shapiro NL. Interaction between warfarin and cranberry juice.Pharmacotherapy. 2006;26:1314–1319

Because the juice is highly acidic and many men with prostatitis are sensitive to acid loads in their diet, it may make symptoms worse.

No placebo-controlled studies have confirmed a protective effect, and no evidence shows cranberry juice reduces UTIs in men with category II prostatitis. In addition, dangerous interactions with warfarin have been reported. Because the juice is highly acidic and many men with prostatitis are sensitive to acid loads in their diet, it may make symptoms worse. Although a more recent study found no difference. In addition, supplementation does not increase prostatic fluid levels, so there is no convincing evidence that zinc helps treat infection or symptoms or prevent recurrence in category II prostatitis

 

Category III

Phytotherapies have shown the greatest potential in category III prostatitis, termed CP/CPPS, which is the most common of the clinical prostatitis syndromes. The symptoms may be similar to those experienced by patients with chronic bacterial prostatitis (category II) but without infection and probably with more pain and discomfort (certainly with more durable and sustained discomfort). The etiology is unknown, but there are many theories, including persistent, occult prostate infection or inflammation, possibly as a response to infection or a dysregulated immune response or a true autoimmune disease. All the symptoms of CP/CPPS, however, can be caused by pelvic muscle spasm and can be extrinsic to prostate tissue. In some patients who underwent radical prostatectomy for CP/CPPS or prostate cancer, CP/CPPS symptoms did not resolve. In these cases, disease may never have been in the prostate or, because of long-term prostatic inflammation and pain, an autonomous neuromuscular condition developed.

Even though the term prostatitis is often applied to category III, there is often no evidence of inflammation. Only about 50% of symptomatic patients have leukocytes in expressed prostatic secretions (EPS). Many phytotherapies have antioxidant and anti-inflammatory characteristics, and it might be by these mechanisms that these compounds produce their clinically beneficial effects. The best-studied phytotherapies in this category are quercetin, rye and other pollen preparations, and saw palmetto.

 

Category IV

Although category IV prostatitis is asymptomatic, new evidence of the role inflammation may play in the progression of BPH and in prostate cancer makes this category, defined almost as an afterthought, one of the most important and interesting for study and a potential target of treatment. Here, too, phytotherapy may have a role. Many of the proposed mechanisms for the phytotherapies in the prostate are anti-inflammatory. It is beyond the scope of this review to examine the potential role of phytotherapies in the management of category IV prostatitis, but this will likely become an important topic in the near future.

Phytotherapies have shown the greatest potential in category III prostatitis, termed CP/CPPS, which is the most common of the clinical prostatitis syndromes. The symptoms may be similar to those experienced by patients with chronic bacterial prostatitis (category II) but without infection and probably with more pain and discomfort (certainly with more durable and sustained discomfort). The etiology is unknown, but there are many theories, including persistent, occult prostate infection or inflammation, possibly as a response to infection or a dysregulated immune response or a true autoimmune disease. All the symptoms of CP/CPPS, however, can be caused by pelvic muscle spasm and can be extrinsic to prostate tissue. In some patients who underwent radical prostatectomy for CP/CPPS or prostate cancer, CP/CPPS symptoms did not resolve. In these cases, disease may never have been in the prostate or, because of long-term prostatic inflammation and pain, an autonomous neuromuscular condition developed.

Prostatic Cancer

Complementary and alternative medical therapies present great opportunities in prostate cancer, especially in the watchful waiting population. Although many older men with well-differentiated tumors will not die of prostate cancer they do have a 20% to 25% chance of dying of the disease in 15 to 20 years. Patients recommended for watchful waiting want to do something to keep their cancer from progressing, so many are using off-label medications and CAM therapies.

Urologists need to give them and all patients’ advice that will stand the test of time. Patients have a right to know what the best evidence is for different CAM therapies and, most important, how to increase their chance of survival. Following is a summary of the current evidence on CAM therapies of interest to patients seeking to prevent prostate cancer and/or its progression.

Conclusion

In conclusion, Phytotherapies pose great challenges and present tremendous opportunities in prostate disease. However, not all men diagnosed prostatic diseases also benefits of CAM. The most important thing I urged you the patient to understand is that single ingredients is not enough for managing prostatic conditions and never succumb with centers promising cure. Natural treatments are not ‘magic bullet’ drugs; so the treatment could take you between six months to even a year to start experiencing the benefits. Natural treatments do not work very fast! With products on the market you need to read the product label and research on the ingredients based on science use for the formulations. Any product you taking for prostatic cancer; kindly confirm with your PSA, if no improvement kindly stop and see your Doctor.

Some of the natural products could even worsen your symptoms though it has been clinically proven effective for prostatic diseases management. It means the product or a particular ingredient in it is not good or working for you. Do not waste your money on product formulated with single ingredients. Also check who formulated the product you are using; some have no knowledge in natural treatment for prostatic conditions. Do not also fall to advertisement because a celebrity has endorsed it. It is therefore also important for a conventional Urologist to collaborate with Naturopathic Urologists to help address the issue of prostate conditions.

In a market without the rigorous clinical trials and regulation that can ensure efficacy and safety, the dangers are high, and failures, such as with PC-SPES, can be spectacular. But nutraceutical research shows that some of these compounds present opportunities to manage prostate disease that may even exceed those afforded by today’s pharmaceuticals. Clinical and basic research is indicating that inflammation may play a crucial role in the genesis and progression of BPH and prostate cancer. That hints at even more potential for nutraceuticals in prostate disease because so many have anti-inflammatory properties hence conventional Urologists needs to recognize this and advise their patients.

A number of nutraceutical preparations tested in BPH, such as African stargrass, have produced results equal to or better than finasteride or alpha-blockers and deserve rigorous study and testing. The proposed NIH study to test saw palmetto in a classical, phase II dose-finding study, and more studies like this for other nutraceuticals in BPH, could not only address Urologists concerns but bring new, more effective BPH therapies. In category III prostatitis (CP/CPPS), the category understand least and for which Urologists have no therapies that are consistently or robustly effective, some nutraceuticals, especially quercetin, may offer patients some relief of symptoms that have been unable to provide otherwise. Urologists can look to successes with nutraceuticals and other CAM approaches in cardiovascular disease to increase the chance of success in prostate cancer prevention and treatment. Indications are that the CAM therapies that reduce cardiovascular events and improve lipid profiles and other cardiovascular risk factors may also reduce PSA, prostate cancer cell growth, and the prevalence of prostate cancer. “Even if a CAM therapy that reduces cardiovascular risk does not reduce prostate cancer risk, we will still improve our patients’ chance of survival.Urologists can look forward to including CAM therapies, including nutraceuticals, in their evidence-based armamentarium for prostate disease if they help ensure that these therapies undergo careful study for effectiveness, quality, and safety” says Curtis et al 2008 in the Journal Review in Urology.

 

Take Home:

  1. Urologists must be aware that over 70% of their patients diagnosed with prostate disease use some complementary and alternative medical (CAM) therapy before seeing them.
  2. For the first time in Ghana; a research from leading Urologists have recognized the significant benefits of traditional medicines on Prostate enlargement(BPH)
  • Urologists should include a discussion of CAM therapy with all their patients diagnosed with prostate disease.
  1. Urologists must educate themselves about the efficacy and risks of the complementary alternatives available for their patients with prostate disease.
  2. Urologists must also collaborate or open their hands with Naturopathic Urologists or Natural Medicine Doctors who have the scientific knowledge in the disease and have conducted extensive research in this field of Naturopathic Urology.
  3. Buyer beware: Many studies have confirmed that herbal preparations from different producers may have drastically different composition, durability, contaminants, and even efficacy.
  • The best-studied CAM therapies for benign prostatic hyperplasia (BPH) include the phytotherapiesSerenoarepens (saw palmetto), Pygeumafricanum, phytosterols, and rye pollen extract (eg, Cernilton®).
  • The most clinical evidence for a CAM therapy being effective in BPH is for extract of the berries of the saw palmetto or the American dwarf palm tree (Serenoarepens), and even that evidence is not conclusive.
  1. Of all the prostatitis syndromes, CAM therapies hold the most promise for category III chronic prostatitis/chronic pelvic pain syndrome, and the most effective candidates appear to be quercetin, pollen extract, and saw palmetto.
  2. CAM therapies are attractive (for both patients and physicians) in men on watchful waiting or active surveillance protocols.
  3. The best-studied vitamin and mineral CAM therapies for prostate cancer include vitamin E and selenium.
  • The leading cause of death in prostate cancer trials is cardiovascular disease. CAM therapy for the heart appears to be the most effective therapy for the prostate.
  • Hibiscus sabdariffa has also been studied extensively and beats green tea for prostate cancer
  • Do not rely on croton membranaceus if you have been diagnosed with biopsy proven prostate cancer.
  1. Saw palmetto is superior to croton Membranaceus, however, the recommended daily allowance of 32Omg is ineffective for BPH. 640mg has been proven to be effective.
  • Do not buy product as a patient which contains single ingredients.
  • Check who formulated your prostate product.
  • Work with someone who has conducted extensive research or specialized in Naturopathic Urology in Natural medicine to help you with your prostate health pathway.

I shall be back with write ups on what have been proven to work scientifically on natural medicines. Stay blessed!

Dr. Raphael NyarkoteyObu is a Research Professor of Prostate Cancer and Alternative Medicine –Da Vinci College of Holistic Medicine, Larnaca City, Cyprus. A prolific science writer, product developer and scientists at RNG Medicine Research Lab& president of Nyarkotey College of Holistic Medicine at Tema, Com 7 Post Office.Dr. Nyarkotey is the National President of the Alternative Medical Association of Ghana (AMAG) and a member of the Prostate cancer Transatlantic Consortium (CAPtc) under University of Florida..A registered alternative Medical practitioner by the Traditional Medicine Practice Council (TMPC) with research interest in Naturopathic Urology/Oncology.He can be reached on 0541090045. E mail: Oburalph30@yahoo.co.uk

Share this:

Share News

submit to reddit