Benign Prostatic Hyperplasia
Description
Benign prostatic hyperplasia (BPH, also known in the past as benign prostatic hypertrophy) is a non-infectious, non-malignant enlargement of the prostate gland. It is progressive and may lead to obstruction of the rethra and to interference with the flow of urine.
The incidence of BPH is estimated at 50-60% of men between 40 and 59 years of age. The projected annual overall cost of hospital care and surgery for BPH is over a billion dollars in the U.S. alone.
Causes
BPH represents a male hormone-dependent disorder of metabolism reflecting the many significant changes in steroid levels in aging men. Testosterone and, in particular, free testosterone levels decrease with age after the fifth decade.
Prolactin, estradiol, sex hormone-binding ligand, luteinizing hormone, and follicle stimulating hormone levels are all increased. The ultimate effect of these changes is an increased prostatic concentration of a potent androgen derived from testosterone. This is largely due to a decreased rate of removal. Excessive levels of this hormone (and/or excessive binding to the prostate cells) and elevated levels of prolactin result in prostatic hyperplasia.
Signs & Symptoms
Symptoms of bladder outlet obstruction (progressive urinary frequency, urgency and waking at night to urinate, hesitancy and intermittence with reduced force and caliber of urine).
Enlarged, non-tender prostate
Uremia if prolonged obstruction
Nutritional Supplements
Structure & Function: Men's Health
---------------------------------
General Supplements
---------------------------------
| Adult | ||
| Alanine | 200 mg/d | |
| Bee pollen* | ||
| Copper | 2 mg/d | |
| EPO* | ||
| Flax seed oil* | ||
| Glycine | 200 mg/d | |
| Glutamic acid | 200 mg/d | |
| Zinc picolinate | 50 mg/d |
* Please refer to the respective topic for specific nutrient amounts.
Amino Acids
The combination of glycine, alanine and glutamic acid has been shown in several studies to relieve many of the symptoms of BPH. In a controlled study of 45 men, nocturia (waking at night to urinate) was relieved or reduced in 95%, urgency reduced in 81%, frequency reduced in 73%, and delayed urination alleviated in 70%. These results have also been reported in other controlled studies. The mechanism of action is unknown.
Copper
Low level copper supplementation is recommended to prevent zinc supplementation-induced copper deficiency.
Essential Fatty Acids
The administration of an essential fatty acid (EFA) complex containing linoleic, linolenic and arachidonic acids has resulted in significant improvement for many BPH patients. All 19 subjects in an uncontrolled study showed diminution of residual urine, with 12 of the 19 having no residual urine by the end of several weeks of treatment. These effects appear to be due to the correction of an underlying EFA deficiency, since these patients' prostatic and seminal lipid levels and ratios are often abnormal.
Flaxseed oil has been successful since some early trials (1941).
Zinc
Paramount to an effective BPH treatment plan is adequate zinc intake and absorption. Zinc has been shown to reduce the size of the prostate - as determined by rectal palpation, x-ray, and endoscopy - and to reduce symptomatology in the majority of patients. The clinical efficacy of zinc is probably due to its critical involvement in many aspects of androgen metabolism. Intestinal uptake of zinc is impaired by estrogens, but enhanced by androgens. Since estrogen levels are increased in men with BPH, zinc uptake may be low. Zinc has been shown to inhibit the conversion of testosterone to its more toxic form. Zinc also inhibits specific binding of androgens to the prostatic cell receptors.
Zinc has also been shown to inhibit prolactin secretion. Prolactin has been shown to increase the uptake of testosterone by the prostate, thereby leading to increased levels of its metabolites. Prolactin antagonists have been shown to reduce many of the symptoms of prostatic hyperplasia. However, these drugs have severe side effects and are of limited value. Beer (but not pure alcohol), tryptophan and stress all increase prolactin secretion and may therefore be aggravating factors.
When considering the importance of adequate zinc nutriture, one must also consider zinc antagonists, particularly cadmium. Although cadmium is a known antagonist of zinc and increases the conversion of testosterone to toxic metabolites, its concentration in, and effects on, the prostate are unclear. Exposure to cadmium should however be carefully avoided. Sources of cadmium include cigarettes, acid foods stored in cadmium plated cook ware and welding of cadmium plated metals.
(Decrease dose to 15 mg/d after 6 months.)
Note: All amounts are in addition to those supplements having a Recommended Dietary Allowance (RDA). Due to individual needs, one must always be aware of a possible undetermined effect when taking nutritional supplements. If any disturbances from the use of a particular supplement should occur, stop its use immediately and seek the care of a qualified health care professional.
Dietary Considerations
BPH will often respond to nutritional and herbal support, especially if introduced early on.
The paramount nutritional consideration is zinc. The selection of mineral salt (or chelate) is important: zinc picolinate and zinc citrate are most often used. A rich natural source of zinc is pumpkin seeds (which also contributes tryptophan that can be useful in stress and sleep disorders). Absorption is improved in the presence of vitamin B6 which has other benefits as well.
Essential fatty acids may also improve metabolism, leading candidates being: evening primrose, linseed, soy, sunflower and walnut oils.
Symptomatic relief has also been reported with amino acid therapy: glycine, alanine and glutamic acid in combination.
There have been no clinical trials of the use of diet in the treatment of BPH.
Cholesterol
Cholesterol metabolites are toxic to many cells and carcinogenic and have been shown to accumulate in the hyperplastic human prostate. They can initiate degeneration of prostate cells, leading to the increased regeneration seen in BPH. Drugs which lower cholesterol levels have been shown to have a favorable influence on BPH, preventing the accumulation of cholesterol in the prostatic cells and limiting subsequent formation of cholesterol metabolites. Every effort should be made to decrease cholesterol levels by utilizing the principles outlined in the Atherosclerosis treatment screens.
The patient should limit alcohol; avoid drug, pesticide and hormone contaminated foods; and limit cholesterol-rich foods.
Drugs and Pesticides
The diet should be as free as possible from pesticides and other contaminants, since many of these compounds (e.g., dioxin, polyhalogenated biphenyls, hexachloro-benzene, and dibenzofurans) increase conversion of testosterone to its toxic metabolites. Diethylstilbestrol (DES) should also be avoided, since it produces changes in rat prostates similar to BPH.
Dietary contributors include beer, which raises prolactin levels thereby increasing androgen levels within the prostate gland. High cholesterol levels also seem to make matters worse. Pesticides and hormone-laden meats also have a negative effect on hormone metabolism in men (as well as women). Hence, organic foods are a wise investment.
Psychologically, stress is another contributory factor.
Homeopathic Remedy
| 1.* Thuja occidentalis tinct. | 15C |
| 2.* Ferrum picricum | 30X to 15C |
| 3.* Sabal tinct. | 15C |
Treatment Schedule
Doses cited are to be administered on a 3X daily schedule, unless otherwise indicated. Dose usually continued for 2 weeks. Liquid preparations usually use 8-10 drops per dose. Solid preps are usually 3 pellets per dose. Children use 1/2 dose.
Other recommendations, with indications, are as follows:-
Causticum
Essentials:
Pressure and pulsations in the prostate with pain extending into the urethra and bladder after a few drops of urine have passed.
Chimaphilla umbellato
Essentials:
Soreness in the region of the gland is worse with pressure, especially during sitting Confirmatory symptoms
Sensation of sitting on a ball or of painful swelling.
Discharge of mucus from the penis or the presence of stringy mucus in the urine
Kali bichromicum
Essentials
Prostate pain aggravated by walking; must stand still for relief
Confirmatory symptoms
Needlelike pain or drawing pains extending from the prostate into the penis
Burning in the urethra after urination
Discharge of very thick, sticky, or stringy material from the penis
Lycopodium
Essentials:
Pressure in the prostate aggravated during and after urination
Confirmatory symptoms:
Needle-like pains in the bladder and anus
Pulsatilla
Essentials:
Pain in the prostate after urination; or
The general symptoms of Pulsatilla are present.
Confirmatory symptoms:
Sharp pains or spasms in prostate area extending into the bladder and pelvis
Thick, bland discharge from the penis
Sabal serrulata
Essentials:
Indicated during chronic prostatic enlargement with difficult urination; there may be burning during urination as well.
Legend
X = 1 to 10 dilution - weak (triturition)
C = 1 to 100 dilution - weak (potency)
M = 1 to 1 million dilution (very strong)
X or C underlined means it is most useful potency
Asterisk (*) = Primary remedy. Means most necessary remedy. There may be more than one remedy - if so, use all of them.
References
Boericke, D.E., 1988. Homeopathic Materia Medica.
Coulter, C.R., 1986. Portraits of Homeopathic Medicines.
Kent, J.T., 1989. Repertory of the Homeopathic Materia Medica.
Koehler, G., 1989. Handbook of Homeopathy.
Shingale, J.N., 1992. Bedside Prescriber.
Smith, Trevor, 1989. Homeopathic Medicine.
Ullman, Dana, 1991. The One Minute (or so) Healer.
Tissue Salts
| Calc. Fluor. | hypertrophy, hard, enlarged testicles; |
| Calc. Phos. | dribbling of prostatic fluid; |
| Ferr. Phos. | hypertrophy, fever; |
Herbal Approaches
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Herbs
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African Pygeum
Flower pollen (Cernilton)
Ginseng
Nettle leaf
Pumpkin Seed
Saw palmetto (berries) [Serenoa repens]
Wild yam (Dioscorea)
Saw palmetto (berries) [Serenoa repens] is the definitive choice, probably in combination e.g.
| Saw Palmetto: | 250-1,000 mg |
| African Pygeum: | 100-200 mg |
| Pumpkin Seed Extract: | 25-100 mg |
Diminished urination (German Commission E)
Pumpkin Seed
Saw palmetto (berries)
Nettle root
Note: The misdirected use of an herb can produce severely adverse effects, especially in combination with prescription drugs. This Herbal information is for educational purposes and is not intended as a replacement for medical advice.
Discussion:
Recent research in Europe at 20 different facilities, published in 7 different journals, has indicated the African bark (from pygeum africanum) works in a similar fashion to serenoa repens: reducing inflammation, pain and discomfort while restoring erections and sexual vigor.
In France 81% of prescriptions for BPH relate to pygeum.
Flower pollen (Cernilton) has been popular in Europe and Japan, presumably because of its flavonoids.
A flower pollen produced by A. B. Cernelle of Sweden ("Cernilton") has been used to treat prostatitis and BPH in Europe for more than 25 years. Although its mechanism of action has not been elucidated, it has been shown to be quite effective in several double-blind studies. It is possible the efficacy of this product is due to its plant hormone and essential fatty acid content. No side effects of any form have been reported.
Ginseng (Panax ginseng) has increased testosterone levels and decreased prostate weight in animal studies.
In experimental animal studies, Ginseng increased testosterone levels while decreasing prostate weight. This suggests ginseng should have favorable affects in BPH, since increased testosterone would improve intestinal zinc absorption, and decreased prostatic size would help alleviate the symptoms.
Nettle leaf has been proven, in clinical studies, to improve urine flow, residual urine and nycturia among men with BPH. It is a leading phytopharmaceutical seller for urologic problems in Germany, together with Saw palmetto. [Rankings are 8th and 7th, respectively with sales in excess of $20 million for each.]
Pumpkin Seed is noted for possessing tryptophan and zinc which may be useful in this condition. It is also a non-irritating diuretic and seems to possess a cytotoxic principle useful in combating prostate cancer.
Saw palmetto (berries) [Serenoa repens] has a long history in folk medicine, which has survived intact through contemporary clinical trials.
The fruit of the palm tree (saw palmetto berries, also known as Sabal serrulata), native to Florida, has been shown to significantly improve the signs and symptoms of BPH in clinical studies. The mechanism of action is related to inhibition of testosterone metabolite binding to prostate cells. The inhibition of the binding is 25 times that of cyproterone, the commonly used anti-prostatic cancer agent, which is too toxic to use in BPH. (1 capsule t.i.d.)
Wild yam (Dioscorea) established itself as an estrogen replacement for women. However, estrogen by itself would contribute to prostate cancer by inhibiting the release of DHT. Several additional ingredients are required to make it a suitable therapy for BPH. Typically, preparations will also include: damiana, ginkgo, gotu kola and saw palmetto.
In addition a large variety of other diuretics have also been used: Buchu, Cornsilk, Gravel root and Horsetail.
References:
Andro, M & Riffaud, J: Pygeum africanum extract for the treatment of patients with benign prostatic hyperplasia: a review of 25 years of published experience. Curr. Ther. Res. 1995, 56(8):796-817.
Boccafoschi, et al., Comparison of Serenoa repens extract with placebo by controlled clinical trial in patients with prostatic adenomatosis. Urologia, 1983, 50:1,257-1,263.
Blumenthal, M (Ed.): The Complete German Commission E Monographs: Therapeutic Guide to Herbal Medicines. American Botanical Council. Austin, TX. 1998.
Braeckman, J: The extract of Serenoa repens in the treatment of BPH: a multicenter open study. Curr. Ther. Res. 1994, 55:776-785.
Briley, M et al., Permixon, a new treatment for benign prostatic hyperplasia acts directly at the cytosolic androgen receptor in rat prostate. Br. J. of Pharm. 1983, 79:327P.
Carilla E et al., Binding of Permixon, a new treatment for prostatic benign hyperplasia, to the cytosolic androgen receptor in the rat prostate. J Steroid Biochem.
Casarosa C et al., Lack of effects of a lyposterolic extract of Serenoa repens on plasma levels of testosterone, follicle-stimulating hormone, and luteinizing hormone. Clin Ther. 1988, 10 (5) p585-8.
Champault, G et al., A double-blind trial of an extract of the plant Serenoa repens in benign prostatic hyperplasia. Br. J. Clin. Pharmacol. 1984, 18:461-462.
Chiles, V.K. 1968. Drug interactions and the pharmacist. Canadian Pharaceutical Journal, 101(7). pp. 241-247.
Cirillo-Marucco, E et al., Extract of Serenoa repens (Permixon) in the early treatment of prostatic hypertrophy. Urologia, 1983, 50:1,269-1,277.
Crimi, A & Russo, A: Extract of Serenoa repens for the treatment of the functional disturbances of prostate hypertrophy. Med. Praxis, 1983(4): 47-51.
Cukier, et al., Permixon versus placebo. Curr. Res. Ther. Pharm. Clin. 1985, 4(25):15-21.
Di Silverio F et al., Evidence that Serenoa repens extract displays an antiestrogenic activity in prostatic tissue of benign prostatic hypertrophy patients. Eur Urol. 1992, 21 (4) p309-14.
Di Silverio, F. et al: Plant extracts in BPH. Minerva Urol. Nefrol. 1993, 45(4): 143 - 149.
Dreikorn K et al.,[Status of phytotherapeutic drugs in treatment of benign prostatic hyperplasia] Stellenwert von Phytotherapeutika bei der Behandlung der benignen Prostatahyperplasie (BPH). Urologe A. Mar 1995, 34 (2): 119-29.
Dreikorn, et al., Status of phytotherapeutic drugs in treatment of benign prostatic hyperplasia (BPH): effects on voiding symptoms, urodynamic parameters and serum prostate antigen (PSA). J Urol. 1997, 157 (Suppl):S331.
Elghamry, M.I. & Haensel, R. Activity and isolated phytoestrogen of shrub palmetto fruits (Serenoa repens Small), a new estrogenic plant. Experientia, 25, 828-829, 1969.
Grasso, M. et al: Comparative effects of alfuzosin versus Serenoa repens in the treatment of symptomatic benign prostatic hyperplasia. Arch. Esp. Urol. 1995, 48(1): 97 - 103.
Lowe, FC & Ku, JC: Phytotherapy in treatment of benign prostatic hyperplasia: a critical review. Urology, 1996, 48(1):12-20.
Niederpriim HJ, et al. Testosterone 5 -reductase inhibition by fatty acids from sabal serrulata fruits. Phytomedicine 1: 127133, 1994.
Plosker, GL & Brogden, RN: Serenoa repens: a review of its pharmacology and therapeutic efficacy in benign prostatic hyperplasia. Drugs Aging, 1996, 9:379-395.
Ravenna, L. et al: Effects of the lipidosterolic extract of Serenoa repens (Permixon) on human prostatic cell lines. Prostate, 1996, 29(4): 219 - 230.
Rugendorff, EW & Buck, AC: Results of treatment with polen extract (Cernilton N) in chronic prostitis and prostatodynia. Br. J. Urology, 1993, 71(4):433-438.
Strauch G, et al. Comparison of finasteride (proscar) and serenoa repens (permixon) in the inhibition of 5-alpha reductase in healthy male volunteers. European Urology 26: 247-252,1994.
Sultan C, et al. Inhibition of androgen metabolism and binding by a liposterolic extract of Serenoa repen B in human foreskin fibroblasts. Journal of Steroid Biochem.20: 515-519, 1984.
Tasca, A et al., Treatment of obstructive symptomatology caused by prostatic adenoma with an extract of Serenoa repens. Double-blind clinical study vs placebo. Min. Urol. Nefr. 1985, 37:87-91.
Tripodi, V et al., Treatment of prostatic hypeertrophy with Serenoa repens extract. Med. Praxis, 1983(4):41-46.
Walji, H: Prostate Health, Natural Health Series, Kian Press, 1997.
Aromatherapy - Essential Oils
Enlargement (uncomplicated):
Onion Essence,
Thuja Essence.
Prostatitis:
Pine Essence.
Related Health Conditions
AbstractsReferences
Abrams P. et al., International Continence Society "Benign Prostatic Hyperplasia" Study: background, aims, and methodology. Neurourol Urodyn, 1997, 16:2, 79-91.
Albertsen PC: Prostate disease in older men: 1. Benign hyperplasia. Hosp Pract (Off Ed), 1997 May 15, 32:5, 61-4, 67-8, 77 passim.
Ask-Upmark, E. Prostatitis and its treatment. Acta Med Scand. 181, 1967.
Barry MJ et al., The natural history of patients with benign prostatic hyperplasia as diagnosed by North American urologists. J Urol, 1997 Jan, 157:1, 10-4; discussion 14-5.
Barry MJ et al., A nationwide survey of practicing urologists: current management of benign prostatic hyperplasia and clinically localized prostate cancer. J Urol, 1997 Aug, 158:2, 488-91; discussion 492.
Barry M & Roehrborn C: Management of benign prostatic hyperplasia. Annu Rev Med, 1997, 48:, 177-89.
Boyd & Berry. Prostatic hypertrophy as part of a generalized metabolic disease. Evidence of the presence of a lipopenia. J Urol 41:406-11, 1939.
Bush, I.M., et al. Zinc and the prostate. Presented at the annual meeting of the AMA, 1974.
Calais Da Silva F et al., Relative importance of sexuality and quality of life in patients with prostatic symptoms. Results of an international study. Eur Urol, 1997, 31:3, 272-80.
Carilla, E., M. Briley, F. Fauran, et al. Binding of Permixon, a new treatment for prostatic benign hyperplasia, to the cytosolic androgen receptor in the rat prostate. J Steroid Biochem 20:521-3, 1984.
Collins MM et al., Diagnosis and treatment of benign prostatic hyperplasia. Practice patterns of primary care physicians. J Gen Intern Med, 1997 Apr, 12:4, 224-9.
Corenblum & Whitaker. Inhibition of stress-induced hyperprolactinaemia. Br Med J 275:1328, 1977.
de la Rosette JJ et al., Current status of thermotherapy of the prostate. J Urol, 1997 Feb, 157:2, 430-8.
DeRosa, G., S.M. Corsello, M.P. Ruffilli, et al. Prolactin secretion after beer. Lancet 2:934, 1981.
Di Siliverio, F. et al: Evidence that Serenoa repens extract displays an antiestrogenic activity in prostatic tissue of benign prostatic hypertrophy patients. Eur. Urology, 1992, 21(4): 309 - 314.
Downey P & Dean M: Benign prostatic hyperplasia. Prof Nurse, 1997 Apr, 12:7, 501-6.
Dumrau, F. Benign prostatic hyperplasia. Amino acid therapy for symptomatic relief. Am J Ger 10:426-30, 1962.
Dutkiewicz S: Zinc and magnesium serum levels in patients with benign prostatic hyperplasia (BPH) before and after prazosin therapy. Mater Med Pol, 1995 Jan-Mar, 27:1, 15-7.
Eri LM & Tveter KJ: Treatment of benign prostatic hyperplasia. A pharmacoeconomic perspective. Drugs Aging, 1997 Feb, 10:2, 107-18.
Fahim, W.S., J.M. Harman, T.E. Clevenger, et al. Effect of Panax ginseng on testosterone level and prostate in male rats. Arch Androl 8:261-3, 1982.
Farnsworth, W.E., W.R. Slaunwhite, M. Sharma, et al. Interaction of prolactin and testosterone in the human prostate. Urol Res 9:79-88, 1981.
Fawzy A Practice patterns among primary care physicians in benign prostatic hyperplasia and prostate cancer. Fam Med, 1997 May, 29:5, 321-5.
Feinblatt, H.M. & J.C. Gant. Palliative treatment of benign prostatic hypertrophy. Value of glycine, alanine, glutamic acid combination. J Maine Med Assoc 49:99-102, 1958.
Gilad E et al., Interplay between sex steroids and melatonin in regulation of human benign prostate epithelial cell growth. J Clin Endocrinol Metab, 1997 Aug, 82:8, 2535-41.
Giovannucci E et al: Intake of carotenoids and retinol in relation to risk of prostate cancer. J Natl Cancer Inst, 1995 Dec 6, 87:23, 1767-76.
Guthrie R: Benign prostatic hyperplasia in elderly men. What are the special issues in treatment? Postgrad Med, 1997 May, 101:5, 141-3, 148, 151-4 passim.
Hart, J.P. & W.L. Cooper. Vitamin F in the treatment of prostatic hyperplasia. Report Number 1, Lee Foundation for Nutri Research, Milw, Wi, 1941.
Hinman, F. Benign Prostatic Hyperplasia. Springer-Verlag, N Y, 1983.
Hood HM et al., Adherence to Agency for Health Care Policy and Research guidelines for benign prostatic hyperplasia. J Urol, 1997 Oct, 158:4, 1417-21.
Irani J et al., Inflammation in benign prostatic hyperplasia: correlation with prostate specific antigen value. J Urol, 1997 Apr, 157:4, 1301-3.
Judd, A., R. MacLeod, & I. Login. Zinc acutely, selectively & reversibly inhibits pituitary prolactin secretion. Brain Res 294:190-2, 1984.
Kappas, A., K. Anderson, A. Conney et al. Nutrition-endocrine interactions Induction of reciprocal changes in the delta-5-alpha- reduction of testosterone and the cytochrome P-450-dependent oxidation of estradiol by dietary macronutrients in man. Proc Nat Acad Sci USA 80:7646-9,1983.
Klippel KF et al., A multicentric, placebo-controlled, double-blind clinical trial of beta-sitosterol (phytosterol) for the treatment of benign prostatic hyperplasia. German BPH-Phyto Study group. Br J Urol, 1997 Sep, 80:3, 427-32.
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Lahtonen, R. Zinc and cadmium concentrations in whole tissue and in separated epithelium and stroma from human benign prostatic hypertrophic glands. Prostate 6:177-83, 1985.
Leake, A., G.D. Chrisholm, A. Busuttil & F.K. Habib. Subcellular distribution of zinc in the benign and malignant human prostate: Evidence for a direct zinc androgen interaction. Acta Endocrinol 105:281-8, 1984.
Leake, A., G.D. Chisholm, & F.K. Habib. The effect of zinc on the 5-alpha-reduction of testosterone by the hyperplastic human prostate gland. J Steroid Biochem 20:651-5, 1984.
Lee M & Sharifi R: Benign prostatic hyperplasia: diagnosis and treatment guideline. Ann Pharmacother, 1997 Apr, 31:4, 481-6.
Levine AC et al., The role of sex steroids in the pathogenesis and maintenance of benign prostatic hyperplasia. Mt Sinai J Med, 1997 Jan, 64:1, 20-5.
Login, I.S., M.O. Thorner, & R.M. MacLeod. Zinc may have a physiological role in regulating pituitary prolactin secretion. Neuroendoc. 37:317-20, 1983.
Lowe-FC & Ku-JC.: Phytotherapy in treatment of benign prostatic hyperplasia: a critical review. Urology. 1996 Jul; 48(1): 12-20.
References M-Z
McDermott T: Optimising the medical management of benign prostatic hyperplasia. Br J Clin Pract, 1997 Mar, 51:2, 116-8.
Ohkoshi, M., N. Kawamura, & I. Nagakubo. Clinical evaluation of Cernilton in chronic prostatitis. Jap J Clin Urol 21:73-85, 1967.
Pizzorno, Joseph E. & Murray, Michael T. A Textbook of Natural Medicine. JBC Publs, Seattle, WA, 1985.
Portis AJ & Mador DR: Treatment options for benign prostatic hyperplasia. Can Fam Physician, 1997 Aug, 43:, 1395-404.
Reilly NJ et al., Benign prostatic hyperplasia in older men. Lippincotts Prim Care Pract, 1997 Sep-Oct, 1:4, 421-30.
Rodrigues Netto N Jr et al., Latin American study on patient acceptance of the International Prostate Symptom Score (IPSS) in the evaluation of symptomatic benign prostatic hyperplasia. Urology, 1997 Jan, 49:1, 46-9.
Rugendorff, E.W. & Buck, A.C.: Results of treatment with pollen extract (Cernilton N) in chronic praostatitis and prostatodynia. Br. J. Urology, 1993, 71(4): 433 - 438.
Ruud Bosch JL: Conservative non-instrumental treatment of benign prostatic hyperplasia. Urol Res, 1997, 25 Suppl 2:, S107-14.
Saranga, R., et al: Local Microwave Hyperthermia in The Treatment of Benign Prostatic Hypertrophy. British Journal of Urology, 1990;65:349-353.
Schmidt, K. Effect of Radix Urticae extract and its several secondary extracts on blood SHGB in benign prostate hyperplasia. Fortschr Med 10 I (I 5) (1983): 713-716.
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Singuin, R.F., J.F. Charles, & H.H. Floch. Testosterone metabolism by homogenates of human prostates with benign hyperplasia: Effects of zinc, cadmium, and other bivalent cations. J Steroid Biochem 20:733-80, 1984.
Strauch G, et al. Comparison of finasteride (proscar) and serenoa repens (permixon) in the inhibition of 5-alpha reductase in healthy male volunteers. European Urology 26: 247-252,1994.
Tammela T: Benign prostatic hyperplasia. Practical treatment guidelines. Drugs Aging, 1997 May, 10:5, 349-66.
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