Benign prostatic hyperplasia (BPH) is a non-cancerous proliferative disease characterized by enlargement of the prostate gland primarily affecting males over the age of 50. It causes lower urinary tract symptoms (LUTS) such as hesitancy, reduced stream, incomplete voiding, retention, overflow incontinence, and increased urgency and frequency of urination, especially at night (nocturia) (Kwon, 2019). Those symptoms make it increasingly more difficult to urinate, severely impairing the afflicted men’s health and quality of life. As the “most common benign neoplasm in men” (Ye et al., 2019, p. 172) that manifests in different ways across individuals, BPH requires a flexible approach to its treatment. Although medication and surgery are generally preferred in more severe cases, they may not always be optimal. Moreover, many patients prefer the less drastic alternatives offered by herbal medicine. The framework of person-centered care makes it imperative to take such preferences into account, though possible drug interactions and other side effects must be considered as well. Ultimately, whether or not to recommend the use of herbal supplements for treating BPH depends on the specific circumstances of each patient.
The case of L.L., a 67-year-old man who has been diagnosed with BPH, is somewhat typical and relatively mild. While his symptoms impede urination enough for his doctor to suggest medication, they are not so severe as to require surgery. L.L. would prefer to treat the disease using herbal remedies. Aside from taking Cozaar (losartan potassium) 100mg tablets for hypertension, L.L. is not on any other medication, and his blood pressure is currently under control. As L.L.’s condition is not urgent, and his overall health appears to be in a good state, it should be safe for the doctor to try to satisfy his request. In the absence of other contraindications, a herbal supplement may be ideal for keeping the symptoms of BPH in check while maintaining L.L’s quality of life.
Saw palmetto or Serenoa repens is the most popular source of herbal supplements for reducing urinary problems in men. The fruit of this American dwarf palm has long been used in traditional medicine, while its extracts have gained medical acknowledgement in many parts of the world today (Kwon, 2019). Its anti-androgenic and anti-inflammatory effects have been shown to arrest the enlargement of the prostate gland and improve LUTS while causing minor or no side-effects (Ye et al., 2019). Although the effectiveness of saw palmetto has been occasionally contested, this may be attributed to differences in the composition of extracts (Kwon, 2019). Extracts prepared with hexane have proven to be more consistently effective, making it the preferable option for herbal treatment of BPH (Görne, Wegener, Kelber, Feistel, & Reichling, 2017). The standard dosage of the extract is 320mg daily or 160mg twice a day, although taking more than that causes no ill effect (Görne et al., 2017, p. 178). Overall, a standard daily 320mg dose of the hexane extract of saw palmetto seems to be L.L.’s best herbal option for managing BPH.
Both doctors and patients should be aware of the possible complications involved in herbal supplements usage. Many of them may cause adverse drug interactions that reduce the effectiveness of other treatments. Those interactions or other side effects may also actively worsen the patient’s condition. Saw palmetto has few such interactions and, unlike some other herbal supplements, does not seem to cause any problems with losartan potassium in particular (Asher, Corbett, & Hawke, 2017). However, saw palmetto had been tentatively connected to an increased risk of bleeding when used alongside anticoagulants (Nabavizadeh, Zangi, Kim, Bejestani, & Tabatabaei, 2018). Some studies have shown side-effects such as gastrointestinal disorders, headaches, fatigue, and the common cold, but such reactions appear rare (Nabavizadeh et al., 2018; Ye et al., 2019). The lack of a standard formula makes it especially important to pay attention to the exact composition of the supplement. While the risks are small, L.L. needs to be informed of them, allowing him to make educated decisions and monitor himself effectively, changing the treatment quickly if necessary.
Herbal supplements are a legitimate and useful part of modern medicine. If used correctly, they can mitigate various health conditions without forcing patients to resort to a more drastic and costly pharmaceutical or surgical intervention. Along with concerns about side effects caused by drugs, this often motivates patients to seek out such remedies. However, as with all cures, herbal supplements should be approached with proper diligence and care. Doctors must watch out for possible harmful side-effects or adverse drug interactions that may undermine other treatments. Differences in composition between herbal supplements derived from seemingly identical sources can complicate this process of selection. In more severe cases, herbal remedies may not be a valid alternative for medication or surgery. Nevertheless, many herbal supplements such as saw palmetto extracts are sufficiently well-documented to justify choosing them for patients with no contraindications and no urgent need for more conventional medical interventions. By allowing doctors to meet the patients’ preferences and averting avoidable side-effects and expenses, herbal treatments play a significant part in person-centered care.
References
- Asher, G. N., Corbett, A. H., & Hawke, R. L. (2017). Common herbal dietary supplement—drug interactions. American family physician, 96(2), 101-107.
- Görne, R. C., Wegener, T., Kelber, O., Feistel, B., & Reichling, J. (2017). Randomized double-blind controlled clinical trials with herbal preparations of Serenoa repens fruits in treatment of lower urinary tract symptoms. Wiener Medizinische Wochenschrift, 167(7-8), 177-182.
- Kwon, Y. (2019). Use of saw palmetto (Serenoa repens) extract for benign prostatic hyperplasia. Food Science and Biotechnology, 28(6), 1599-1606.
- Nabavizadeh, R., Zangi, M., Kim, M. M., Bejestani, M. Y., & Tabatabaei, S. (2018). Herbal supplements for prostate enlargement: current state of the evidence. Urology, 112, 145-150.
- Ye, Z., Huang, J., Zhou, L., Chen, S., Wang, Z., Ma, L.,… & Qiu, S. (2019). Efficacy and safety of Serenoa repens extract among patients with benign prostatic hyperplasia in China: a multicenter, randomized, double-blind, placebo-controlled trial. Urology, 129, 172-179.