BENIGN prostatic hyperplasia (BPH) is the most common benign tumour of the adult male and men with Lower Urinary Tract Symptoms (LUTS) from clinical BPH constitute a great percentage of patients seen in urology clinics. Its treatment does constitute a significant economic burden.
There are various options of treatment depending on the stage of the disease with many urologists preferring medications in the early stages and surgery for the more advanced stages or complicated cases. Different medications of proven efficacy over the years include ?-adrenergic blockers like prazocin, doxazocin, tamsulocin, alfuzocin and 5 alpha reductase inhibitors like finasteride and dutasteride.
The use of locally available materials, mostly of plant origin, has recently gained recognition as alternatives to orthodox medicine. In fact, almost 90 per cent of all medicines prescribed for BPH in Germany and Austria are phyto-therapeutic agents. The biodiversity of plants found in Africa, which is arguably the richest in the world, coupled with the low purchasing power of Africans, especially with respect to orthodox drugs, make this type of research even more important.
According to a recent study published in Malaysian Journal of Medical Science, titled “Towards the Prevention and Management of Prostatic Diseases in Nigeria: A Framework” currently, extracts from plants, such as Serenoa repens, Urtica dioica, Pygeum africanum, Secale cereale, Curcubita pepo, Hypoxis rooperi, Piper cubeba, Bixa orellana, Cocos nucifera, and Telfairia occidentalis, are known to be potent botanicals in the management of prostatic diseases. It is reasonable to expect that many other locally available plants harbour phytochemicals that can be used to manage prostatic diseases.
Also, another study published in the International Research Journal of Biochemistry and Bioinformatics reviewed the anti-cancer properties of some plants used in traditional medicine in Nigeria.
A team of researchers from the Department of Chemical Sciences, Federal University Otuoke, Bayelsa State, led by Taye T. Alawode, identified onion, shallot, pineapple, garlic, Resurrection plant, lime, wormwood, Sodom apple, red palm oil, sausage tree, mango tree, sour-sop, bitter leaf, among others as potent against cancers.
It has also been shown that pumpkin seed oil and phytosterol-F can block testosterone/prazosin-induced prostate growth in rats.
Researchers from the Institute of Clinical Medicine, Department of Urology, College of Medicine, National Cheng Kung University, Tainan, Taiwan in a study published in Urology International investigated the effects of pumpkin seed oil alone or combined with Phytosterol-F on testosterone/prazosin-induced (T-P) prostate growth in rats.
Forty adult Wistar rats were divided into five groups, including: one control group, rats treated with vehicle only, one group treated with T-P, and two groups of T-P-treated rats, one receiving orally pumpkin seed oil alone and one group receiving orally pumpkin seed oil combined with Phytosterol-F.
Two weeks later, the prostatic weight-to-body weight ratio was determined after sacrifice. The total protein concentration was measured by using a protein assay. Some ventral prostatic tissues were histologically examined after hematoxylin-eosin staining.
Histological sections of the ventral prostate showed that the architecture of the prostate glands became hyperplastic in the T-P rats, but not in the control or vehicle-treated animals. As compared with the control or vehicle group, T-P rats had a significantly higher prostatic weight-to-body weight ratio for the ventral prostate, but not for the dorsolateral prostate.
The T-P rats had significantly higher protein levels within both lobes. As compared with the T-P-alone rats, the TP rats treated with pumpkin seed oil alone or pumpkin seed oil combined with Phytosterol-F had a significantly lower weight ratio for the ventral prostate and significantly lower protein levels within both lobes. In addition, Phytosterol-F had some additive effect on the total protein synthesis within the ventral prostate.
“Pumpkin seed oil alone or combined with Phytosterol-F can block the T-P-induced increases in prostatic weight-to-body weight ratio and protein synthesis,” they concluded.
Researchers from the Centre of Natural Products, National Centre for Scientific Research, Havana City, Cuba, in another study published in Journal Pharmacy and Pharmacology studied the effects of coconut oil on testosterone-induced prostatic hyperplasia in Sprague-Dawley rats.
The researchers wrote: “Saw palmetto lipid extracts (SPLE), used to treat BPH, have been shown to inhibit prostate 5a-reductase, and some major components, such as lauric, myristic and oleic acids also inhibit this enzyme.
“Coconut oil (CO) is also rich in fatty acids, mainly lauric and myristic acids. We investigated whether CO prevents testosterone-induced prostate hyperplasia (PH) in Sprague-Dawley rats. Animals were distributed into seven groups (10 rats each). A negative control group were injected with soya oil; six groups were injected with testosterone (3 mg kg(-1)) to induce PH: a positive control group, and five groups treated orally with SPLE (400 mg kg(-1)), CO or sunflower oil (SO) (400 and 800 mg kg(-1)).
“Treatments were given for 14 days. Rats were weighed before treatment and weekly thereafter. Rats were then killed and the prostates were removed and weighed. CO (400 and 800 mg kg (-1)), SPLE (400 mg kg (-1)) and SO at 800 mg kg (-1), but not at 400 mg kg(-1), significantly reduced the increase in prostate weight (PW) and PW: body weight (BW) ratio induced by testosterone (percentage inhibition 61.5 per cent, 82.0 per cent, 43.8 per cent and 28.2 per cent, respectively).
“Since CO and SPLE, but not SO, contain appreciable concentrations of lauric and myristic acids, these results could be attributed to this fact. In conclusion, this study shows that CO reduced the increase of both PW and PW:BW ratio, markers of testosterone-induced PH in rats.”
The Malaysian Journal of Medical Science study led by Chukwunonso Ejike concluded: “The development of a Central Prostatic Diseases Unit (CPDU) in the Federal Ministry of Health is advocated. The CPDU would be responsible for planning research and information dissemination programmes. Emphasis should be placed on targeting modifiable risk factors at the population level, proper surveillance to identify emerging trends, and research on both the operational dynamics and the efficacy of locally available herbs that could be useful in the management of prostatic diseases.”
Another study on “Effect Of The Plant Extracts Pygeum africanum And Urtica dioica On Lower Urinary Tract Symptoms Due To Benign Prostatic Hyperplasia In Nigerian Men” by researchers from Lagos State University College of Medicine published in The Internet Journal of Urology evaluated the effect of a combined extract of Urtica dioica and Pygeum africanum on LUTS in Nigerian men.
The researchers reviewed the clinical records of patients with LUTS from BPH who had used the combined extract of Urtica dioica and Pygeum africanum.
The researchers wrote: “We assessed the International Prostate Symptom Severity Scores (IPSS) and the postvoidal residual urine volume (PVR) before and after an eight-week of use of the extract.
“There was an improvement in the IPSS in 69.1 per cent from a mean of six to a mean of 3.5. There was also an improvement in PVR in 43.8 per cent of the patient from a mean of 102 mls to 40 mls. There was no recorded sexually related side-effect.
“The plant extracts containing Urtica dioica and Pygeum africanum may play a role in ameliorating LUTS in some selected patients with BPH.”
Recently some plant extracts like Pygeum africanum have been shown in some studies to have an effect on LUTS in men. Though the active ingredients in these extracts and their mechanisms of action are often poorly understood, the appeal of plant extracts is the fact that their usage avoids some of the untoward side effects of the synthetic agents used in the treatment of Clinical BPH/LUTS. There are however concerns about the pharmaceutical quality of some of these extracts and sometimes unknown risks with prolonged use.
Pygeum africanum is derived from the African plum tree. It is postulated that the active components in the extracts include phytosterols and long chain fatty alcohols and animal studies suggest that these compounds modulate bladder contractility, decrease inflammation and decrease the production of leukotrienes. Recent data suggest that African plum tree extract can improve urinary symptoms when compared to placebo. Though like most phytotherapeutic agents, the exact mechanism of Pygeum africanum is unknown, meta-analysis of clinical studies of Pygeum africanum suggests it modestly improves urinary flow rates.
The researchers concluded: “Although this study cannot be regarded as entirely conclusive and further randomised prospective clinical trials would be required, we believe that the preparation of plant extracts of Pygeum africanum and Urtica dioica has a potential role in the treatment of some patients with mild to moderate LUTS from BPH. This report could serve as groundwork for further study on these plant extracts for treatment of BPH in our environment.”
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