Benign Prostatic Hypertrophy. Its’ Causes, Diagnosis and Non-Pharmacological Agents Used in Its’ Treatment

In the recent years there has been a lot of research done on Benign Prostatic Hypertrophy or BPH as it is commonly called. The research that has been done has centered on its cause and the new treatments being used in leu of the traditional surgical interventions. In this article we will discuss what BPH is, the causes of BPH and the non pharmacalogical agents that are being used in its’ treatment.

By definition BPH is a condition of the prostate that is non-malignant and one that affects men over the age of fifty years, but the actual changes that start in the gland may actually start when men are in their 30’s. BPH is true to its’ name in fact because it is an enlargement of the prostate gland, the small walnut shaped gland that sits at the base of the bladder and surrounds the urethra. The prostate is responsible for the production of seminal fluid and assists with its transport. BPH is more prevalent in white males than in Asian or black males. (Wright, 2001)

There are many suspected causes for BPH. The first theory is that BPH is caused by androgen mediated growth from the androgen dihydrotestosterone or DHT. DHT is the unbound form of testosterone due to the enzyme 5-a reductase. and is responsible for promoting the synthesis of prostate DNA and as a by product, BPH occurs. The second theory holds that there is a increased making of prostate stem cells or the reduced rate of death in the mature prostate cells. The final theory spoken is that there is a modification of prostate stromal growth factors that may be the result of aging . (Chow, 2001)

Symptoms of BPH appear approximately when men are in the age range of fifty to seventy five years of age. The signs and symptoms of BPH are many and may include: difficulty to start a urine stream, the inability to empty the bladder, loss of force of urine stream, hesitancy and frequency, straining to start a urine stream, terminal dribbling, dysuria, nocturia, and urge incontinence. The long term effects of BPH include urinary tract infections and kidney damage due to the backing up of urine.

Diagnosis of BPH is made from the patients’ history of symptoms to include hesitancy frequency and nocturia, the patients’ other health history, direct rectal exam, measurement of the prostate specific antigen, urinalysis and measurement of the creatinine.

The usual route of treatment of BPH include: monitoring the status of the prostate and treating when conditions warrant, using medications to treat the enlarged prostate and surgery. When monitoring the patient. the American Urilogical Associations’ symptom index is used to monitor the patients’ symptom development. Usual pharmocologic treatment of BPH include alpha-1 blockers, Hytrin, Cardura, Tamsulosin and Finesteride. The Alpha blockers help permit the flow of urine but do nothing to keep the prostate from enlarging. Drugs like finasteride do have an effect on shrinking the enlarged prostate but take three months to take effect. The side effects from taking Terasozin and Doxasozin include: dizziness, weakness, headache. sleepiness, low blood pressure, and syncope, while the side effects of finasteride include: erectile dysfunction, reduced libido ( a 4-6% chance); with the effects reversing when the drug is stopped. When the medication route fails, the usual surgical interventions for BPH is the transurethral urethral resection of the prostate (TURP), or a radical prostatectomy. The problems associated with the TURP is failure to resolve the symptoms in 20% of the patients, the morbidity rate is 5-10%, and there are side effect problems of possible impotency (5% chance), and patients that can achieve erection and orgasm, 60% of them experience retrograde ejaculation. In viewing the open prostatectomy, the outcomes and complications are the same as with the TURP. (Miller, 2001)

In the last few years there have been new emphasis on the non-pharmacological medications available to the patient with BPH. Using non pharmacological agents has been noted to be more prevalent in Europe then in America and more readily available than pharmacological agents. Some of these agents are made from plant substances; tree barks, seeds and berries. These treatments and medications include Saw Palmetto Berries, Stinging Nettle African Plum Tree bark extract, and Pumpkin seeds to name a few. The name of using these substances is called phytotherapy. The major chemical ingredient in these plant compounds is thought to be beta-sitasterol; an agent that can bring about significant symptom relief and improved urinary flow rates.

The non pharmacological agent with the most promise is the saw palmetto berry and its extract. It is the most widely studied and the most popular with its’ plant name officially being Serenoa Repens. The plant is hypothesized to inhibit the conversion of certain testosterones that are prevalent in BPH and cancer of the prostate. The patients symptoms should decrease after taking the saw palmetto berry for one to two months. The evidence supporting it’s use comes from 18 different trials that were randomized using a placebo. The research concluded that Saw Palmetto improved BPH symptoms and urinary flow rates similar to finasteride with a lower incidence of the side effects.

The next agent is the extract from the African plum tree; or more specifically, its’ bark from the tree Pygenum Africanum. This substance is widely used in Europe as the name Tadenan and as Prostata in the United States. Its’ supposed mechanism of actions include: stopping the growth of fibroblasts, and antiestrogenesis. The compound also has an anti-inflammatory effect.

Some support for African plum tree has occurred from twelve double blind studies that suggest the extracts usefulness in improving symptoms and urinary flow while minimizing the side effects. But these clinical trials were produced in a short amount of time with the number of enrolled less than one hundred. The only other support for the African plum tree is from studies that are currently under way in Europe.

The next agent is that of Pumpkin seeds. Pumpkin seeds, of course, come from common pumpkin that is used for baking pies at Thanksgiving or decorating at Halloween. The seeds have been noted to have many useful health benefits; most particularly when treating an enlarged prostate gland. The seeds contain a high amount of the minerals zinc and magnesium which is thought to aid in reducing the prostate gland itself. Research done at Vienna University in Europe; specifically targeting the men in the Transylvanian Alps has shown that there is practically no incidence of impotence or prostatic enlargement among the men there due to their high intake of pumpkin seeds.

Other plants that have shown promise are: Stinging Nettle, Rye, South African star grass, and Echinachea, but more clinical trials are needed to corroborate their use.

Nursing implications for the non-pharmacological treatment of BPH are aimed at teaching the patient about his BPH and the need to seek medical assistance if symptoms do not improve or if they get worse, and at teaching the patient about the use of the new agents and if they interact with any other medications that the patient is currently taking.

The use of non-pharmacological agents is likely to increase over the next few years due to their availability the new scientific research supporting their use. With the increase of these agents there is an opportunity for nurses to take and active role not only learning about these agents themselves, but in learning about the potential for the interaction with other medications and in promoting their use when warranted.

References Used

Chow, R., (March, 2001). Benign Prostatic Hyperplasia: Patient evaluation and relief of obstructive symptoms. Geriatrics: Internet

Cramer, D., (1999). Enlarged Prostate. Gale Encyclopedia of Medicine: Gale Research.

Miller, K., (January 2001). Laser Therapy for Benign Prostatic Hypertrophy. American Family Physician. Gale Research.

Wright, K., (2001). Prostate Enlargement. Gale Encyclopedia of Medicine. Gale Research.

Weitzel, M., Wolff L., Zornow, R., Zsohar, H., (1983). Fundamentals of Nursing. Seventh Edition. Lippincot: Philadelphia.

WWW.Holisticonline. (January 2002). Internet Information of Pumpkins Seeds. International Cyber Business Services.

WWW.Naturalhealthconsult.com. (January 2002). Internet Information on Prostate Swelling.