- Acute prostatitis, andropause, benign prostatic hyperplasia, BPH, chronic prostatitis, decreased libido, decreased sex drive, ED, enlarged prostate, erectile dysfunction, impotence, incontinence, male menopause, metastatic prostate cancer, nocturia, prostate cancer, prostatectomy, prostatitis.
- Males may develop health conditions specific to their gender, such as infections or cancers that affect their reproductive organs. The male reproductive organs include the penis, testicles, scrotum, and prostate gland. Other common examples of male health issues include andropause, benign prostatic hyperplasia (BPH), erectile dysfunction, male hypogonadism, and prostatitis. Treatments and prognoses vary, depending on the specific condition.
- Although some conditions cannot be prevented, adopting a healthy lifestyle that includes regular exercise and healthy eating habits, as well as undergoing regular health examinations and screenings, may help reduce the risk of developing some of these conditions.
Strong scientific evidence:
- Pygeum: Pygeum (P. africanum bark extract) has been observed to moderately improve urinary symptoms associated with enlargement of the prostate gland or prostate inflammation. Numerous human studies report that pygeum significantly reduces urinary hesitancy, urinary frequency, the number of times patients need to wake up at night to urinate, and pain with urination in men who experience mild-to-moderate symptoms. However, pygeum does not appear to reduce the size of the prostate gland or reverse the process of benign prostatic hypertrophy.
- Avoid if allergic or hypersensitive to pygeum.
- Saw palmetto: Numerous human trials report that saw palmetto (Serenoa repens) improves symptoms of benign prostatic hyperplasia (BPH), such as nighttime urination and urinary flow, and overall quality of life, although it may not greatly reduce the size of the prostate. Although the quality of these studies has been variable, overall they suggest effectiveness.
- Avoid if allergic or hypersensitive to saw palmetto. Avoid prior to some surgical or dental procedures. Use cautiously with bleeding disorders, hormone-sensitive conditions, gastrointestinal disorders, and high blood pressure. Use cautiously if taking drugs that thin the blood such as warfarin (Coumadin®), hormonal agents such as finasteride (Proscar®, Propecia®) or birth control pills, and blood pressure-altering agents.
Good scientific evidence:
- Beta-sitosterol: Beta-sitosterol and beta-sitosterol glucoside have been used to treat symptoms of benign prostatic hyperplasia (BPH). Additional clinical study is needed before a firm recommendation can be made.
- Avoid if allergic to beta-sitosterol, beta-sitosterol glucoside, or pine. Use cautiously with asthma or breathing disorders, diabetes, primary biliary cirrhosis, ileostomy, neurodegenerative disorders, diverticular disease (bulging of the colon), short bowel syndrome, celiac disease, or sitosterolemia. Use cautiously with a history of gallstones.
- Selenium: There is evidence that low selenium levels are associated with an increased risk of prostate cancer. In human studies, initial evidence has suggested that selenium supplementation reduces the risk of developing prostate cancer in men with normal baseline PSA (prostate-specific antigen) levels and low selenium blood levels. Selenium deficiency may be diagnosed by measuring selenium in the blood; the normal level is 70 nanograms per milliliter (ng/ml) in blood plasma (liquid component) or 90ng/ml in red blood cells. Laboratory studies have reported several potential mechanisms for selenium’s beneficial effects in prostate cancer, including a decrease in androgen receptors and PSA production, the inhibition of angiogenesis (the growth of new blood vessels in tumors), and increased antioxidant effects, including cancer cell apoptosis (cell death). There is ongoing research in this area.
- Avoid if allergic or sensitive to products containing selenium. Avoid with history of nonmelanoma skin cancer.
Unclear or conflicting scientific evidence:
- Acupressure, shiatsu: Results from preliminary study suggest a benefit of pelvic massage in the treatment of sexual dysfunction. Additional studies are needed.
- With proper training, acupressure appears to be safe if self-administered or administered by an experienced therapist. Serious long-term complications have not been reported, according to scientific data. Hand nerve injury and herpes zoster (“shingles”) cases have been reported after shiatsu massage. Forceful acupressure may cause bruising.
- Acupuncture: Acupuncture is commonly used throughout the world. While limited evidence suggests that benefits may be possible, there is currently insufficient available human evidence to recommend either for or against acupuncture for prostatitis.
- A few clinical studies have suggested that acupuncture may help individuals suffering from erectile dysfunction (ED). The results found that acupuncture may be an effective treatment option in more than two-thirds of patients with ED caused by psychological factors, including stress, anxiety, and depression.
- Needles must be sterile in order to avoid disease transmission. Avoid with valvular heart disease, medical conditions of unknown origins, or infections. Acupuncture should not be applied to the chest in patients with lung diseases or on any area that may rely on muscle tone to provide stability. Avoid use in infants, young children, or in patients with needle phobias. Use cautiously with bleeding disorders, neurological disorders, seizure disorders, or diabetes. Use cautiously in elderly or medically compromised patients. Use cautiously in patients who will drive or operate heavy machinery after acupuncture. Use cautiously if taking anticoagulants.
- African wild potato: The African wild potato is native to South Africa. It is a bitter plant used for a wide variety of medical conditions. African wild potato may be a potentially effective treatment option for benign prostatic hyperplasia. Additional study is needed to make a firm conclusion.
- Avoid if allergic to African wild potato or any species of the Hypoxidaceae family. Use cautiously with diabetes, liver disease or damage, HIV/AIDS, or kidney disease or damage.
- Arginine: Early studies propose that men with low nitrate levels in their blood or urine may find arginine supplements to be useful for managing erectile dysfunction (ED). A randomized, controlled clinical trial reported improvements in patients with mild to moderate ED following the use of a combination of L-arginine, glutamate, and yohimbine hydrochloride. Notably, yohimbine hydrochloride is an FDA-approved therapy for this condition, and the effects caused by arginine alone in this combination therapy are difficult to determine. It is not clear what doses of arginine may be safe or effective in treating this condition, and comparisons have not been made with other agents used for ED.
- Avoid if allergic to arginine, or with a history of stroke, or liver or kidney disease. Avoid if pregnant or breastfeeding. Use caution if taking blood-thinning drugs (such as warfarin or Coumadin®) and blood pressure drugs, or herbs or supplements with similar effects. Blood potassium levels should be monitored if using arginine.
- Calcium: Calcium is the most abundant mineral in the human body. It is currently unclear if calcium may help reduce the risk of prostate cancer. Study results are mixed. The lack of agreement among these studies suggests complex interactions among risk factors for prostate cancer. Until the relationship between calcium and prostate cancer is clarified, it is reasonable for men to consume recommended intakes according to the Food and Nutrition Board of the Institute of Medicine. Treatment of prostate cancer should only be done under the supervision of a qualified healthcare professional.
- Avoid if allergic to calcium or lactose. High doses taken by mouth may cause kidney stones. Avoid with high levels of calcium in the blood, high levels of calcium in the urine, high levels of parathyroid hormone, bone tumors, digitalis toxicity, ventricular fibrillation (where the ventricles of the heart contract in unsynchronized rhythm), kidney stones, kidney disease, or sarcoidosis. Calcium supplements made from dolomite, oyster shells, or bone meal may contain unacceptable levels of lead. Use cautiously with achlorhydria (the absence of hydrochloric acid in gastric juices) or irregular heartbeats.
- Carnitine: L-carnitine, carnitine, or acetyl-L-carnitine, is an amino acid (a building block for proteins). High concentrations of carnitine are found in muscle tissue. Preliminary studies suggest that addition of acetyl-L-carnitine (in combination with propionyl-L-carnitine, another form of carnitine) helped sildenafil (Viagra®) work better for patients with ED. However, more rigorous trials should be performed.
- Caution is advised when taking L-carnitine supplements, as adverse effects including drug interactions are possible.
- Clove: A small amount of human research reports that a combination cream with clove and other herbs may be helpful in the treatment of premature ejaculation. However, well-designed studies of the effectiveness of clove alone are needed before a conclusion can be drawn.
- Avoid if allergic to Balsam of Peru, clove, eugenol, or some licorice and tobacco (clove cigarette) products. Avoid with bleeding disorders and in pediatric patients. Avoid use of undiluted clove oil on the skin. Use cautiously with seizure disorders and kidney or liver dysfunction. Avoid if pregnant or breastfeeding.
- Coenzyme Q10: Limited available study using a combination that included CoQ10 did not find a significant effect on PSA levels in patients with prostate cancer. Although PSA levels may be an indicator of cancer, it is unclear whether CoQ10 would have any effect on cancer treatment of prevention. More study is needed in this area. There is early evidence that supports the use of CoQ10 for increasing sperm count and motility in patients with idiopathic asthenozoospermia. Better studies are needed before a conclusion can be made.
- Allergy associated with Coenzyme Q10 supplements has not been reported, although rash and itching have been reported rarely. Stop use two weeks before surgery/dental/diagnostic procedures with bleeding risk and do not use immediately after these procedures. Use caution with a history of blood clots, diabetes, high blood pressure, heart attack, or stroke, or with anticoagulants (blood thinners) or antiplatelet drugs (like aspirin, warfarin, clopidogrel (like Plavix®), or blood pressure, blood sugar, cholesterol or thyroid drugs.
- Coleus: Coleus (Coleus forskohlii) has been used in Asian traditional medicine for over 2,000 years. A component of coleus, called forskolin, was studied in humans in addition to prostaglandin E1, a drug commonly used in erectile dysfunction. Positive effects were seen with the forskolin and progstaglandin when the prostaglandin alone did not work for ED.
- Caution is advised when taking coleus supplements, as numerous adverse effects including drug interactions with blood pressure-lowering medications are possible.
- Cordyceps: Cordyceps sinensis is a fungus found mainly in China, Nepal, and Tibet. There is currently not enough available scientific evidence regarding the use of Cordyceps for sexual dysfunction. High quality clinical research is needed in this area.
- Avoid if allergic or hypersensitive to cordyceps, mold, or fungi. Use cautiously with diabetes, prostate conditions, bleeding disorders, or if taking anticoagulant medications, immunosuppressive medications, or if on hormonal replacement therapy or oral contraceptives. Avoid with myelogenous-type cancers. Avoid if pregnant or breastfeeding.
- Danshen: Danshen (Salvia miltiorrhiza) is widely used in traditional Chinese medicine (TCM), often in combination with other herbs. Limited available study found that danshen combined with routine Western medicine was less effective than warming needle moxibustion for the treatment of chronic prostatitis. More studies are warranted in this area.
- Avoid if allergic or hypersensitive to danshen. Use cautiously with sedatives or hypolipidemics, cardiac glycosides, CYP-metabolized agents, nitrate ester, steroidal agents, and some anti-inflammatories (such as ibuprofen). Use cautiously with altered immune states, arrhythmia, compromised liver function, or a history of glaucoma, stroke, or ulcers. Stop use two weeks before surgery or dental or diagnostic procedures with bleeding risk, and do not use immediately after these procedures. Use cautiously if driving or operating heavy machinery. Avoid if taking blood thinners (anticoagulants), digoxin, or hypotensives, including ACE inhibitors such as captopri, Sophora subprostrata root, or herba serissae. Avoid with bleeding disorders or low blood pressure, and following cerebal ischemia.
- DHEA: DHEA (Dehydroepiandrosterone) is a hormone made in the human body and secreted by the adrenal glands. DHEA serves as a precursor to male and female sex hormones. The results of studies vary on the use of DHEA in erectile dysfunction and sexual function, in both men and women. Better research is necessary before a clear conclusion can be drawn.
- Avoid if allergic to DHEA. Avoid with a history of seizures. Use cautiously with adrenal or thyroid disorders. Use cautiously if taking anticoagulants, or drugs, herbs, or supplements for diabetes, heart disease, seizure, or stroke. Stop use two weeks before surgery or dental or diagnostic procedures with bleeding risk, and do not use immediately after these procedures.
- Ephedra: Early small studies suggest that ephedra may increase sexual arousal. Further well-designed research is needed to confirm these results.
- The U.S. Food and Drug Administration (FDA) has collected more than 800 reports of serious toxicity, including more than 22 deaths from the use of ephedra and/or ephedra containing products. Avoid use in individuals younger than 18 years old. Avoid use for prolonged periods (longer than seven days) due to risk of abuse or toxicity. Discontinue use at least one week prior to major surgery or diagnostic procedures. Use cautiously with cardiovascular disease, including structural heart disease, arrhythmia, coronary artery disease, high blood pressure, cerebrovascular disease, and a history of stroke or transient ischemic attack. Use cautiously with depression, anxiety disorders, anorexia/bulimia, a history of suicidal ideation, insomnia, tremors, urinary retention, enlarged prostate, diabetes, kidney disease, glaucoma, thyroid disease, and peptic ulcer disease. Use cautiously with monoamine oxidase inhibitor (MAOI) or stimulant use. Avoid if pregnant or breastfeeding.
- Flaxseed and flaxseed oil: Flaxseed (Linum usitatissimum) and its derivative flaxseed oil/linseed oil are rich sources of the essential fatty acid alpha-linolenic acid, which is a biologic precursor to omega-3 fatty acids such as eicosapentaenoic acid. There is limited high quality research of the effects of flaxseed or alpha-linolenic acid (which is in flaxseed) on prostate cancer risk. This area remains controversial as there is some data reporting possible increased risk of prostate cancer with alpha linolenic acid. Prostate cancer should be treated by a medical oncologist.
- Flaxseed has been well-tolerated in studies for up to four months. Avoid if allergic to flaxseed, flaxseed oil or other plants of the Linaceae family. Avoid large amounts of flaxseed by mouth and mix with plenty of water or liquid. Avoid flaxseed (not flaxseed oil) with history of esophageal stricture, ileus, gastrointestinal stricture or bowel obstruction. Avoid with history of acute or chronic diarrhea, irritable bowel syndrome, diverticulitis, or inflammatory bowel disease. Avoid topical flaxseed with open wounds or abraded skin surfaces. Use cautiously with history of a bleeding disorder or with drugs that cause bleeding (like anticoagulants and non-steroidal anti-inflammatories (like aspirin, warfarin, Advil®)), high triglyceride levels, diabetes, mania, seizures or asthma. Avoid ingestion of immature flaxseed pods.
- Ginkgo biloba: Ginkgo biloba has been used medicinally for thousands of years. Recently it has been used and studied for the treatment of sexual dysfunction in men and women. In general, studies are small and not well-designed. Additional research is needed before a recommendation can be made.
- Avoid if allergic or hypersensitive to members of the Ginkgoaceaefamily. If allergic to mango rind, poison sumac, poison ivy, poison oak, or cashews, then allergy to ginkgo is possible. Avoid if taking anticoagulants, due to an increased risk of bleeding. Ginkgo should be stopped two to three weeks before surgical procedures. Use cautiously with seizures or in children. Ginkgo seeds are dangerous and should be avoided. Skin irritation and itching may also occur due to ginkgo allergies.
- Ginseng: For more than 2,000 years ginseng root has been valued in Chinese medicine. Preliminary evidence indicates that Panax ginseng may be effective in improving the signs and symptoms of erectile dysfunction. However, additional research is warranted in this area.
- Researchers have found that a topical herbal combination containing Panax ginseng may increase the effects of standard treatment for premature ejaculation. However, additional studies using ginseng alone are needed.
- Avoid if allergic to ginseng or other plants in the Araliaceae family. Avoid with bleeding disorders, leukemia, or liver disorders. Avoid if taking anticoagulants or antiplatelet drugs. Use cautiously with gastrointestinal disorders, high blood pressure, hormone-dependent conditions (such as breast cancer or prostate cancer), sleep disorders, attention-deficit hyperactivity disorders (ADHD), irregular heartbeat, heart disease, diabetes, joint or muscle disorders (such as arthritis or fibromyalgia), eye disorders, or psychological disorders. Use cautiously if taking ACE inhibitors, antihyperlipidemics, antineoplastics, cytotoxic drugs, central nervous system stimulants (including caffeine), diuretics, glucocorticoids, HIV protease inhibitors, monoamine oxidase inhibitors (MAOIs), morphine, mitomycin C, sodium channel blockers, nifedipine, agents that increase photosensitivity, or drugs that are broken down by the liver. Use cautiously if undergoing chemotherapy or radiation therapy.
- Green tea: Green tea (Camelia sinensis) is reported to have antioxidant- and immune-stimulating properties. Limited human study reported minimal benefit using green tea extract capsules for the treatment of hormone-refractory prostate cancer. Further research is needed before a clear conclusion can be reached.
- Caution is advised when drinking green tea, as adverse effects, including an increased risk of bleeding and drug interactions, are possible. Caffeine-free products are available.
- Horny goat weed: Horny goat weed has been traditionally used to increase fertility. Early study suggests that horny goat weed may be of benefit for sexual dysfunction in renal failure patients. Additional study is needed in this area.
- Avoid if allergic/hypersensitive to horny goat weed (Epimedium grandiflorum), its constituents, or related plants in the Berberidaceae family. Use cautiously with tachyarrhythmia, decreased blood pressure, frequent nosebleeds, musculoskeletal disorders, bipolar disorder, immune function disorders, homocysteine disorders, hypothyroid conditions, and cardiovascular disease. Use cautiously if taking anticoagulant or antiplatelet (blood thinning) medications, antihypertensive (blood pressure) medications, antidepressants (MAOIs), interleukins, or cholesterol-lowering medications. Avoid with hormone-sensitive conditions or if taking estrogen or oral contraception. According to traditional Chinese medicine (TCM), avoid in patients with “fire from yin deficiency” (people with too much “yang” or heat, masculinity, and activity, based on Chinese philosophy). Avoid if pregnant or breastfeeding.
- Hypnotherapy, hypnosis: There is inconclusive evidence from preliminary research on the use of hypnotherapy for erectile dysfunction. Additional study is needed before a firm conclusion can be drawn.
- Use cautiously with mental illnesses like psychosis/schizophrenia, manic depression, multiple personality disorder or dissociative disorders. Use cautiously with seizure disorders.
- Lycopene: High levels of lycopene are found in tomatoes and in tomato-based products. Tomatoes are also sources of other nutrients such as vitamin C, folate, and potassium. Early studies examining tomato-based products and blood lycopene levels suggest that lycopene may be associated with a lower risk of developing cancer and may help stimulate the immune system. Laboratory studies have reported that lycopene inhibits the growth of prostate cancer cells. Patients diagnosed with benign prostatic hypertrophy or enlarged prostate may be at an increased risk of developing prostate cancer and may benefit from taking lycopene supplements. Further studies are necessary before lycopene may be recommended.
- Avoid if allergic to tomatoes or to lycopene.
- Maca: Maca (Lepidium meyenii) is a vegetable that has been cultivated as a root crop for at least 2,000 years. It can be found wild in Peru, Bolivia, Paraguay, and Argentina, but has primarily been cultivated in the highlands of the Peruvian Andes. Traditionally in Peru, maca has been used as a male aphrodisiac to increase sexual desire. Maca may improve sexual desire in healthy men independent of changes in mood, or serum testosterone (male hormone), and estradiol (female hormone) levels. Higher quality studies are needed in this area, in both men and women.
- Avoid if allergic/hypersensitive to maca (Lepidium meyenii), any of its constituents, or other members of the Brassicaceae family, formerly Cruciferae (broccoli, brussel sprouts, cabbage, or cauliflower). Use cautiously with anticoagulation therapy, hypertension, hormone responsive cancers such as breast cancer, or prostate cancer, and if using oral contraceptives or stimulants. Avoid if pregnant or breastfeeding.
- Modified citrus pectin: Pectins are gel-forming polysaccharides from plant cell walls, especially apple and citrus fruits. Modified citrus pectin may reduce the metastasis (spread to other areas of the body) of certain types of cancers, including lung, prostate, and breast cancer. More research is needed in this area, especially with other types of cancer and with other criteria for prostate cancer progression.
- Avoid if allergic or hypersensitive to modified citrus pectin. MCP may cause gastrointestinal discomfort in patients allergic or sensitive to MCP. Use cautiously if taking chelating medications or if under treatment for cancer. Use cautiously if taking oral drugs, herbs, or supplements as MCP may reduce or slow their absorption. Use cautiously in geriatric patients or patients with gastrointestinal disorders.
- Muira puama: Muira puama (Ptychopetalum olacoides) has long been used by Brazilian native people as a treatment for impotence (erectile dysfunction). Relaxation of the corpus cavernosum can be related to penile erection. Preliminary case series suggest usefulness. Well-designed human trials of muira puama, as well as safety data, are necessary.
- PC-SPES: Studies of PC-SPES® have reported improvements in patients with prostate cancer. Overall, these studies found prostate-specificantigen (PSA) levels to fall by greater than 50% in most patients, improvements in bone scans and x-rays, reductions in pain scores, and improvements in quality of life. In addition, PC-SPES® extracts were reported to cause cell death (apoptosis) or to slow the growth of cancer cell lines. Because of these complicated circumstances, and the fact that PC-SPES® has never been compared to placebo or standard cancer treatments in a well-reported study, the question of effectiveness remains unclear.
Note: PC-SPES ® has been recalled from the U.S. market and should not be used. Based on safety concerns associated with PC-SPES®, no dosage is recommended.
- Physical therapy: The goal of physical therapy is to improve mobility, restore function, reduce pain, and prevent further injury. A variety of techniques, including exercises, stretches, traction, electrical stimulation, and massage, are used during physical therapy sessions. Currently, it is unclear if physical therapy is beneficial for patients with chronic prostatitis.
- Not all physical therapy programs are suited for everyone, and patients should discuss their medical history with qualified healthcare professionals before beginning any treatments. Based on the available literature, physical therapy appears generally safe when practiced by a qualified physical therapist. However, physical therapy may aggravate some pre-existing conditions. Persistent pain and fractures of unknown origin have been reported. Physical therapy may increase the duration of pain or cause limitation of motion. Pain and anxiety may occur during the rehabilitation of patients with burns. Both morning stiffness and bone erosion have been reported in the physical therapy literature, although causality is unclear. Erectile dysfunction has also been reported.
- Pomegranate: Pomegranate juice has received publicity for being possibly helpful for prostate cancer. In laboratory study, flavonoid compounds from pomegranate fruit have been shown to have anticancer activity against prostate cancer cells. The scientific evidence is limited in this area, and further research is necessary before a clear conclusion can be drawn.Pomegranate juice has also been studied in the treatment of mild to moderate erectile dysfunction. Early study is unclear, and therefore more studies are needed.
- Avoid if allergic to pomegranate. Avoid with diarrhea or high or low blood pressure. Avoid taking pomegranate fruit husk with oil or fats to treat parasites. Pomegranate root or stem bark should only be used under the supervision of a qualified healthcare professional. Use cautiously with liver damage or disease.
- Psychotherapy: Individual, couples, or group psychotherapy may be helpful for men with erectile dysfunction. However, prescription medication may be needed to alleviate symptoms.
- Psychotherapy cannot always fix mental or emotional conditions. Psychiatric drugs are sometimes needed. In some cases symptoms may worsen if the proper medication is not taken. Not all therapists are qualified to work with all problems. Use cautiously with serious mental illness or some medical conditions because some forms of psychotherapy may stir up strong emotional feelings and expression.
- Pycnogenol®: Pycnogenol® is the patented trade name for a water extract of the bark of the French maritime pine (Pinus pinaster spp. atlantica), which is grown in coastal southwest France. Pycnogenol® has shown a protective effect on blood vessels. Pycnogenol®, in combination with L-arginine, may cause an improvement in sexual function in men with ED. It is not known what effect each of the individual compounds may have directly on this condition. Further research is needed. Caution is advised when taking Pycnogenol®, as it may increase the chances of bleeding in sensitive individuals, such as those taking blood thinning drugs such as warfarin (Coumadin®).
- Quercetin: There is some evidence that quercetin, a bioflavonoid and antioxidant, may be useful for the treatment of chronic prostatitis (inflammation of the prostate). Further research is needed to confirm these results. Quercetin is reported safe in recommended dosages.
- Quercetin is generally considered safe when taken at doses normally found in foods. Avoid if allergic to quercetin. Possible eye, skin, gastrointestinal, or respiratory tract infection can occur.
- Red clover: Red clover is a legume that has plant-based chemicals that are similar to estrogen. Red clover isoflavones may have estrogen-like properties in the body, and have been proposed as a possible therapy in prostate cancer. Well designed human research is lacking in this area. There is also only limited study of red clover for benign prostatic hypertrophy. More research is needed before a firm conclusion can be made.
- Avoid if allergic to red clover or other isoflavones. Use cautiously if taking hormone replacement therapy (HRT). Use cautiously with a history of a bleeding disorder or if taking drugs that thin the blood.
- Saw palmetto: There is not enough scientific evidence to recommend the product PC-SPES® (which contains saw palmetto) for prostate cancer. PC-SPES® also contains seven other herbs (Chrysanthemum morifolium, Isatis indigotica, Glycyrrhiza glabra, Ganoderma lucidum, Panax pseudo-ginseng, Rabdosia rubescens, and Scutellaria baicalensis). It has been a popular treatment for prostate cancer, but the U.S. Food and Drug Administration (FDA) has issued a warning not to use PC-SPES® because it contains the anticoagulant chemical warfarin and may cause bleeding.
- A prospective, randomized, open label, one-year study was designed to assess the safety and efficacy of saw palmetto and finasteride in the treatment of men diagnosed with category III prostatitis/chronic pelvic pain (CP/CPPS). CP/CPPS treated with saw palmetto had no appreciable long-term improvement. In contrast, patients treated with finasteride had significant and durable improvement in multiple parameters except for voiding.
- Avoid if allergic or hypersensitive to saw palmetto. Use cautiously with a history of health conditions involving the stomach, liver, heart, or lungs; hormone-sensitive conditions; or bleeding disorders. Use cautiously with drugs that thin the blood or hormonal drugs.
- Soy: Early research has examined the effects of dietary soy intake on prostate cancer development in humans, but results have been inconclusive. Better study is needed before a recommendation can be made.
- Avoid if allergic to soy. Breathing problems or rash may occur in sensitive people. The effects of high doses of soy or soy isoflavones in humans are not clear, and therefore are not recommended. There has been a case report of vitamin D deficiency rickets in an infant nursed with soybean milk (not specifically designed for infants). People who experience intestinal irritation (colitis) from cow’s milk may experience intestinal damage or diarrhea from soy. It is not known if soy or soy isoflavones share the same side effects as estrogens, such as increased risk of blood clots. The use of soy is often discouraged in patients with hormone-sensitive cancers, such as breast, ovarian, or uterine cancer. Other hormone-sensitive conditions such as endometriosis may also be worsened. Patients taking blood-thinning drugs such as warfarin should check with a doctor and pharmacist before taking soy supplementation.
- Stinging nettle: Stinging nettle is used rather frequently in Europe in the treatment of symptoms associated with benign prostatic hyperplasia (enlarged prostate). Early evidence suggests an improvement in symptoms, such as the alleviation of lower urinary tract symptoms associated with stage I or II BPH, as a result of nettle therapy. Additional study is warranted in this area.
- Avoid if allergic or hypersensitive to nettle, members of the Urticaceae family, or any ingredient of nettle products. Use cautiously with diabetes, bleeding disorders, or low sodium levels in the blood. Use cautiously if taking diuretics or anti-inflammatory drugs. The elderly should also use nettle cautiously.
- Vitamin C (ascorbic acid): Vitamin C (ascorbic acid) is a water-soluble vitamin that the body needs to form collagen in bones, cartilage, muscle, and blood vessels. It also aids in the absorption of iron. Vitamin C has been used in prostate cancer patients, but there is currently a lack of sufficient evidence to determine its effect in this disease.
- Avoid if allergic or sensitive to vitamin C product ingredients. Vitamin C is generally considered safe in amounts found in foods. Vitamin C supplements are also generally considered safe in most individuals if taken in recommended doses. Avoid high doses of vitamin C with glucose 6-phosphate dehydrogenase deficiency, kidney disorders or stones, cirrhosis, gout, or a bleeding disorder called paroxysmal nocturnal hemoglobinuria.
- Vitamin E: The role of vitamin E supplementation in the prevention of prostate cancer is controversial. There are numerous laboratory studies that suggest possible anticancer properties. However, the results of population research and human research have been mixed, with some studies reporting benefits and others finding no effects. Vitamin E succinate (one specific form of vitamin E) has been reported in laboratory studies to inhibit the growth of human prostate cancer cells.
- Avoid if allergic to vitamin E. For short periods of time, and in the recommended doses, vitamin E supplementation is generally considered safe. Avoid doses higher than 1,000 milligrams a day. Avoid with retinitis pigmentosa (loss of peripheral vision). Use cautiously with bleeding disorders.
- Yoga: Yoga is an ancient system of relaxation, exercise, and healing with origins in Indian philosophy. There is early evidence to support the use of yoga in the treatment of delayed ejaculation in males. Larger well designed and controlled trials are needed to further assess the effects of yoga for sexual health.
- Yoga is generally considered to be safe in healthy individuals when practiced appropriately. Avoid some inverted poses with disc disease of the spine, fragile or atherosclerotic neck arteries, extremely high or low blood pressure, glaucoma, detachment of the retina, ear problems, severe osteoporosis, cervical spondylitis, or if at risk for blood clots. Certain yoga breathing techniques should be avoided with heart or lung disease. Use cautiously with a history of psychotic disorders. Yoga techniques are believed to be safe during pregnancy and breastfeeding when practiced under the guidance of expert instruction. However, poses that put pressure on the uterus, such as abdominal twists, should be avoided in pregnancy.
- Yohimbe bark extract: Yohimbine hydrochloride is a prescription drug that has been shown in multiple human trials to effectively treat erectile dysfunction. Yohimbine hydrochloride has also been suggested to treat sexual side effects of selective serotonin reuptake inhibitor (SSRI) antidepressants. However, although yohimbine is present in yohimbe bark extract, levels are variable and often very low. More study is needed before a conclusion can be made.
- Yohimbine is generally well tolerated in recommended doses. However, many side effects have been reported with yohimbine hydrochloride and may apply to yohimbe bark. Avoid if allergic to yohimbe, any of its components, or yohimbine-containing products. Use cautiously with peptic ulcer disease, kidney disease, high blood pressure, heart disease or if taking drugs that affect blood sugar levels. Avoid with benign prostate hypertrophy (enlarged prostate), anxiety, mania, depression, stress disorders, post-traumatic stress disorders, bipolar disorders, or schizophrenia. Avoid use in children or if pregnant or breastfeeding.
- Zinc: Zinc formulations have been used since ancient Egyptian times to enhance wound healing. Early studies suggest that zinc supplements taken with antibiotics may be more effective than antibiotics alone in reducing pain, urinary symptoms, quality of life, and maximum urethra closure pressure for patients with chronic prostatitis. Further research is needed to confirm these results.
- Zinc is generally considered safe when taken at the recommended dosages. Avoid zinc chloride since studies have not been done on its safety or effectiveness. Avoid with kidney disease.
Fair negative scientific evidence:
- Deer velvet: Deer velvet, also referred to as antler velvet, refers to antlers that have been removed in the growth stage when they are covered in soft velvet-like hair. In both traditional and popular use, deer velvet has a reputation as an aphrodisiac that may improve sexual energy by potentially strengthening and balancing the body and restoring overall energy. However, early research suggests that deer velvet is not effective for this condition.
- Vitamin D: Although there was preliminary evidence based on laboratory and limited human studies that high-dose vitamin D was possibly beneficial in the treatment of metastatic prostate cancer, a large study reported that patients taking high-dose calcitriol along with chemotherapy did worse than patients taking chemotherapy alone. Therefore, this treatment should be discouraged.
- This information has been edited and peer-reviewed by contributors to the Natural Standard Research Collaboration (www.naturalstandard.com).
- American Cancer Society (ACS). .
- American Urological Association (AUS). .
- Hoffman R, Monga M, Elliot S, et al. Microwave thermotherapy for benign prostatic hyperplasia. Cochrane Database Syst Rev. 2007;(4):CD004135.
- Koh KA, Sesso HD, Paffenbarger RS Jr, et al. Dairy products, calcium and prostate cancer risk. Br J Cancer. 2006;95(11):1582-5.
- Kristal AR, Stanford JL. Cruciferous vegetables and prostate cancer risk: confounding by PSA screening. Cancer Epidemiol Biomarkers Prev. 2004;13(7):1265.
- National Institutes of Health (NIH). .
- Natural Standard: The Authority on Integrative Medicine. .
- Prostate Cancer Foundation. .
Overview: As males age, they tend to experience a decrease in their sex hormone, which is called testosterone. This process is called andropause or sometimes male menopause. Most males go through andropause when they are between the ages of 40 and 55 years old.
Causes: Andropause is caused by decreased levels of the hormone testosterone and is considered a natural part of aging in males.
Symptoms: Common symptoms of andropause include fatigue, depression, hot flashes, night sweats, infertility, decreased sex drive, and erectile dysfunction. Erectile dysfunction (ED), also called impotence, occurs when a male is unable to achieve or maintain an erection. Men also have an increased risk of developing osteoporosis, or weak, brittle bones, after andropause.
Diagnosis: If it is suspected that a male patient is going through andropause, a blood sample may be taken to measure the amount of testosterone in the blood. Males who have undergone andropause may have low levels of testosterone in their blood. Patients may also have increased levels of globulin. This hormone binds to testosterone, resulting in lower levels of testosterone in the tissues.
Treatment: Although hormone replacement therapy has been used to treat andropause, there is little research on its safety or effectiveness.
- Males who experience ED as a complication of andropause may receive treatment. Several drugs, including sildenafil (Viagra®), tadalafil (Cialis®), and vardenafil (Levitra®), have been used treat males who experience ED as a result of aging. These drugs are taken by mouth a few hours before sexual activity. These drugs should not be taken more than once every 24 hours. In general, side effects may include headache, upset stomach, diarrhea, dizziness, flushing, or stuffy nose. Serious side effects may include sudden severe loss of vision, blurred vision, changes in color vision, painful erection, priaprism (a prolonged erection lasting longer than four hours), fainting, chest pain, difficulty breathing, hoarseness, itching or burning during urination, and rash. Patients should seek immediate medical treatment if any of these serious side effects develop.
Prevention: Andropause is a normal part of aging. Strength training may be beneficial because the body produces testosterone when a person builds or maintains muscle mass.
Benign prostatic hyperplasia (bph)
Overview: Benign prostatic hyperplasia (BPH) is a normal, gradual enlargement of the prostate gland, which is located in front of the rectum and under the bladder. BPH usually beings during middle age. Hormonal changes in the prostate tissue are linked to BPH. For instance, decreases in testosterone and increases in dihydrotestosterone (DHT) and estrogen have been shown to cause BPH.
- This condition is called “benign” because it does not lead to cancer. BPH does not generally cause pain, but discomfort (a feeling of pressure) in the groin area is generally found. An enlarged prostate may push against the urethra and interfere with urination. The bladder wall also thickens and becomes irritated. The bladder starts to contract even when it contains small amounts of urine, which results in frequent urination.
Causes: BPH affects about half of men who are 60 or older and 80 percent of men who are 80 or older. It is considered by clinicians to be related to aging because most men older than 45 have some prostate enlargement. However, symptoms are rarely felt before the age of 60.
Symptoms: Common symptoms of BPH include difficulty urinating, altered urinary flow (including variable flow rate), frequent urination, urinary urgency, dribbling of urine at the end of urination, and frequent urination at night (called nocturia). As the bladder weakens, it may not empty completely after urination. When the prostate blocks or narrows the urethra, it may lead to several problems, such as urinary tract infections (UTIs), bladder stones, or kidney or bladder damage.
Diagnosis: A digital rectal exam (DRE) is commonly performed during routine physical examinations. During a DRE, a doctor feels the prostategland by passing a gloved finger into the individual’s rectum. If hard or lumpy areas of the gland are detected, it may indicate anabnormality. If the doctor suspects an abnormal prostate, a sample of urine and prostate fluid may be analyzed.
- The doctor may also assess the degree of pain or discomfort the person feels when the muscles and ligaments of the pelvic floor and perineum are pressed. Patients with BPH generally do not feel pain.
- A doctor may also take a sample of blood to analyze the patient’s prostate-specific antigen (PSA) levels. PSA is an enzyme normally made by cells in the prostate gland that helps break down proteins in seminal fluid to aid with fertility. It is normal for the bloodstream to contain some PSA (about 4.0 nanograms per milliliter (ng/ml)). However, if the PSA level is elevated, it may indicate prostate infection, inflammation, enlargement (BPH), or cancer. If the PSA level is above 4.0, further tests, such as an ultrasound or prostate biopsy, are usually recommended. Even if the PSA is less than 4.0, further tests may be recommended if the PSA has risen a significant amount since a prior measurement. PSA values tend to be lower in younger men, and it has been suggested that the PSA level at which to consider a biopsy should be lower for younger men than for older men.Even if the PSA is elevated, it does not necessarily mean that cancer is present, since there are other causes of PSA elevation. This is why further evaluation with a biopsy is often recommended.
Treatment: The U.S. Food and Drug Administration (FDA) has approved several drugs for the treatment of BPH symptoms, although drug therapy is not effective in all patients. 5-alpha reductase inhibitors, including finasteride (Proscar®) and dutasteride (Avodart®), may help prevent the progression of prostate enlargement or help shrink the prostate gland. Other drugs, called alpha blockers, may also help reduce bladder obstruction. FDA-approved drugs include terazosin (Hytrin®), doxazosin (Cardura®), tamsulosin (Flomax®), and alfuzosin (Uroxatral®). Terazosin and doxazosin were first developed to treat high blood pressure. Tamsulosin and alfuzosin were developed specifically to treat BPH.
- Some patients may require surgery. Transurethral resection of the prostate (TURP) is a surgical procedure that involves removing tissue from the prostate that may be blocking urine flow. This surgery is sometimes performed to relieve symptoms caused by benign (noncancerous) tumors. Transurethral resection of the prostate may also be done in men who cannot have a radical prostatectomy because of their age or overall health.
- Several laser procedures are also available. They are performed to remove obstructing prostate tissue. Laser procedures generally require less anesthesia and are associated with a lower risk of bleeding and a quicker recovery time than TURP. However, laser procedures may not be as effective in the long term as TURP.
- Microwave therapy may also be performed. During this procedure, microwave energy is delivered to the prostate in order to kill some of the cells and shrink the prostate. Although microwave therapy is not a cure, it may help reduce urinary frequency, urgency, and straining, as well as intermittent urine flow. It has not been shown to improve symptoms of incomplete bladder emptying.
- The FDA has also approved the Transurethral Needle Ablation (TUNA) System for the treatment of BPH. The TUNA System is a minimally invasive procedure that involves placing interstitial radiofrequency (RF) needles through the urethra and into the prostate. The low-level radiofrequency energy burns away part of the prostate. The TUNA System has been shown to improve urine flow and relieve symptoms with fewer side effects than TURP. Neither incontinence nor impotence has been observed.
Prevention: It has been suggested that ejaculating on a regular basis may help prevent BPH. However, this has not been scientifically proven. Drinking eight glasses of water per day may help prevent UTIs in men with BPH. However, if the patient is experiencing increased urinary frequency as a symptom of BPH, drinking more water may worsen the symptom.
Overview: Erectile dysfunction (ED), sometimes called impotence, occurs when a man is unable to achieve or maintain an erection that is firm enough for sexual intercourse. The term impotence may also refer to other problems that interfere with sexual intercourse, such as decreased sexual desire or difficulty with ejaculation.
- Although ED is more common in men older than 65, it can occur at any age. Occasional ED is considered normal and happens to most men. As men age, it is also normal to experience changes in erectile function. For instance, it may take longer to achieve erections or they may be less rigid. Some men may have less intense orgasms or produce less ejaculate. The recovery time between erections may also increase with age.
Causes: There are many causes of erectile dysfunction. In some instances, ED may be one of the first signs of an underlying medical problem. Physical diseases account for about 70 percent of ED cases. For instance, long-term diseases that affect the lungs, liver, kidneys, heart, nerves, arteries, or veins are risk factors for ED. The most common causes of ED include heart disease, high blood pressure, clogged arteries (called atherosclerosis), diabetes, obesity, and metabolic syndrome. This is because an erection is dependent on proper blood flow in the penis.
- If the veins and muscles in the penis cannot prevent blood from leaving the penis during sexual arousal, an erection cannot be maintained. Venous leakage can be the result of injury, disease, or damage to the veins in the penis.
- Prostate gland enlargement, such as with benign prostatic hyperplasia (BPH), can also cause symptoms of ED by placing pressure on the blood vessels that fill the penis to cause an erection.
- Damage to the nerves that control erections can cause erectile dysfunction. It may result from an injury to the pelvic area or spinal cord. Surgery to treat bladder, rectal, or prostate cancer may also damage sensitive nerves and blood vessels and may cause ED.
- Spinal cord and brain injuries can cause impotence if they interfere with nerve impulses transferred from the brain to the penis. Other nerve disorders, such as multiple sclerosis (MS), Parkinson’s disease, and Alzheimer’s disease, may also result in ED.
- Hormonal disorders cause less than five percent of ED cases. Testosterone deficiency, although uncommon, may result in a decreased sex drive and ED. An excess of the hormone prolactin, caused by a pituitary gland tumor, can reduce levels of testosterone and cause ED. Hormone imbalances can also result from kidney or liver disease, causing ED.
- Peyronie’s disease is a rare inflammatory condition that causes scarring of erectile tissue. The normal skin cells are replaced by scar tissue. Scarring causes the penis to curve and may interfere with sexual function, cause painful erections, and even block some of the blood flow.
- Psychological conditions, such as performance anxiety, stress, guilt, or depression, may also contribute to loss of sexual drive and may result in ED. If an individual experiences loss of erection during sexual intercourse, he may worry that it will happen again. This can produce anxiety associated with performance and may lead to ED during sex.
- ED is also a common side effect of many medications. In fact, medications may cause as much as 25 percent of all ED cases. Several types of drugs can cause ED by interfering with nerve impulses or blood flow to the penis. Examples include antidepressants (e.g., Elavil®, Prozac®, Paxil®, or Zoloft®), stimulants (e.g., Adderall®), antihistamines (e.g., Benadryl® or Allegra®), medications to treat high blood pressure (e.g., Inderal® or Catapres®), heart medications (e.g., Lanoxin®), antiulcer drugs (e.g., Tagamet®), pain relievers (e.g., methadone, codeine, morphine, or oxycodone), prostate cancer drugs (e.g., Proscar®), tranquilizers (e.g., Valium® or Xanax®), and sleeping aids (e.g., Restoril® or Ambien®). Excessive or long-term use of alcohol, marijuana, heroin, cocaine, methamphetamine, or other drugs often cause ED and decreased sexual drive.
- Low levels of iron may also lead to ED.
Symptoms: Symptoms associated with ED include the occasional inability to obtain a full erection, inability to maintain an erection throughout sexual activities, and complete inability to achieve an erection. Lack of morning erections is also seen along with a decrease in sex drive (libido).
Diagnosis: After a physical examination, several tests are available to determine the cause of erectile dysfunction.
- A complete blood count may be taken to determine if the patient has low levels of iron in the blood. Low levels of iron may lead to erectile dysfunction.
- A blood test may be performed to determine whether or not high levels of fat in the blood are causing the condition.
- Low levels of sex hormones, including testosterone, may indicate erectile dysfunction.
- A duplex ultrasound, which takes pictures of the penis, may also be performed. An ultrasound helps the healthcare provider evaluate blood flow to the penis. It can detect leaking arteries, hardened or blocked arties, or tissue scarring, which may be causing erectile dysfunction.
Treatment: Several drugs, including sildenafil (Viagra®), tadalafil (Cialis®) and vardenafil (Levitra®), have been used to treat males who experience ED as a result of aging. These drugs are taken by mouth a few hours before sexual activity. These drugs should not be taken more than once every 24 hours.
- In general, side effects may include headache, upset stomach, diarrhea, dizziness, flushing, or stuffy nose. Serious side effects may include sudden severe loss of vision, blurred vision, changes in color vision, painful erection, prolonged erection lasting longer than four hours (called priaprism), fainting, chest pain, difficulty breathing, hoarseness, itching or burning during urination, and rash. Individuals should seek immediate medical treatment if any of these serious side effects develop.
Prevention: A simple way to help prevent ED is to introduce lifestyle changes. For some men, adopting a healthier lifestyle by quitting smoking, exercising regularly (at least 30 minutes daily), or reducing stress may be all that is needed to find relief. For others, adopting these lifestyle changes in addition to other treatments, such as medicines or surgery, can further help.
- Some additional methods that may help prevent symptoms of ED include limiting or avoiding the use of alcohol and other recreational drugs (marijuana, cocaine), getting enough sleep (eight hours a night), dealing with anxiety or depression (through counseling and medication), and seeing a doctor for regular checkups and medical screening tests.
Overview: Male hypogonadism is a hormonal disorder that occurs when the male gonads (testes) are underactive. The testes secrete testosterone, which is a hormone that is essential for reproductive function, development of secondary sexual characteristics, body composition, and mood. Some males may be born with hypogonadism, while others develop it later in life.
Causes: Primary hypogonadism occurs when the gonads are directly affected. Common causes of primary hypogonadism in males include a genetic disorder called Klinefelter’s syndrome, undescended testicles, mumps orchitis, testicle injury, cancer treatment, or an inherited disorder called hemochromatosis, which causes the body to absorb too much iron.
- Secondary hypogonadism occurs when other parts of the body, such as the hypothalamus or pituitary gland (both located in the brain), cause the gonads to be underactive. Common causes of secondary hypogonadism include Kallman syndrome, opiate medications, inflammatory diseases (such as sarcoidosis), and obesity.
Symptoms: If the body does not produce enough testosterone during fetal development, the growth of sex organs may be impaired. Male children born with hypogonadism may have female genitals, ambiguous genitals that are neither male nor female, or underdeveloped male genitals. If hypogonadism occurs during puberty, the male may experience decreased development of muscle mass, impaired growth of body hair, impaired growth of genitals, excessive growth of the arms and legs in proportion to the trunk of the body, development of breast tissue, and a lack of deepening of the voice. Males who develop hypogonadism during adulthood may experience erectile dysfunction, infertility, decreased body hair growth, increased body fat, decreased testicle size, decreased muscle mass, development of breast tissue, and osteoporosis (hollow, brittle bones).
Diagnosis: Hypogonadism is diagnosed when a patient experiences symptoms that are characteristic of the disorder and has low levels of sex hormones in the blood. Males will have low levels of testosterone. Additional tests may be performed to determine the underlying cause.
Treatment: Patients with hypogonadism typically receive hormone replacement therapy (HRT) with testosterone injections. This treatment has been shown to stimulate puberty and restore fertility in patients.
Prevention: Because obesity may lead to secondary hypogonadism, patients who maintain a normal body weight can reduce their risk of developing the condition. Reducing the risk of head trauma may also reduce the risk of hypogonadism. This is because some cases occur as a result of injury to parts of the brain, such as the hypothalamus.
Overview: Prostate cancer is the uncontrollable growth of cells in the prostate gland. After skin cancer, prostate cancer is the most common form of cancer in America, affecting about one in six men.
- The prostate gland, which is located in front of the rectum and under the bladder, is part of a man’s reproductive system. It surrounds the urethra, the tube that carries urine. A healthy prostate is about the size of a walnut.
- Prostate tumors are masses of prostate cells. Prostate tumors can be noncancerous (benign) or cancerous (malignant). Benign tumors in the prostate are rarely life-threatening. Benign prostatic hyperplasia (BPH) is the abnormal growth of noncancerous prostate cells. The prostate grows larger and squeezes the urethra, preventing the normal flow of urine. BPH is common, affecting about 30 million men worldwide.
- Malignant prostate tumors are generally more serious than benign tumors. In some cases, malignant prostate tumors may be life-threatening, especially if they spread to other areas of the body, such as the lymph nodes, liver, bones, colon, and other organs.
- When diagnosed and treated early, prostate cancer can be successfully cured more than 90 percent of the time. It is important to be diagnosed early, which is why the American Cancer Society recommends that healthcare professionals offer screening tests annually, beginning at age 50. Men at high risk may be encouraged to undergo screening earlier.
Causes: As men get older (particularly after age 50), their risk of prostate cancer increases.
- The incidence of prostate cancer varies among populations worldwide. Asian men typically have a very low incidence of prostate cancer, with age-adjusted incidence rates ranging from 2-10 per 100,000 men. Higher incidence rates are generally observed in northern European countries. African-American men, however, have the highest incidence of prostate cancer in the world. In the United States, African-American men have a 60 percent higher incidence rate compared with Caucasian men. If an immediate family member has prostate cancer, the risk of developing the disease is greater than that of the average American man.
- A high-fat diet and obesity may increase the risk of prostate cancer. Researchers theorize that fat increases production of the hormone testosterone, which may promote the development of prostate cancer cells. Obese men who are diagnosed with prostate cancer are two-and-a-half times more likely to die from the disease than men of normal weight at the time of diagnosis. Scientists believe that obesity increases the risk of prostate cancer by increasing inflammation and steroid hormones, such as testosterone.
- Because testosterone naturally stimulates the growth of the prostate gland, men who have high levels of testosterone are more likely to develop prostate cancer than men who have lower levels of testosterone. It has also been suggested that testosterone therapy might increase or speed up the growth of prostate cancer that is already present.
Symptoms: If the cancer is identified at its earliest stages, most men will not experience any symptoms. Some men, however, experience symptoms, such as a need to urinate frequently (especially at night); difficulty starting or stopping urination; weak or interrupted flow of urine; a painful or burning sensation during urination; difficulty having an erection; painful ejaculation; blood in urine or semen; or frequent pain or stiffness in the lower back, hips, or upper thighs. Because these symptoms can also indicate the presence of other conditions, such as urinary tract infections or bladder problems, men who experience any of these symptoms will undergo a thorough work-up to determine the underlying cause of the symptoms.
Diagnosis: Men with risk factors for developing prostate cancer, such as men older than 50 years of age, should undergo routine prostate cancer screenings.
- The digital rectal exam (DRE) is commonly performed during routine physical examinations. During a DRE, a doctor feels the prostategland by passing a gloved finger into the patient’s rectum. A hard or lumpy area may indicate anabnormality.
- A doctor may also take a sample of blood to analyze the patient’s prostate-specific antigen (PSA) levels. PSA is an enzyme normally made by cells in the prostate gland that helps break down proteins in seminal fluid to aid with fertility. It is normal for the bloodstream to contain some PSA. In the United States, a generally accepted standard PSA level is 4.0 nanograms per milliliter (ng/ml). However, if the PSA level is elevated, it may be an indication of prostate infection, inflammation, enlargement (BPH), or cancer. Using the PSA test to screen men for prostate cancer is controversial because it is not yet known if this test actually saves lives. It is also unclear if the benefits of PSA screening outweigh the risks of follow-up diagnostic tests and cancer treatments. For instance, the PSA test may detect small tumors that would never become life-threatening.
- If the PSA level is elevated, or if the person has an abnormal digital rectal exam, a doctor may recommend a prostate biopsy. The patient will be prescribed antibiotics, usually a three-day course, before the surgery. Most individuals receive local anesthesia, such as lidocaine (Xylocaine®). To do a biopsy, a doctor inserts a small, lubricated probe (called a transrectal ultrasound) into the rectum. The probe uses sound waves, which are then converted to visual data in order to see a picture of the prostate gland, which is then analyzed for changes. If an abnormal area is seen on the transrectal ultrasound, the doctor will likely biopsy that area. During a biopsy, a fine, hollow needle is aimed at the abnormal area(s) of the prostate, and a small section of tissue is removed. Biopsies generally take about 15-45 minutes to complete, depending on the procedure. The procedure used to diagnose prostate cancer (prostate biopsy) may cause side effects, such as bleeding and infection. Fifty-five percent of men report discomfort during the biopsy. The same procedure can be performed through the perineum area (between the anus and the scrotum) and is called a transperineal biopsy, or through the urethra (the canal that the urine travels through for elimination), and is called a transurethral biopsy.
- If a doctor thinks the cancer may have spread to other parts of the body, other tests may be used. These include procedures such as a bone scan, ultrasound, a computerized tomography (CT) scan, magnetic resonance imaging (MRI), and lymph node biopsies.
Treatment: When prostate cancer has not spread beyond the prostate, most practitioners will discuss options with patients that include the surgical removal of the prostate (called a prostatectomy), radiation treatment, or active surveillance (also called watchful waiting or observation). The goal of a prostatectomy and radiation treatment is to cure the patient by eradicating the cancer. There are other, less well-established approaches, including cryotherapy and high-intensity focused ultrasound (HIFU), for which there is less scientific evidence available compared to prostatectomy or radiation therapy.
- When prostate cancer has spread beyond the prostate, it is said to be ”metastatic” or to have metastasized. The most common areas of metastasis are the bones (especially the ribs, spine, skull, and pelvis) and lymph nodes, and less commonly the lungs and liver. Once the cancer spreads to the bones, liver, or lungs, it is not generally curable, and treatments are aimed at controlling the growth of the cancer for as long as possible. The standard initial treatment for metastatic prostate cancer is hormonal therapy. Chemotherapy is generally not given unless the cancer becomes resistant to the effects of hormonal therapy. Generally, the prostate area itself is not treated if the cancer has spread, although in some cases if there is a lot of cancer in the prostate area, radiation may be given for ”local control” to avoid complications from the cancer growing too large in the pelvis area.
Prevention: A new vaccine, although not FDA-approved, has been developed to help extend survival for patients with deadly metastatic prostate cancer. The FDA has requested additional clinical data before the vaccine, called Provenge®, can be approved. The vaccine is targeted at individuals with prostate cancer who have ceased responding to hormone therapy and have cancer that has spread to other organs and tissues. Reported side effects include fever, chills, and fatigue (tiredness).
- Because high-fat dairy products and the calcium contained in dairy may increase the risk of developing prostate cancer, these foods should be limited. Examples of high-fat dairy foods include cheese, sour cream, and ice cream.
- Cruciferous vegetables (such as broccoli, cabbage, and cauliflower) have been reported to contain cancer-fighting phytochemicals that may decrease the chance of developing prostate cancer. Antioxidant-containing foods, including fruits (such as berries, grapes, and tomatoes) and vegetables (such as peppers and carrots) may help prevent the development of prostate cancer.
- Eating large amounts of red meat or processed meats has been shown to increase the risk of colon cancer. It has also been suggested to increase the risk of developing prostate cancer, although this is an area of ongoing research.
- Exercise (at least 30 minutes daily for five days a week), smoking cessation, and relaxation all may contribute to decreasing the risk of developing prostate cancer.
Overview: Prostatitis is inflammation of the prostate gland. It often affects younger men. With treatment, prostatitis generally goes away within several days to two weeks. Treatment of chronic (long-term) bacterial prostatitis usually involves antibiotics for 4-12 weeks. This type of prostatitis is difficult to treat and recurrence is possible.
Causes: Prostatitis usually results from the blockage or irritation of some of the ducts within the prostate gland, and the cause may be mechanical (such as a narrowing of the urethra) or infectious. Infectious causes may be viral or bacterial, including E. coli or sexually transmitted infections such as chlamydia.
- There are four types of prostatitis. Chronic nonbacterial prostatitis is the most common type. Prostadynia, also known as chronic pelvic pain syndrome, is a condition associated with similar symptoms as chronic nonbacterial prostatitis, but which has no evidence of prostate inflammation. Chronic bacterial prostatitis is not very common. It typically affects men who are 40-70 years old. Asymptomatic inflammatory prostatitis does not cause symptoms and generally occurs in men who are 60 years of age or older. Acute bacterial prostatitis is the least common form. It usually occurs in men who are younger than 35.
Symptoms: Symptoms of prostatitis may include painful, burning, or frequent urination; weak urine flow or incomplete emptying; fever and chills; lower abdominal pain or pressure; painful ejaculation; impotence; and low back pain.
- Chronic prostatitis and chronic pelvic pain syndrome are the most common types of prostatitis, but are probably the most poorly understood. Symptoms may go away and then reappear without warning. The infection may be considered inflammatory. This occurs when the infecting organism is not present in the urine, semen, or other secretions but infection-fighting cells are present. In other cases, the infection may be considered noninflammatory, in which inflammation and infection-fighting cells are both absent.
- Chronic bacterial prostatitis is a frequent infection of the prostate gland that is difficult to treat. Symptoms are often similar to acute bacterial prostatitis, but they are often less severe. Symptoms of chronic bacterial prostatitis generally last longer and do not cause a fever.
- Asymptomatic inflammatory prostatitis may be diagnosed when infection-fighting cells are present, but common symptoms of prostatitis are not. A diagnosis is usually made incidentally during an examination for other conditions, such as infertility or prostate cancer.
- Acute bacterial prostatitis can occur at any age. Symptoms are usually sudden and severe. Symptoms may include painful and/or difficult urination, fever, chills, lower back pain, pain in the genital area, frequent urination, burning during urination, urinary urgency at night, and aches and pains throughout the body.
Treatment: Acute bacterial prostatitis (infectious prostatitis) is usually treated with oral antibiotics for one to two weeks. The commonly used antibiotics include quinolones, such as norfloxacin (Noroxin®), ciprofloxacin (Cipro®), or levofloxacin (Levaquin®). In severe cases, treatment with intravenous (IV) antibiotics may be necessary. Chronic bacterial prostatitis is also treated with oral antibiotics for 4-12 weeks. Other medications used to treat infectious prostatitis include: stool softeners, such as docusate sodium (Colace®); anti-inflammatory medications, such as ibuprofen (Motrin®); analgesics or pain medications, such as hydrocodone (Vicodin®, Lortab®); alpha blockers such as tamsulosin (Flomax®); and 5-alpha reductase inhibitors, such as finasteride (Proscar®) or dutasteride (Avodart®).
- If the individual has nonbacterial prostatitis, antimicrobial medication is not needed. Treatment depends on the symptoms. If the condition responds to muscle relaxation, the individual may be given an alpha blocker, a drug that can relax the muscle tissue in the prostate and reduce the difficulty in urination. Pain meditations, anti-inflammatories, and warm sitz baths may also be helpful.
- Chronic prostatitis may respond to multidisciplinary approaches incorporating exercise, progressive relaxation, and counseling. Asymptomatic inflammatory prostatitis may respond to the same treatment measures, but this condition generally does not require treatment.
Prevention: Men are encouraged to practice good hygiene. Keeping the penis clean can help prevent some types of infections that can lead to prostatitis. Patients are encouraged to drink plenty of fluids, especially water, to cause regular urination.
The information in this monograph is intended for informational purposes only, and is meant to help users better understand health concerns. Information is based on review of scientific research data, historical practice patterns, and clinical experience. This information should not be interpreted as specific medical advice. Users should consult with a qualified healthcare provider for specific questions regarding therapies, diagnosis and/or health conditions, prior to making therapeutic decisions.