Benign Prostatic Hyperplasia
Also indexed as: BPH, Enlarged Prostate, Prostatic
Also known as BPH, this common condition is characterized by
frequent urges to urinate. What can you do to relieve prostate pressure? According to research
or other evidence, the following self-care steps may be helpful:
- See what saw palmetto has to offer
- Control BPH symptoms with this effective herbal remedy; take 320
mg a day of a liposterolic extract, standardized for 80 to 95% fatty acids
- Discover the benefits of beta-sitosterol
- Take 130 mg a day of this edible plant compound to improve urinary
flow and other symptoms
- Try flower pollen
- Take several tablets or capsules a day of flower pollen extract to
- Get to know pygeum
- Try 100 to 200 mg a day of this evergreen tree bark extract,
standardized for 13% total sterols
- Focus on physical fitness
- Increase your physical activity by walking more or adding other
These recommendations are not comprehensive and are not intended to replace
the advice of your doctor or pharmacist. Continue reading the full benign prostatic
hyperplasia article for more in-depth, fully-referenced information on medicines, vitamins,
herbs, and dietary and lifestyle changes that may be helpful.
About benign prostatic hyperplasia
Benign prostatic hyperplasia (BPH) is a non-malignant enlargement of the prostate
The prostate is a small gland that surrounds the neck of the bladder and urethra in men.
Its major function is to contribute to seminal fluid. If the prostate enlarges, pressure may
be put on the urethra, acting like a partial clamp and causing a variety of urinary symptoms.
Half of all 50-year-old men have BPH, and the prevalence of the condition increases with
advancing age. The name “benign prostatic hyperplasia” has replaced the older term
“benign prostatic hypertrophy”; both terms refer to the same condition.
Product ratings for benign
What are the symptoms?
A man with BPH has to urinate more often, especially at night, and experiences less force
and caliber while urinating, often dribbling. If the prostate enlarges too much, urination is
difficult or impossible, and the risk of urinary
tract infection and kidney damage increases. A doctor can usually detect an enlarged
prostate during a rectal exam.
Prescription medications used to treat BPH include finasteride (Proscar®), terazosin (Hytrin®), and tamsulosin (Flomax®). Though these drugs can
reduce urinary symptoms in men with BPH, it is not clear whether they slow the progression of
Doctors often recommend surgery when symptoms are severe or when there is a high risk of
urinary obstruction. Though prostate surgery has a high success rate, it also has a higher
rate of complications than drug therapy.
Lifestyle changes that may be helpful
More physically active men have a lower frequency of symptoms related to BPH. In a
preliminary study, physical activity was associated with a decrease in occurrence of BPH,
surgery for BPH, and symptoms of BPH.1 Walking, the most prevalent activity among
men in this study, was related to a decreased risk of BPH. Men who exercised by walking two to
three hours per week had a 25% lower risk of BPH compared with men who didn’t use
walking for exercise.
Vitamins that may be helpful
Beta-sitosterol, a compound found in many
edible plants, has also been found to be helpful for men with BPH. In one double-blind trial,
200 men with BPH received 20 mg of beta-sitosterol three times a day or a placebo for six
months. Men receiving beta-sitosterol had a significant improvement in urinary flow and an
improvement in symptoms, whereas no change was reported in men receiving the
placebo.2 Another double-blind study reported similarly positive results using 130
mg per day of beta-sitosterol.3
Rye pollen extract has improved the
symptoms of BPH in preliminary trials.4 5 6 Double-blind
trials have also reported that rye pollen extract is effective for reducing symptoms of
BPH7 8 This rye pollen extract was shown to be comparable in effect to
an amino acid mixture used for BPH in a
double-blind study.9 A double-blind comparison with pygeum resulted in significant subjective improvement
in 78% of those given the rye pollen extract compared with 55% using pygeum.10
Research on this commercial rye pollen extract has used three to six tablets, or four
capsules, per day; the effect of other pollens in men with prostate conditions has not yet
In a controlled trial, men with BPH received a supplement containing three amino acids (glycine,
alanine, and glutamic acid) totaling about
760 mg three times per day for two weeks, then 380 mg three times per day for a total of three
months. After three months, about half of these men reported reduced urgency, frequency,
and/or less delay starting urine flow, compared to 15% or less of the men who received a
placebo.11 Another similar controlled trial of this combination also reported
positive results12 Although it is not known how the amino acid combination works,
it is believed to reduce the amount of swelling in prostate tissue.
In a 1941 preliminary report, 19 men with BPH were given an essential fatty acid (EFA)
supplement.13 In every case, the amount of retained urine was reduced, and
nighttime urination problems stopped in 69% of cases. Dribbling was eliminated in 18 of the 19
men. All men also reported improved libido and a reduction in the size of the enlarged
prostate, as determined by physical examination. Because this study did not include a control
group and the amount given was surprisingly small, the possibility of a placebo effect cannot
be ruled out.
Despite the lack of good published research, many doctors have been impressed with the
effectiveness of essential fatty acids (EFAs) in cases of BPH. A typical recommendation is one
tablespoon of flaxseed oil per day, perhaps
reduced to one or two teaspoons per day after several months. Because taking EFAs increases
the requirement for vitamin E, most doctors
recommend taking a vitamin E supplement along with EFAs. However, controlled research is
needed to establish whether EFAs are helpful for BPH.
Prostatic secretions are known to contain a high concentration of zinc; that observation suggests that zinc plays a role
in normal prostate function. In one preliminary study, 19 men with benign prostatic
hyperplasia took 150 mg of zinc daily for two months, and then 50 to 100 mg daily. In 74% of
the men, the prostate became smaller.14 Because this study did not include a
control group, improvements may have been due to a placebo effect. Zinc also reduced prostatic
size in an animal study but only when given by local injection.15 Although the
research supporting the use of zinc is weak, many doctors recommend its use. Because
supplementing with large amounts of zinc (such as 30 mg per day or more) may potentially lead
to copper deficiency, most doctors recommend
taking 2 to 3 mg of copper per day along with zinc.
Are there any side effects or interactions?
Refer to the individual supplement for information about any side effects or interactions.
Herbs that may be helpful
In many parts of Europe, herbal supplements are considered standard medical treatment for
BPH. Although herbs for BPH are available without prescription, men wishing to take them
should be monitored by a physician.
The fat-soluble (liposterolic) extract of the
saw palmetto berry has become the leading natural treatment for BPH. This extract, when
used regularly, has been shown to help keep symptoms in check.16 Saw palmetto
appears to inhibit 5-alpha-reductase, the enzyme that converts testosterone to its more active
form, dihydrotestosterone (DHT). Saw palmetto also blocks DHT from binding in the
prostate.17 Studies have used 320 mg per day of saw palmetto extract that is
standardized to contain approximately 80 to 95% fatty acids.
A three-year preliminary study in Germany found that 160 mg of saw palmetto extract taken
twice daily reduced nighttime urination in 73% of patients and improved urinary flow rates
significantly.18 In a double-blind trial at various sites in Europe, 160 mg of saw
palmetto extract taken twice per day treated BPH as effectively as finasteride without side effects, such as loss of
libido.19 A one-year dose-comparison study found that 320 mg once per day was as
effective as 160 mg twice per day in the treatment of BPH.20 A review of all
available double-blind trials has concluded that saw palmetto is effective for treatment of
men with BPH and is just as effective as, with fewer side effects than, the drug
finasteride.21 One study found saw palmetto to be ineffective as a treatment for
BPH. However, the study excluded men with mild BPH, even though previous studies had found the
herb effective for mild to moderate BPH.22
In a preliminary study, supplementation with a special aged garlic extract (Kastamonu
Garlic) in the amount of 1 ml per 2.2 pounds of body weight per day for one month resulted in
a 32% reduction in the size of the prostate gland and a significant improvement in urinary
symptoms.23 It is not known whether other forms of garlic would have the same
Pygeum, an extract from the bark of the
African tree, has been approved in Germany, France, and Italy as a remedy for BPH. Controlled
studies published over the past 25 years have shown that pygeum is safe and effective for men
with BPH of mild or moderate severity.24 These studies have used 50 to 100 mg of
pygeum extract (standardized to contain 13% total sterols) twice per day. This herb contains
three compounds that may help the prostate: pentacyclic triterpenoids, which have a diuretic
action; phytosterols, which have anti-inflammatory activity; and ferulic esters, which help
rid the prostate of any cholesterol deposits that accompany BPH.
Another herb for BPH is a concentrated extract made from the roots of the nettle plant. This extract may increase urinary volume
and the maximum flow rate of urine in men with early-stage BPH.25 It has been
successfully combined with both saw palmetto
and pygeum to treat BPH in double-blind trials.26 It has also been shown in a
double-blind trial, when used by itself, to relieve symptoms of BPH and to improve disease
severity.27 An appropriate amount appears to be 120 mg of nettle root extract (in
capsules or tablets) twice per day or 2 to 4 ml of tincture three times per day.
Pumpkin seed oil has been used in
combination with saw palmetto in two double-blind human studies to effectively reduce symptoms
of benign prostatic hyperplasia (BPH).28 29 Only one group of
researchers has evaluated the effectiveness of pumpkin seed oil alone for BPH, but the results
of their large preliminary trials have been favorable.30 31 Researchers
have suggested the zinc, free fatty acid, or plant sterol content of pumpkin seeds may account
for their benefit in men with BPH, but this has not been confirmed. Animal studies have shown
that pumpkin seed extracts may improve the function of the bladder and urethra; this might
partially account for BPH symptom relief.32 Pumpkin seed oil extracts standardized
for fatty acid content have been used in BPH studies in the amount of 160 mg three times per
day with meals.
Are there any side effects or interactions?
Refer to the individual herb for information about any side effects or interactions.
1. Platz EA, Kawachi I, Rimm EB, et al. Physical activity and benign
prostatic hyperplasia. Arch Intern Med 1998;158:2349–56.
2. Berges RR, Windeler J, Trampisch HJ, et al. Randomized,
placebo-controlled, double-blind clinical trial of beta-sitosterol in patients with benign
prostatic hyperplasia. Lancet 1995;345:1529–32.
3. Klippel KF, Hiltl DM, Schipp B. A multicentric, placebo-controlled,
double-blind clinical trial of ß-sitosterol (phytosterol) for the treatment of benign
prostatic hyperplasia. Br J Urol 1997;80:427–32.
4. Horii A, Iwai S, Maekawa M, Tsujita M. Clinical evaluation of
Cernilton in the treatment of the benign prostatic hypertrophy. Hinyokika Kiyo
1985;31:739–45 (in Japanese).
5. Ueda K, Jinno H, Tsujimura S. Clinical evaluation of Cernilton®
on benign prostatic hyperplasia. Hinyokika Kiyo 1985;31:187–91 [in
6. Hayashi J, Mitsui H, Yamakawa G, et al. Clinical evaluation of
Cernilton in benign prostatic hypertrophy. Hinyokika Kiyo 1986;32:135–41 [in
7. Buck AC, Cox R, Rees RW, et al. Treatment of outflow tract obstruction
due to benign prostatic hyperplasia with the pollen extract, cernilton. A double-blind,
placebo-controlled study. Br J Urol 1990;66:398–404.
8. Becker H, Ebeling L. Conservative therapy of benign prostatic
hyperplasia (BPH) with Cernilton. Urologe (B) 1988;28:301–6 [in German].
9. Maekawa M, Kishimoto T, Yasumoto R, et al. Clinical evaluation of
Cernilton on benign prostatic hypertrophy—a multiple center double-blind study with
Paraprost. Hinyokika Kiyo 1990;36:495–516 [in Japanese].
10. Dutkiewicz S. Usefulness of Cernilton® in the treatment of
benign prostatic hyperplasia. Int Urol Nephrol 1996;28:49–53.
11. Damrau F. Benign prostatic hypertrophy: amino acid therapy for
symptomatic relief. J Am Geriatr Soc 1962;10:426–30.
12. Feinblatt HM, Gant JC. Palliative treatment of benign prostatic
hypertrophy: value of glycine, alanine, glutamic acid combination. J Maine Med Assoc
13. Hart JP, Cooper WL. Vitamin F in the treatment of prostatic
hypertrophy. Report Number 1, Lee Foundation for Nutritional Research, Milwaukee, Wisconsin,
14. Bush IM, Berman E, Nourkayhan S, et al. Zinc and the prostate.
Presented at the annual meeting of the American Medical Association Chicago, 1974.
15. Fahim MS, Fahim Z, Der R, Harman J. Zinc treatment for reduction of
hyperplasia of prostate. Fed Proc 1976;35(3):361.
16. Schneider HJ, Honold E, Mashur T. Treatment of benign prostatic
hyperplasia. Results of a surveillance study in the practices of urological specialists using
a combined plant-base preparation. Fortschr Med 1995;113:37–40.
17. Koch E, Biber A. Pharmacological effects of sabal and urtica extracts
as a basis for a rational medication of benign prostatic hyperplasia. Urologe
18. Bach D, Ebeling L. Long-term drug treatment of benign prostatic
hyperplasia—results of a prospective 3-year multicenter study using Sabal extract IDS
89. Phytomedicine 1996;3:105–11.
19. Carraro JC, Raynaud JP, Koch G, et al. Comparison of phytotherapy
(Permixon®) with finasteride in the treatment of benign prostate hyperplasia: a
randomized international study of 1,098 patients. Prostate 1996;29:231–40.
20. Braeckman J, Bruhwyler J, Vandekerckhove K, Géczy J. Efficacy
and safety of the extract of Serenoa repens in the treatment of benign prostatic
hyperplasia: therapeutic equivalence between twice and once daily dosage forms.
Phytotherapy Res 1997;11:558–63.
21. Wilt TJ, Ishani A, Stark G, et al. Saw palmetto extracts for
treatment of benign prostatic hyperplasia. A systematic review. JAMA
22. Bent S, Kane C, Shinohara K, et al. Saw palmetto for benign prostatic
hyperplasia. N Engl J Med 2006;354:557–66.
23. Durak I, Yilmaz E, Devrim E, et al. Consumption of aqueous garlic
extract leads to significant improvement in patients with benign prostatic hyperplasia and
prostate cancer. Nutr Res 2003;23:199–204.
24. Andro MC, Riffaud JP. Pygeum africanum extract for the
treatment of patients with benign prostatic hyperplasia: a review of 25 years of published
experience. Curr Ther Res 1995;56:796–817.
25. Koch E, Biber A. Pharmacological effects of sabal and urtica extracts
as a basis for a rational medication of benign prostatic hyperplasia. Urologe
26. Metzker H, Kieser M, Hölscher U. Efficacy of a combined
Sabal-Urtica preparation in the treatment of benign prostatic hyperplasia (BPH). Urologe
27. Safarinejad MR. Urtica dioica for treatment of benign prostatic
hyperplasia: a prospective, randomized, double-blind, placebo-controlled, crossover study.
J Herb Pharmacother 2005;5:1–11.
28. Carbin BE, Eliasson R. Treatment by Curbicin in benign prostatic
hyperplasia (BPH). Swed J Biol Med 1989;2:7–9 [in Swedish].
29. Carbin BE, Larsson B, Lindahl O. Treatment of benign prostatic
hyperplasia with phytosterols. Br J Urol 1990;66:639–41 [in Swedish].
30. Schiebel-Schlosser G, Friederich M. Phytotherapy pf BPH with pumpkin
seeds—a multicenter clinical trial. Zeits Phytother 1998;19:71–6.
31. Friederich M, Theurer C, Schiebel-Schlosser G. Prosta Fink Forte
capsules in the treatment of benign prostatic hyperplasia. Multicentric surveillance study in
2245 patients. Forsch Komplementarmed Klass Naturheilkd 2000;7:200–4 [in
32. Zhang X, Ouyang JZ, Zhang YS, et al. Effect of the extracts of
pumpkin seeds on the urodynamics of rabbits: an experimental study. J Tongji Med Univ