Are Prostate Drugs Harmful?

Multiple treatments are available for enlarged prostate including medications and minimally invasive surgery. A patient’s choice of treatment - be it surgery, radiation, or other forms of management depends on several factors, including:

•    Size of enlarged prostate
•    Severity of symptoms
•    Age and life expectancy
•    Presence of serious health problems, such as heart disease
•    Informed personal preferences about whether to begin treatment or to wait
•    Concerns about side effects common with prostate cancer therapies, such as erectile dysfunction, incontinence and urine leakage.

BENIGN PROSTATIC HYPERPLASIA (BPH)
Benign prostatic hyperplasia (BPH) is a non-cancerous prostate enlargement that happens in almost all men as they grow older. BPH typically leads to difficulty with urination, along with frequent urges to urinate and the lingering feeling that the bladder is not completely empty afterwards - making it necessary to go to the bathroom many times, even at night.

Treatment options depend on how troublesome the symptoms are and can include medications as well as surgery. Medications are used to relieve BPH symptoms and improve quality of life. In general, their side effects are minor and stop when patients stop taking the medicine. At the same time, symptoms also usually return when treatment is stopped.

BPH does not cause prostate cancer. However, its symptoms should be evaluated by a competent physician to be certain they are not being caused by prostate cancer.

Drugs to treat BPH include alpha-blockers which relieve symptoms within a few weeks but don’t slow down prostate enlargement. Another class of drugs known as 5-alpha reductase inhibitors is typically used to reduce prostate size, but they may take 6 months or more to show any effects on BPH symptoms. Typically they also reduce the desire for sex (decreased libido).

Some physicians use a combination of an alpha-blocker with a 5-alpha reductase inhibitor for greater overall efficacy, because they affect different prostate tissues. How much BPH symptoms improve depends on which tissue is contributing the most to the symptoms.

PROSTATE CANCER
As many as 1 in 5 American men will be diagnosed with prostate cancer at some time in their lives - even though most have low-risk, harmless cancers. Withholding treatment while closely monitoring the cancer, known as watchful waiting or active surveillance, is increasingly being recommended as a safer alternative to surgery or radiation.

Nine out of 10 men with low-risk disease still opt for treatment, either because they aren’t offered active surveillance or because they rejected it. The idea of not treating a known cancer risk goes against the psyche of a typical American patient. However, since surgery and radiation involve a risk of life-altering side effects including erectile dysfunction and incontinence, treatment approaches need to be tailored for men with low-risk disease.

Early-stage prostate cancer refers to cancer that is contained entirely within the prostate gland and has not spread - or metastasized - to other areas of the body such as bone. This type of cancer, known as being a low-risk disease, is the most curable.

One out of every two men diagnosed with prostate cancer is aged 72 years or older. Since prostate cancer often grows very slowly, many of these men may die from other causes before the cancer causes them significant problems. In other words, many men will die with prostate cancer but not from prostate cancer.

Another thing to keep in mind is that therapies for prostate cancer can have significant side effects and complications. So trying for an outright cure may not always be the right or healthy choice.

There are three basic options for treating early stage prostate cancer. The two active treatment options - surgery and radiation - can often lead to a cure when used alone. Men with intermediate-risk or high-risk disease usually need a combination of therapies for a high likelihood of cure or disease control.

The three options for early-stage/low-risk prostate cancer are:
•    Surgery
•    Radiation therapy
•    Active surveillance, also known as expectant management or watchful waiting

The third option is not actually a form of treatment. Instead, it's a form of close patient management.
There is a fourth basic treatment option: hormone therapy, usually reserved for older men too debilitated for active treatment and for men with more advanced disease. Chemotherapy plays only a limited role in prostate cancer treatment. It's reserved primarily for the treatment of men with advanced or recurrent prostate cancer that does not respond at all to hormone therapy.

SAW PALMETTO
Saw palmetto extract - obtained from the fruit of Serenoa repens - is today the most popular herbal treatment for BPH. It is rich in fatty acids and phytosterols and has long been used in traditional and alternative medicine to treat many ailments and conditions, most notably BPH.

Native Americans used the fruit to treat a variety of urinary and reproductive system problems. Crude saw palmetto extract has been used by European and American medical practitioners for at least 200 years for various conditions, including urogenital problems.

Early research suggested that saw palmetto extract is well tolerated and provides mild to moderate improvement in urinary symptoms and flow measures. An observational retrospective study in Italy evaluated the benefits of saw palmetto extract on 298 male BPH patients and found an improvement in their symptoms with minimal side effects.

A recent randomized double-blind placebo controlled clinical trial evaluated the efficacy and safety of an orally dosed herbal preparation containing saw palmetto extract and other herbal remedies in the management of symptoms of medically diagnosed BPH. This trial was conducted on 57 otherwise healthy males aged 40-80 years presenting with BPH.

They received 3 months of treatment (1 capsule per day) with either the herbal preparation (n=32) or a matched placebo capsule (n=25). This study showed a significant improvement (36%) in the treatment group compared to 8% for the placebo group during the 3 month intervention period. Both the daytime and night-time urinary frequency showed a significant reduction over the 3-month intervention period.

Saw palmetto extract shows significant promise, although more carefully controlled clinical trials are needed to evaluate its safety and efficacy in the treatment of BPH.

References
http://men.webmd.com/prostate-enlargement-bph/benign-prostatic-hyperplasia-bph-topic-overview
http://www.webmd.com/prostate-cancer/guide/prostate-cancer-overview-facts
http://en.wikipedia.org/wiki/Saw_palmetto_extract
http://www.ncbi.nlm.nih.gov/pubmed/23642948
http://www.ncbi.nlm.nih.gov/pubmed/23210402

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