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  • Enlargement of the Prostate or Benign Prostatic Hyperplasia (BPH)

    What’s the Alternative Doc?

    Saw palmetto is thought to be a natural remedy for prostatism. It is otherwise known as Serenoa repens and is an American dwarf palm plant. The ripe berry of this plant is the source of the herbal extract, which is known to contain a mixture of fatty acids and flavinoids (antioxidants), as well as other substances thought to be good for the prostate. It is not known exactly how saw palmetto works but it appears to be safe.enlarged-prostate Side effects may include mild nausea or reduced libido but the rate of such problems appears to be much less common than in men taking drugs to treat BPH symptoms. However its long-term safety has not been proven. If saw palmetto does not provide any relief of symptoms after a period of three months then it is reasonable to stop using it.

    There has been some suggestion that saw palmetto may affect PSA levels. Therefore, before commencing taking it, it is best to discuss this with your doctor so all the issues relating to your prostate, including the possibility of prostate cancer, can be fully discussed.

    Medication

    Currently there are two pharmaceutical drug treatment options for BPH. Firstly, alpha blockers can improve BPH symptoms in about 70 per cent of men. These medications relax the smooth muscle of the prostate and bladder neck, which allows urine to flow more easily. These drugs can work quickly to provide relief of symptoms but reverse on stopping the drug. One side effect of alpha blockers is low blood pressure upon standing, which can cause dizziness and light-headedness. Other side effects can include fatigue, headaches and nasal congestion. To minimise these side effects, the dose of medication is usually gradually increased and the first dose is usually given at night. There are several alpha blockers available, all of which can be effective. Examples include terazosin, doxazosin and tamsulosin. The effect of terazosin and doxazosin on blood pressure can be worsened as a result of using medications for erectile dysfunction (ED), such as sildenafil (Viagra), vardenafil (Levitra) and tadalafil (Cialis). These medications should not be used by men who take terazosin or doxazosin. Tamsulosin and alfuzosin do not usually interact with ED medications and can provide a safer alternative option. As with all medication, check with your doctor and pharmacist first.

    Secondly, alpha reductase inhibitors (finasteride) work by counteracting the effects of testosterone within cells of the prostate. By doing so, they may help the prostate from increasing further in size and can sometimes actually shrink the size of the prostate. This can decrease BPH symptoms. Finasteride may take several months to work and it must be used indefinitely to prevent recurrence of symptoms. Up to one-third of men have clinically significant improvements. These drugs tend to be more effective in men with larger prostates. The main side effects are impotence, decreased libido and decreased volume of ejaculate in a small percentage of men. These side effects tend to resolve on stopping the drug. Of note, finasteride tends to lower the PSA (prostate specific antigen) level by about 50 per cent. This is important to realise when screening for prostate cancer. Therefore it is recommended that patients starting finasteride should have a PSA level taken before and six to twelve months after starting therapy.