Efficacy of Alternative and Other Treatments According to GRADE* Ranking:

Thuja (Eastern White Cedar, Thuja Occidentalis) [1, 9, 10, 11]:

Please note, this management does NOT treat the condition itself. It may mildly help with some of the symptoms, and even then has insufficient evidence to back up this claim at present. Little is known about the full effects of Thuja, so it is not recommended for medicinal use. Thuja can be poisonous if ingested in large amounts.

Recommendation: no recommendation (There is insufficient evidence to support claims that Thuja helps to treat benign prostatic hyperplasia)

Grade of Evidence: very low quality of evidence

Saw Palmetto Extract [1, 2, 3, 4, 5, 6, 7, 8]:

Please note, this management does NOT treat the condition itself. It may mildly help with some of the symptoms, and even then has insufficient evidence to back up this claim at present. Palmetto extract may cause side effects, though these are uncommon. They may include headache, vomiting, dizziness, constipation, diarrhoea, insomnia or fatigue. Long term effects have not yet been researched.

Recommendation: Weakly in favor (Clinical trials have shown that Saw Palmetto may help to treat the symptoms of benign prostatic hyperplasia. Although a review concluded that most studies suggest improvement in symptoms, there have been studies with decidedly mixed or negative results. Further research is needed.)

Grade of Evidence: moderate level quality of evidence

* www.gradeworkinggroup.org

Benign Prostatic Hyperplasia

Men have a specialized organ called prostate. This special structure produces fluid that carries sperm during ejaculation. As males grow older, the prostate usually increases in size. This is called Benign Prostatic Hyperplasia (BPH) and it does not increase the likelihood of getting prostate cancer. However, as the gland enlarges, it may press on the urethra that could lead to urination and bladder problems.^[1]

Epidemiology

BPH is a common medical problem. One-third of men greater than 50 years old have their quality of life affected due to BPH. It is estimated that 30 million men have symptoms related to BPH. ^[2] Symptoms are rarely encountered in men before the age of 40. Around 50% of men in their 60s and 90% of men in their 70s and 80s have symptoms related to BPH. ^[3]

Causes

The exact mechanism behind BPH is unknown. The condition is commonly observed in older males and men with removed testes during their younger years (before puberty) do not develop BPH. Because of these observations, BPH is linked to aging and testes. ^[3]

Symptoms

Symptoms vary from person to person. Usually, the earliest sign is increased urination at night. Other symptoms of BPH include: ^{[4] [1]}

• urination problems (difficulty starting urination)
• weak or interrupted urinary stream
• sensation of incompletely emptying the bladder after urination
• frequent urination especially at night
• urinary urgency (need to urinate right away)
• terminal dribbling of urine
• pain during urination
• straining to urinate

Diagnosis

Patients are asked about their symptoms. A digital rectal exam is done to assess if the prostate is enlarged or not. The urine may also be examined and the kidney function may be assessed by the physician. A blood sample may also be sent to check Prostate Specific Antigen (PSA) level, a way of ruling out prostate cancer. ^[4] If prostate cancer is suspected, a rectal ultrasound and prostate biopsy are recommended. ^[3]

Treatment

Drugs like finasteride and doxazosin are usually prescribed. If there is infection, antibiotics are given.  Other treatment options for BPH are transurethral microwave procedures, transurethral needle ablation, water-induced thermotherapy, high-intensity focused ultrasound and surgery. ^[3]

Self-care procedures often help such as avoiding alcohol and caffeine particularly after dinner, reducing stress, keeping the self warm and having regular exercise. ^[1]

References:

1. http://www.nlm.nih.gov/medlineplus/ency/article/000381.htm

2. http://emedicine.medscape.com/article/437359-overview#a0156

3. http://kidney.niddk.nih.gov/kudiseases/pubs/prostateenlargement/

4. http://www.netdoctor.co.uk/diseases/facts/prostaticenlargement.htm

Summary References

Treatments:

1. Ades T, Alteri R, Gansler T, Yeargin P, "Complete Guide to Complimentary & Alternative Cancer Therapies", American Cancer Society, Atlanta USA, 2009

2. http://www.cancer.org/Treatment/TreatmentsandSideEffects/ComplementaryandAlternativeMedicine/HerbsVitaminsandMinerals/saw-palmetto

3. http://nccam.nih.gov/health/palmetto/

4. http://www.nlm.nih.gov/medlineplus/druginfo/natural/patient-sawpalmetto.html

5. http://www.ncbi.nlm.nih.gov/pubmed/12137626

6. http://www.ncbi.nlm.nih.gov/pubmed/16467543

7. http://www.ncbi.nlm.nih.gov/pubmed/18423748

8. http://www.mayoclinic.com/health/saw-palmetto/NS_patient-sawpalmetto

9. http://www.nlm.nih.gov/medlineplus/ency/article/002769.htm

10. http://plants.usda.gov/plantguide/pdf/cs_thoc2.pdf

11. http://vsearch.nlm.nih.gov/vivisimo/cgi-bin/query-meta?v%3Aproject=medlineplus&query=thuja&x=0&y=0