Prostate Health

Understanding Prostate Health

Prostate health is the healthy function of the prostate, a walnut-sized gland that surrounds the urethra just below the bladder and contributes to seminal fluid. The three common problems are benign prostatic hyperplasia (BPH), prostatitis and prostate cancer.^{[1, 2, 3]} Each is handled differently, so the type of problem matters more than the label "prostate trouble."

Common symptoms

BPH is a non-cancerous enlargement that compresses the urethra and causes lower urinary tract symptoms, including a weak stream, frequent or urgent urination, getting up at night and a feeling that the bladder does not empty fully.^[1] Chronic prostatitis and chronic pelvic pain syndrome (CP/CPPS) cause pelvic or perineal pain and urinary symptoms, and often affect men younger than 50.^[2]

Acute bacterial prostatitis is a sudden infection, and it needs prompt medical care.^[4] Most early prostate cancers cause no symptoms, which is one reason screening is discussed with a physician. Late symptoms can include bone pain and fatigue.^[3]

Causes and risk factors

BPH becomes more common with age: it is found at autopsy in 50 to 60 percent of men in their 60s and 80 to 90 percent of men over 70. Genetics and obesity also influence it.^[1] Acute bacterial prostatitis is often linked to bladder outlet obstruction or a weakened immune system.^[4]

CP/CPPS has no single known cause and is often misdiagnosed and poorly managed.^[2] For prostate cancer, risk is higher in African American men and in men with a family history.^[5]

How it is diagnosed and treated conventionally

Treatment depends on the diagnosis. BPH is managed from watchful waiting through medicines to surgical procedures.^[1] Bacterial prostatitis needs medical assessment and antibiotics.^[4] For CP/CPPS, physicians look at several approaches, and a Cochrane review found that some non-drug options such as acupuncture and shockwave therapy probably reduce symptoms.^[6]

Prostate cancer is diagnosed mainly by PSA blood testing and biopsy, and PSA screening is controversial.^[3] The U.S. Preventive Services Task Force advises men aged 55 to 69 to make an individual decision with their clinician, and advises against routine screening at 70 and older.^[5] Cancer that is still limited to the prostate is called localized, and it is treated with the aim of removing or controlling it.^[3]

Why Prostate Health calls for a whole-person approach

Prostate symptoms are rarely caused by the gland alone. Age, weight, pelvic pain, sleep disturbed by nighttime urination and the strain of living with symptoms all affect how a man feels and functions.^{[1, 2]}

Supportive care can address some of these, but it works beside a urology evaluation that rules out infection, retention and cancer.

Age, hormones and weight

Age is the strongest factor in BPH, and obesity also influences its development.^[1] Weight, activity and diet are therefore reasonable parts of care.

Pelvic pain and quality of life

Chronic prostatitis can have an impact on quality of life comparable to other major long-term conditions such as heart disease or diabetes mellitus.^[2] In the Cochrane review, a physical activity program and lifestyle changes were each linked to some reduction in symptoms, though the evidence was of low or very low quality.^[6]

Urinary symptoms and sleep

Nighttime urination is a typical urinary symptom of an enlarged prostate.^[1] Poor sleep and the distress of urgency can add to the load, so symptom relief matters for daily life as well as for the bladder.

Acupuncture for Prostate Health

What the research shows

The best evidence is for chronic prostatitis and pelvic pain syndrome. In a sham-controlled trial at 10 hospitals in China, 440 men with moderate to severe CP/CPPS received 20 sessions of acupuncture or sham acupuncture over 8 weeks. At week 8, 60.6% of the acupuncture group had a clinically important improvement in symptoms versus 36.8% with sham, and the difference was still present 24 weeks after treatment. No serious adverse events were reported, and the authors noted that sham acupuncture may have some physiological effect.^[7]

Reviews agree. Cochrane found high-quality evidence from 3 short-term trials (204 men) that acupuncture reduced prostatitis symptoms compared with sham, though it may not improve sexual dysfunction.^[6] A meta-analysis of 10 high-quality trials with 798 patients found acupuncture better than sham and medicines for pain, symptom scores and quality of life, and called for larger, longer trials.^[8]

For BPH, the evidence is weaker. A meta-analysis of 8 trials with 661 men found short-term improvement in urinary symptom scores over sham acupuncture, of borderline clinical importance, and no significant effect at 12 to 18 weeks.^[9] After prostate cancer surgery, a single-center sham-controlled trial of 110 men found more men regained urinary continence at 6 weeks with electroacupuncture (43.6% versus 21.8%).^[10] For hot flashes from hormone therapy for prostate cancer, a review says acupuncture may have a role but that more research is needed.^[11]

How acupuncture may work

How acupuncture helps prostate symptoms has not been established, and the large trial did not test a mechanism.^[7] Traditional explanations are described below, and they remain interpretation.

What treatment involves

Treatment uses fine, sterile, single-use needles, with sessions of about 20 to 40 minutes. The prostatitis trial used 20 sessions over 8 weeks, and the prostatectomy trial used 30-minute electroacupuncture sessions three times a week for 6 weeks.^{[7, 10]} We reassess after a short course of visits.

In prospective studies, about 9 in 100 patients had a minor reaction such as brief bleeding, soreness or redness at a needle site, and serious events occurred in about 1 in 10,000 patients.^[12] Tell the practitioner first if you have a bleeding disorder, take blood thinners, or have a pacemaker or other implanted device, which matters for electroacupuncture.

Ayurvedic medicine for Prostate Health

The Ayurvedic view

Ayurveda describes a condition called Vatastheela, whose features of difficulty passing urine, dribbling and hesitancy resemble BPH, and it is classed among disorders of the urinary channels.^[13] In this traditional framework it is linked to disturbed Vata, the principle that governs movement and elimination. These are traditional categories, not biomedical diagnoses.

Therapies that may be used

Care is chosen for the individual and, in tradition, may include:

• Diet and daily routines meant to calm Vata, such as warm, regular meals and good hydration
• Herbs and herbal ghee preparations traditionally used for urinary disorders
• Gentle warm-oil massage of the lower back and abdomen

Panchakarma procedures are not appropriate during acute illness or frailty, which is common in older men. They should be considered only after medical review and with your physician's knowledge.

What the research shows

The research is very limited. We found one small comparative study from India in which men with BPH were divided into two groups, each given a different Ayurvedic compound for 45 days. One compound gave more relief of symptom scores, and the other did better on prostate size and residual urine volume. There was no placebo group.^[13] We found no placebo-controlled trials or systematic reviews of Ayurvedic medicine for prostate conditions.

Herbal medicine for Prostate Health

Herbs and formulas that have been studied

The most studied herb is saw palmetto (Serenoa repens), widely used for BPH symptoms.^[14] Chinese herbal medicine has been studied too, including formulas such as Jingui Shenqi pill and Guizhi Fuling capsule used alongside conventional drugs.^[15] Herbs are prescribed individually and not as a standard remedy.

What the research shows

The evidence is limited and mixed. A Cochrane review of 32 trials with 5,666 men found saw palmetto was not better than placebo for urinary symptoms in the two high-quality long-term trials, and did not improve urine flow or prostate size.^[14] A later meta-analysis limited to one specific hexane extract found fewer nighttime voids and better urine flow than placebo, but it pooled trials with observational studies.^[16]

Reviews of Chinese herbal medicine for BPH are cautious. One review found it beat Western medicines for quality of life and prostate volume, yet judged the evidence too weak to support efficacy because of poor trial methods.^[17] A network meta-analysis of 107 trials with 11,037 patients found most formulas combined with conventional drugs outperformed drugs alone, with some concerns about study quality.^[15]

For prostate cancer, a review of 17 trials of oral Chinese herbal medicine found limited evidence of benefit and judged the trials too poor to recommend any herb for treating it.^[18] We found no systematic review results of herbs for CP/CPPS.

Safety and herb-drug interactions

Herbs can interact with medicines. Case reports describe bleeding when warfarin was combined with herbs including saw palmetto, ginger, ginseng and dan shen.^[19] Tell us about alpha-blockers, finasteride-type drugs, blood thinners and any cancer treatment you take.

About one fifth of Ayurvedic products bought online contained detectable lead, mercury or arsenic.^[20] Herbs should come from tested sources. Tell us if you have liver or kidney disease or surgery planned.

Translating traditional medicine into modern biological language

This is interpretation, not equivalence. Chinese medicine often describes prostate and urinary problems as kidney deficiency, damp-heat or stagnation of qi and blood in the lower body. Researchers instead study the pelvic nerves and muscles, inflammation, hormone effects on prostate tissue and bladder outlet obstruction.^{[1, 2]}

Ayurveda's Vatastheela describes obstructed, dribbling urine and aggravated Vata.^[13] No study has shown that a dosha corresponds to a specific biological process.

How this care fits with your medical care

Integrative care for prostate conditions is complementary. For a condition like this, we ask that you are under a physician's care for it and that your treating team knows you are receiving complementary care. Do not stop or change prescribed medicines, PSA follow-up or cancer treatment without your prescriber.

We do not diagnose prostate disease. New or worsening urinary symptoms, blood in the urine or semen, or a raised PSA need medical evaluation. Please bring your diagnosis, PSA and imaging results, and a full list of medicines and supplements.

When to seek urgent medical care

Some prostate symptoms need prompt assessment.

• Being unable to pass urine, or a painfully full bladder
• Fever, chills, painful urination or sudden pain between the legs, which can signal acute prostatitis^[4]
• Blood in the urine or semen
• Bone pain, new back pain or unexplained weight loss in a man with prostate cancer or a high PSA^[3]
• New leg weakness or loss of bladder or bowel control

If any of these occur, call 911 or go to the nearest emergency department.