Prioritizing health as patients age is a common discussion among those over 50. Many conversations revolve around maintaining a healthy diet, staying active, maintaining a social life and focusing on one’s overall quality of life. However, there is one small, but vital organ that is not discussed enough among men: the prostate. The Urology Care Foundation states that nearly 50% of men aged 50 and above and 90% of men aged 80 and above will develop an enlarged prostate, also referred to as benign prostatic hyperplasia (BPH). BPH can cause uncomfortable lower urinary tract symptoms (LUTS) and is one of the most common conditions urologists diagnose.
Even though many older men will develop an enlarged prostate, a recent survey found 3 out of 4 men don’t understand that the prostate is a male reproductive organ. A healthy prostate is similar in size to a walnut, but it can grow to an unhealthy size of a tennis ball. Signs of LUTS include the inability to fully empty the bladder, frequent urination during the day and night, the need to strain while urinating, and more. These symptoms can impact a patient’s and their partner’s overall quality of life as they might find that the discomfort of LUTS can lead to frequent bathroom visits, embarrassment, and disrupted sleep. Currently, there is no cure for BPH, but for those experiencing BPH-related LUTS, the objective is to manage their symptoms so there is less disruption to quality of life and to reduce the risk of more serious complications.
When a patient’s quality of life is impacted by LUTS, it is important to discuss it with his doctor. Depending on severity, patients can consider both pharmaceuticals and surgery as options to help address these symptoms, however, there can be concerns for both such as sexual health side effects or interference with other prescription medications. For mild to moderate BPH, a more holistic approach is an option, which can involve lifestyle changes like maintaining a healthy diet, staying active and exercising regularly, as well as taking a high-quality dietary supplement like saw palmetto extract.
Saw palmetto extract is a commonly used supplement to help with LUTS and to support prostate health. Recent clinical studies have shed light on the positive role high-quality saw palmetto extract may have for patients. In August 2021, a comprehensive three-part review was published of 58 studies from all around the world, including groundbreaking evidence from 27 foreign language studies translated into English for the first time, providing a first-time view on the benefits of saw palmetto extract (Part I, Part II, Part III). In his analysis of the review, Urologist J. Curtis Nickel, MD, said in a recent interview: “There is enough evidence, I believe, to use [saw palmetto extract] and recommend it to our patients who are looking [for] an alternative to…pharmaceutical products…for the treatment of lower urinary tract symptoms secondary to BPH. It’s extremely safe [and] does no harm as long as the patients are followed in a ‘watchful waiting, active surveillance’ type of way.”
But not all forms of saw palmetto are identical. There are major differences between the most common available forms of saw palmetto extract currently on the market, which are just ground up dried berry powder. The science indicates that a high-quality saw palmetto oil extract product provides the most benefit. In the U.S., supplements are not reviewed and approved by FDA prior to marketing. Many physicians view the supplement industry as the “wild west” due to the lack of standardization and variable efficacy in clinical trials. That is why it is so important to look for products that have been independently verified for quality. The United States Pharmacopeia, or USP, is a 200-year-old nonprofit scientific organization that sets standards for medicines and dietary supplements. USP offers an independent third party verification of dietary supplements to ensure the extract has been verified for purity, potency, and quality. The USP also requires that saw palmetto oil extract has a certain minimum and specific concentration levels of bioactive fatty acids, which have been shown in clinical trials to be effective. In Europe, high-quality saw palmetto extract has been shown to reduce urinary frequency and improve flow rate in clinical studies. In some countries, this supplement is also available by prescription and is part of an accepted physician-directed care regimen for the urinary symptoms associated with an enlarged prostate.
In my decades of experience as an ER doctor, I know that many men aren’t always comfortable talking about prostate health. But as men grow older, the probability of developing an enlarged prostate and/or prostate cancer increases substantially. As men age, it is important for them to have annual checkups and talk to their doctor about their urinary and prostate health. For those already experiencing symptoms — it’s not too late. There are plenty of options for addressing the urinary symptoms of an enlarged prostate.
They just have to be willing to ask.
