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This week's topic: Prostate Health
In this newsletter, I am reviewing what the evidence shows on the non-pharmaceutical treatment of 2 conditions that affect the prostate: BPH (benign prostate hypertrophy) and CP (chronic prostatitis).
Quick quiz:
- Which 3 phytonutrients are endorsed by the AUA for the treatment of CP or CPPS (chronic pelvic pain syndrome)?
- What dose is used for saw palmetto, specifically when treating prostate issues?
- Which mineral is stored in the highest concentrations in the prostate gland?
Overview of today's email:
- Overview
- Clinical tips
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1. Overview
Benign Prostatic Hyperplasia (BPH) is the enlargement of the prostate gland. It is highly prevalent with age, affecting roughly half of men by their 60s and up to 90% by their 80s. However, men can start to experience symptoms when they reach their 40s.
Symptoms: Presents as lower urinary tract symptoms (LUTS), and can be divided into obstructive (e.g. weak stream) or irritative (e.g. nocturia)
Standard of Care Treatments: Includes lifestyle modifications (if symptoms are mild), or pharmaceuticals (first line therapies are alpha-1-adrenergic blockers such as tamsulosin which relax the smooth muscles, followed by 5-alpha reductase inhibitors such as finasteride can reduce prostate size over time).
Chronic Prostatitis / Chronic Pelvic Pain Syndrome (CP/CPPS) encompasses a group of conditions causing pelvic pain and urinary symptoms lasting ≥3 months, and can include chronic bacterial prostatitis or the more common CP/CPPS (inflammatory or non-inflammatory).
Symptoms: Pelvic or genital pain; voiding dysfunction; sexual dysfunction (ejaculatory pain, ED); often no identifiable infection on standard cultures.
Standard of Care Treatments: Include antibiotics, alpha-blockers or NSAIDs (for symptom relief), pelvic floor PT. Use the acronym "UPOINT" to guide therapy (often need more than one treatment).
- U - Urinary symptoms
- P - Psychosocial symptoms
- O - Organ-specific symptoms (such as the prostate)
- I - Infection-related symptoms
- N – Neurologic/systemic symptoms
- T - Tenderness in the muscles and pelvic floor symptom
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2. Clinical Tips
Evaluate for zinc deficiency, since zinc is stored in the highest concentrations in males in the prostate.
For CP and CPPS, phytotherapy is acknowledged and endorsed by the 2025 AUA (American Urological Association), specifically for the use of 3 phytonutrients:
- Saw Palmetto (effective for 3 months as monotherapy, but studies are inconsistent with regards to its efficacy due to no standards for quality of the extract used)
- Rye Grass Pollen
- Quercetin
These may be used to improve pain, voiding symptoms, and quality of life.
For BPH, the strongest evidence supports the use of beta-sitosterols.
My (paid) Substack provides dosing and more details (as well as reference articles) on phytonutrients that can be used in BPH and CP!
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I hope this was clinically useful!
To see more of my deep dive into the literature, as well as dosing and additional studies on this topic, subscribe to my paid Substack ($8 a month) to see the extended version of this email!
Meg
P.S. These emails take a lot of time to create (and I don't receive a lot of feedback on whether they are useful to those that receive them), so I've moved to Substack for an extended version of these at a low monthly cost (available within 24 hours of releasing this email). Why Substack? It has the benefits of being able to comment and ask questions about the posts, you're not bombarded with ads, I'm using the platform as a "micro-mentorship", and it's low cost!
Additional resources that may be helpful:
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If today's pearl was useful, you'd fit right in at the Functional Medicine Collective! It's a members-only space built specifically for medically-trained clinicians who want peer-level content, not the sensationalist version.
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