Frequently the subspecialist perspective regarding Complementary and Integrative Medicine (CAM) is an assumed lack of efficacy, potential side effects, and a lack of objective studies which validate the therapy in question. These cited concerns are reasonable questions. However, to be balanced, we must also consider that the conventional standard of care has similar limitations. The therapeutic norms are often not as scientific as we would like to assume. Empirically, the diagnosis of conditions such as benign prostatic hypertrophy(BPH) and prostatitis are often based on collective symptoms rather than documentable scientific studies. In addition, pharmaceutical applications are frequently applied off label. That is, in a manner that is not approved by the FDA. Therefore, it is not possible to objectively quantify efficacy in the context of the theoretic gold standard of a double blind, placebo controlled, crossover trial. In contrast, applications of integrative models can be more appealing in some situations. Most natural therapies, integrative treatments, or phyto-pharmaceuticals are unapproved in the United States. However, they are the standard of care in many European countries such as Germany. Studies have shown that, in Germany, more than 50% of urologists prefer the natural or CAM therapies in their practices. This preference is based on reduced side effects, an improved clinical response, and reduced cost. In support of this preference there are numerous studies which document the combined synergistic efficacy of many ‘natural medicine’ options. It should be noted that not all therapies falling under the umbrella of CAM are necessarily well studied. There are, however, many evidence based CAM therapies that show clear benefit to patients in the field of Urology. For example, phytotherapy for BPH has demonstrated significant benefit. Extracts of the African dwarf palm, Serenoa Repens, have been subject to several peer-reviewed scientific research studies. Also, beta sitosterol, rye pollen extract(Cernilton), stinging nettle (Urtica Dioca) have shown benefit. Saw palmetto, known in the herbal lore as “the old man’s friend”, has been a popular treatment since the 19th century. It was named after the Harvard botanist, Sereno Watson. Standardized extracts have been shown to be very helpful in BPH, and may be inhibitory to prostate cancer cell growth. Studies comparing saw palmetto to standard therapies such as Finasteride have shown approximately equal efficacy. A significant advantage is that Serenoa Repens is less costly and has negligible side effects. Another helpful therapy is beta sitosterol. This is a plant sterol which is structurally related to cholesterol. It is shown to be significantly helpful as well in BPH voiding symptoms as well as cholesterol reduction. Also, rye pollen extract(Cernilton) has been shown to help with urethral pressure. Green tea extract has also demonstrated inhibition of prostate cancer cell growth. Vitamin D3 is another nutrient that is shown to be very helpful. Some studies have shown that greater than 50% of Americans are deficient in vitamin D, with 22% being severely deficient. In laboratory studies, vitamin D increases cellular differentiation and decreases proliferation of prostate cancer cells, helps control inflammation, and enhances the immune system.
