PROSTATE & HOMOEOPATHIC

MANAGEMENT
 Dr. Sasikumar.V.S. DHMS,
 S.K. HOMOEO CLINIC,
 Sasthamangalam,
 Thiruvananthapuram – 10
 PROSTATE GLAND
 It is a walnut sized gland forms a part of
Male Reproductive System. It consist of
two lobes enclosed by an outer layer of
tissue. A sheet of muscle & fibrous capsule
surrounds the gland. The Prostate seen in
front of the rectum & just below the
bladder where the urine is stored. It also
surrounds the urethra.
 The Prostate produces a thick white fluid
called semen which mixes the sperm
produced by the testes. It also produces a
protein called Prostate-Specific Antigen
[PSA] that turns semen into liquid. Its
normal function is to liquefy gelatinous
semen after ejaculation allows
spermatozoa to easily swim through the
uterine cervix.
 PROSTATE
 Is divided three internal zones: The peripheral zone, The transsition
zone & The central zone.
 Peripheral zone is seen in the rear part of the prostate near the
rectum. It contains major part of the prostate & in this region may
mostly occurs cancer. In younger men the peripheral zone makes
over ½ of the prostate.
 The transitional zone next to urethra is the zone that enlarges & is
known as benign hypertrophy.[ a non cancerous enlargement].
Mostly at the age of 40 it begins to increase in size & eventually
becomes the largest zone.
 The central zone is involved in the connection of seminal vesicles to
the prostate & contains the rest of organ gland.
 The anterior zone is fibro muscular with no glandular structures.
PROSTATE
 It is partly muscular & partly glandular. FUNCTIONS
 The primary function is to produce a white thin fluid that
nourishes the sperm, & makes the vaginal canal less
acidic. During orgasm muscular contractions cause the
semen to be ejaculated through the urethra & from
there out of penis.
 Prostate produce PSA [Prostate specific antigen] a
substance that is added into semen to liquefy the jelly
like fluid after ejaculation. A small amount of PSA leaks
in to space between the cells & ends up in the blood
stream. Easily prostate cancer can often detect by a
blood test measures the PSA levels. Prostate cancer cells
may leaks more PSA.
 It controls the urine flow. Muscle fibers in the prostate
contract to slow the flow of urine.
 PROSTATIS
 The term is for inflammatory codition of
prostate gland.
 This is the most common uroligical disease
seen in men over the age 50, & the 3rd
most common disese youger age.
 Pathophysiology
 In bacterial prostatis sexual transmission of bacteria is common but
haematogenous, lymphatic & contiguous spread of infection from
surrounding anatomy also be considered.
 Acute inflammatory cells presence in the glandular epithelium &
lumens of the prostate with chronic inflammatory cells in the
perigladular tissue characteristic prostatis. The presence & quantity
of inflammatory cells in the urine or prostatic secretions does not
correlate with the severity.
 Non bacterial is diagnosed based on negative cultures of urine &
prostatic sec retations. Neuromuscular dysfunction or congenital
reflux of urine into the ejaculatory & prostatic ducts may be
precipitating factor.
 Viral & granulomatus prostatis may be associated with HIV infection
cause of culture negative disease. A common viral pathogen is
cytomegalovirus [CMV]. Mycobacteria such as Mycobacterium
tuberculosis & fungi such as candida albicans also been seen.
 Mortality/Morbidity
 Susceptible patients include those with
Diabetes mellitus, or dialysis for chronic
renalfailure, immuno-comprimised & post
surgical patients with urethral
instrumentations can lead to urosepsis
significant mortality.
 Types
 There are Mainly four types. Acute bacterial,
Chronic bacterial, Non bacterial & Prostatodynia.
 Acute bacterial prostatitis [ABP] Inflamation of
the prostate gland by bacteria such as
Escherichia coli & Kiebsiella.
 Severe complications may occur if untreated.
ABP can even fatal if the bacterial infection
travels to the bloodstream [sepsis].
 Chronic bacterial prostatis [CBP]
 It is a recurrent infection & inflammation
of the prostate & urinary tact. Symptoms
are less severe & associated with acute
bacterial prostatitis’
 Non bacterial is an inflamed without
bacterial infection.
 Prostatodynia
 Chronic pelvic pain syndrome [CPPS] is
the occurrence of symptoms without
inflammation or bacteria.
 RISK FACTORS
 Bladder outlet obstruction [eg: BPH, stone,
tumor].
 Urethral catheterization.
 Diabetic mellitus.
 Sexually transmitted diseases increase the risk
for developing bacterial prostatitis. [ eg:
nongonnococccal uretritis, gonorrhea].
 Unprotected anal & vaginal intercourse can allow
the bacteria to enter the urethra & travel to the
prostate.
 Suppressed immune system.
 Causes
 Neisseria gonorrhea & Chlamydia
trachomatis should be consided in any
younger male than 35 yrs presenting with
UTI.
 ACUTE BACTERIAL PROSTATIS
 Accending infection through the urethra.
 Refluxing urine into prostate ducts.
 Direct extension or lymphatic spread from
the rectum.
 80% are aerobic gram-negative
organisms. {eg. Escherichia coli,
Enterobacter, Serratia, Psedomonas,
Entetococcus, & Proteus species}.
 NON BACTERIAL PROSTATIS
 Uncommon organisms such as
[Link], Coccidioides, Histoplasma
& Candida must also be considered.
Tuberculous prostatis may be found in
patients with renal tuberculosis.
 C. trachmatis & Ureaplasma species have
been implicated.
 Chronic prostatis
Chronic non bacterial prostatis/
Chronic pelvic pain
syndrome[prostadynia].
 Precipitating factors are heavy lifting when the bladder is
full may cause urine to go back upwards.
 Certain occupations such as driving, or heavy machinery
may cause certain vibrations on prostate.
 Physical activity such as jokking or cycling may irritate
your prostate.
 Pelvic muscle spasm:
 Structural abnormalities of the urinary tract.
 HIV & CMV.
 SIGNS & SYMPTOMS
 Acute bacterial prostatis [ABP]. Symptoms
appear suddenly.
 Frequent urination, Incomplete emptying,
Pain in penis, testicles, & perinium, Painful
ejaculation, Dysuria, Urgency, Tender
swalloen prostate, Chills & fever,
Arthralgia, Lower back pain, Myalgia,
Erectile dysfunction.
 Chronic bacterial prostatis.
 Patients may be asymptomatic. A frequent
& urgent need to urinate, Pain & dysuria,
Pain in the prostate, Nocturia, Pain in the
lower back & genital area, Difficulty
starting to urinate,Haematospermia,
Haematuria, Painful ejaculation, Fever,
Pain in lower abdomen, Recurring bladder
infections.
 Chronic Non Bacterial Prostatitis
 In general signs & symptoms of
nonbacterial Prostatitis are similar
although fever not be present. The test
don ‘t detect any bacteria in urine or
prostate fluid. Wbc & pus cell may be
present or absent in urine or semen.
 Other Conditions
 Prostatitis can be difficult to diagnose because
signs & symptoms resemble. Ex:- infection of
bladder or urethra can cause a urge to urinate,
burning sensation & blood are similar to
thesymptoms of prostatitis.
 Complications. Abscess, Acute urinary retention,
Chronic bacterial prostatitis Sepsis.
 Differential diagnosis. Cystitis, Urethritis,
Pylonephritis, Malignancy, Obstructive calculus,
Acute urinary retention.
 BENIGN PROSTATIC HYPERPLASIA
 BPH is common & enlarged during men ages. It
causes rarely before 40, but more half of men in
the 60’s, & 90% in 70’s & 80’s. As the prostate
enlarges the layer of tissue surrounding it stops
it from expanding causing the gland to press
against the urethra. The bladder wall thickens &
irritable & can cause frequent urination & some
urine will remains in the bladder [causing the
bladder weakens & loses the ability]. The
narrowing of urethra & partial emptying of the
bladder can cause the BHP.
 Why BHP occurs
 The actual cause is not well understood. It
mainly occurs in older men, & it doesnot
develop in men whose testis were
removed before puberty.
 Symptoms
 Frequent urination, Urinary urgency,
Urinary hesitancy & weak urination,
Difficulty to start urination, Unsteady
urinary stem, Urinary dribbling, Not done
feeling, Night urination, Urinary blockage,
& Some sufferers become reluctant to go
out of the home.
 Investigations
 Digital rectal examination[DRI]. This gives
the size & condition of gland.
 Rectal ultrasound & prostate biopsy.
 Urine flow study.
 Cystoscopy.
 Prostate specific antigen [PSA] blood test.
 Complications
 Early detection of BHP lowers the risk & if
not, Serious problems.
 Urine retention & strain on the bladder
can cause UTI.
 Bladder or kidney damage.
 Bladder stones.
 Urinary incontinence.
 Management
 Medicinal treatment.
 Non surgical treatment.
 Surgical treatment.
 Homoeopathy. May help to decrease the size of
enlarged prostate.
 Dietary advice. Diet low in saturated fat &
contains a proper amount of Zinc, & Selenium.
[Sources of zinc: Shellfish, herring, wheat germ, Lean
beef/lamb, eggs, lentills, brazil nuts, almonds, chicken, consuming
less coffee, alcohol & chocolates also helps].
 PROSTATE CANCER
 It is more common in US & less in Asia.
This type cancer is responsible for male
deaths than any other except lung cancer.
 Risk factors. Age, Family history, Ethnicity,
Diet, [Higher serum levels of the short chain omega 3 fatty acids
& linolenic acid, Blood levels of trans fatty acids, Low intake of Vit-
E].Obesity, Diseases. [Inflammation or infection,
Sexually transmitted infections, Elevated blood level of
testosterone].
 Clinical features
a. Advance cases may be give pressure on
urethra. Even advance cases may be
asymptomatic. Symptoms of advace cases
include: a. Bladder outflow obstruction, b.
Painful or burning urination, c. Inability or
difficulty to start urine, d. Frequent urination,
e. Can’t empty the bladder completely, f. Plevic
pain & haematuria, g. Bone pain, malaise, joint
pains, h. Anaemia, i. Renal failure, j. Lower
back pain, pelvis or thighs
 Grading
 Refers by appearance of cancer cells when
the biopsy is looked under microscope.
The grades give an idea of how quick will
cancer grows. There are several grading
systems but Gleason scale is common.
 Grade 1. The cancerous prostate closely resembles normal
prostate tissue. The glands are small well formed & closely packed.
 Grade II. The tissue still has well formed glands but they are
larger & have more tissue between them.
 Grade [Link] tissue still has recognizable glands but the
cells are darker. At high magnification some of these have left the
prostate gland & are beginning to invade the surrounding tissues.
 Grade IV. The tissue has few recognizable glands. Many
cells are invading the surrounding tissue.
 Grade V. The tissue does not have recognizable glands.
They are often just sheets of cells throughout the surrounding
tissue.
 Staging
Means its size & whether it has spread
beyond its original area of the body. There
are different staging systems for prostate
cancer.
T1a & T1b are incidentally found tumors in examination of a
prostatectomy specimen. T1a is a well differentiated tumour in
volving less than 5% of the resected specimen. T1b is poorly
differentiated tumour involving over 5% of resected specimen.
T2a disease presents as a suspicious nodule on rectal examination of
less than 2cm. [Do not felt large enough tumour during DRE or
Ultrasound].
T2b disease is a nodule involving greater than 2cm.
T2c is tumour in both lobes but still clinically confined.
T3 is a tumour involving the seminal vesicles or bladder neck.
T4 is a tumour involving the rectum or the pelvic sidewall.
 Diagnostic Tests
 Digital rectal examination [DRE]
 This is not a confirmed test but helps
to examine the size & surface of the
prostate, roughness & irregular
unevenness to the tissue may be
suspected carcinoma. The men over
the age of 50 should ho for DRE
along with a PSA test yearly.
 General blood test. This are normal in early but in metastatic
disease there may be leukoerythroblastic anemia secondary renal failure.
 Liver function test. [LFT] This will be abnormal if there is
extensive metastatic invasion of the liver. The alkaline phosphates may be
raised from hepatic involvement or secondary's in the bone. This can be
distinguish by measurement of isoenzymes or gamma-glut amyl
transferase.

 Prostate Specific Antigen Test [PSA].

Measuring the blood level of prostate. Specifically PSA is a serine protease.
The amount of this protein in the blood will increase in men who have
prostate cancer. This is reported in nanograms per milliliter [ng/ml].
 Interpretation of PSA:
 count of 0 to 4 ng/ml is normal, 4 to 10 ng/ml is slight elevated, 10 to
20ng/ml is moderately elevated, Anything above 20ng/ml highly elevated.
PSA test is not a full proof & does not automatically means a man has
prostate cancer. Condition other than cancer including an infection or a
benign enlargement of the prostate can result in higher.
 For this reason PSA test should be
combined with a DRE for better results.
 Radiological examination. chest may reveal
metastasis either in lung fields or the ribs. An abnormal may show
the characteristic sclerotic metastasis that occur in the lumbar
vertebrae & pelvic bones. The bone occur dense & coarse some
times it is difficult to distinguish from the Paget’s disease of bones.
 [Link] ultrasonography remains
the most accurate method of staging [T1 &T2]. It can be used in
the early detection of tumuors in screening programmes.
 Bone scan: Once the diagnosis has been established bone scan is
performed as part of staging procedure.
 Prognosis
 The most important clinical prognostic indicators
of disease outcome are stage, pre-therapy PSA
level & Gleason score.
 T1& T2. progression rate of well differentiated
 T1a cancer is very low being about 10 to 14% after 8 years.
 Differentiated tumuors the rate is about 20%, but for the T1b tumuors the
rate is in excess of 35%.
 For T2 disease progression rate is 20 – 30%.
 T3 & T4 about 50% progress to bony metastasis after 3 – 5 years.
 Region wise rates are higher & prognosis poorer in the western socities
than the rest.
 MANAGEMENT
 Prostate cancer risk can be decreased by modifying known risk
factors:
 Decreasing intake of animal fat.
 Several medications & Two dietary supplements such as Vit-E & Selenium may help to prevent.
 Oestrogens from soybeans & other plants
 Medicines. Which block the conversion of testosterone to
dihydrotesterone.
 Surgical treatment: Radically prostatectomy is advised to men. Side
effects. Impotence or erectile dysfunction. Stress incontinence which may require
artificial urinary sphincter.
 Cryotherapy. Freezing cancer with liquid nitrogen.
 Radiation therapy: is a primary option for both localized & locally
advanced prostate cancer. For larger or more aggressive tumuors radiation
therapy may be used in combination with hormonal therapy. Ex: External
beam therapy & Brachy therapy [ Implanting radioactive seeds].
 Side effect of radiation therapy:
 Irritation of the bladder, urethra & or rectum.
 Frequent urination, burning urination.
 Rectum soreness accompanied by slight bleeding.
 More frequent bowel movements.
 Chemotherapy: Generally is not a standard treatment.
 Hormone therapy: The prostate cancers are hormone-
sensitive. There are 3 types
 Antrogen abation blocks the ability of cancer cells to
interact with testosterone at the cellular level.
 LHRH agnoists work by overstimulating the pituitary
gland to release lutenising hormone-releasing hormone.
 Orchiectomy: [surgical removal of the testicles]. Is an
efficient, cost effective & convenient method of reducing
testosterone
 Homoeopathic Medicines
 Some mother tinctures are toxic effect if given
in macro doses & could have side effects for a
prolonged period.
 The selection of an individualized indicated
remedy according to the totality of symptoms.
 There are many mother tinctures & dilutions to
relive the symptom of cancer prostate.
 Almost all patients experience various degrees
of fear & anxiety. Homoeopathy plays a major
role on mental sphere.
 CHIMAPHILA
UMBELLATA
 Botanical name: Chimaphila umbellata [Linn] Borton.
 Family: Ericaceae.
 Common name: Pipsissewa.
 Habitat: Temperate Asia, North america, Canada, Mexico,
Japan, Siberia & Europe.
 Parts used: Whole plant.
 Alcohol %: 66 – 70%v/v.
 Constituents: Chimaphillin, arbutin, ericalin, ursone, tannin,
sugar, gum, resin.
 Clinical: Prostatitis, enlargement.
 Indications
 Sensation of a ball in perinium, as if sitting down a ball
were pressing on it.
 Inability to urinatewithout stamding with feet wide apart
& body inclained forward.
 Acute prostatitis from sitting on a cold damp stone.
 Excessive itching & painful irritation of urethera from the
end of pennis to neck of bladder, which dysuria may
increase to complete retention from swelling of prostate.
 Great quantities of thick, ropy, bloody mucus in urine.
 Prostate disease with waste of prostatic fluid.
 Enlargement & irritation of prostate.
 Prostatorrhea [loss of prostatic fluid].
 Constant desire to urinate,.
 FABIANA IMBRICATTA
 Botanical Name: Fabiana Imbricata [Rutz & Paron]
 Family: Solanaceae.
 Common name: Pichi-Pichi.
 Habitat: Chile, Peru, Bolivia & Argentine republic.
 Parts used: Dried leaf & twig.
 Alcohol %: 62-66%v/v.
 Constituents: Volataile oil, resin, bitter fluorescent
glucoside, an alkaloid fabianine & tannin.
 Action: Tonic, cholagogue.
 Clinical: Dysuria, Prostatitis, Prostatic enlargement.
HYDRANGEA ARBORESCENS
OXYDENDRON ARBOREUM
PAREIRA BRAVA
POPULUS TREMULOIDES
SABAL SERRULATA
SENECIO AUREUS
SOLIDAGO VIRGAUREA