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Treatment of benign Prostatic Hypertrophy with Opuntia ficus-indica.

(L.) Miller By Dan Palevitch, Gideon Earon and Israel Levin

Abstract:
Clinical studies indicates that a dry flower preparation of the cactus Opuntia ficus-indica (L) Miller cv. Offer, commonly known as the Indian -fig prickly pear, improved subjectively the discomforts associated with benign prostatic hypertrophy. The mode of action of this preparation is not yet known.

KEYWORDS: Barbary fig cactus, cactus flower, herbal remedies, Indian-fig prickly pear cactus, urination.

The prostate, an organ of the mammalian male reproductive system which contributes secretions to semen, surrounds the neck of the bladder and the proximal portion of the urethra. Inn middle aged and older men, this organ, consisting of both muscular and glandular elements, frequently enlarges, causing a condition commonly known as benign prostatic hypertrophy where the enlargement pressing on the urethra obstructs urination.

Depending upon the degree of enlargement, the obstruction can be a simple annoyance or serious medical problem. Several herbal, folk medicine remedies and modern herbological preparation are said to ease the situation.

Of these remedies, the most widely used are fruit from saw palmetto (Serenoa repens), seeds from pumpkin (Cucurbita pepo), vegetables tissue from horsetail (Equisetum arvense) and roots and fruits from parsley (Petroselinum International). Urgenin (Madaus International), a commercial preparation of Echinacea angustifolia and Serenoa repens, is a highly praised, natural remedy used in the orthodox medicine to relive prostatic problems and other urinary ailments. Another plant that enjoys a reputation as a remedy for urinary problems is Opuntia ficus-indica (L) Miller.

In Sicily a decoction made from the flower of this plant is widely used as a strong diuretic. In North America the flowers of Opuntia are combined with barley seeds and corn-silk to treat urine obstruction. The cladodes of Opntia spp. are used in Mexico for treating diabetes, hyperlipidemia and obesity. Flowers of Opuntia spp. Are recommended for treatment of benign prostatic hypertrophy in The British Herbal Pharmacopeia. The genus Opuntia consists of 300 species of which the Indian – fig prickly – pear, Opuntia ficus-indica, has the greatest economic importance. The plant, native to Mexico, grows in semi-tropical and tropical regions and has become distributed throughout southern Europe, the Mediterranean region, Africa, South and Central America, India and southwestern United States. In Israel the cactus, grown for centuries as afield edge or windbreak, is cultivated for edible fruit.

The cultivated plants, Opuntia ficus-indica cv. Offer, become two to three meters tall with caldodes 30 to 40 cm long and 15 to 25 cm wide. The cultivar Offer, a spineless type, has yellow flowers at full bloom that change to bright orange at maturity. Flowering usually starts in mid May and lasts until mid-June but autumn flowering can also be achieved by fertilisation and irrigation. Flowers remain open 36 to 48 hours and are highly attractive to pollinators, especially bees. After pollination, the unattached flower dries , and if not picked, eventually becomes destroyed by the wind. The fruit harvesting season is in August and September.

The objective of our studies was to conduct a preliminary evaluation on the potential clinical application of Opuntia flowers in the treatment of benign prostatic hypertrophy.

Material and Methods:
Dried flowers of Opuntia ficus-indica were collected on May 24, 1988 from the Pri-Or Plantation at Nizzanim in Israel. The collected flowers were sun-dried, ground to powder and packed into hard, gelatin capsules (supplied by Assutech, Inc., Rehovot Israel) (250gr dried flower/ capsule) for use in treatment of patients. The effectiveness of dried flowers for treatment of benign hypertrophy was evaluated in two clinical trials:58 patients of a private clinic and 30 patients that visited the Urology Outpatients Clinic in Soroka Medical Center. Each patient, three times per day, took orally two of the gelatin capsules containing the ground Opuntia flowers.

Non-treated controls, patients receiving placebos in place of the Opuntia flowers, were not included due to the preliminary nature these studies. The evaluation trials lasted six to eight (private clinic) and two (outpatient clinic) months and patients were questioned at the end (private clinic) or beginning and end (outpatient clinic) to a set of subjective questions regarding symptoms of benign prostatic hypertrophy.

In addition, the medical history of each patient was collected and the subject underwent a physical examination. Urine was checked for blood and the diameter of the urinary tract was measured by ultrasound. Urodynamic and microbiological tests were also used with the outpatient clinic patients to evaluate urinary tract function.

Results:
In both trials, patients reported improvement in the symptoms of benign prostatic hypertrophy following treatment with dried flowers of Opuntia ficus-indica cv. Offer (Table 1). A large number of patients reported a decrease in the urgency to urinate, emergency urinations and a feeling of fullness in the bladder.

Not all patients received relief from symptoms following treatment, however, and the response to different symptoms was mixed. No deterioration in urinary function was detected for any of the patients in the clinical trials. Kidney performance and the urodynamic parameters did not change in the treated patients (data not shown).

Discussion:
A subjective alleviation of discomforts associated with prostatic hypertrophy was noted by patients using dried flowers of Opuntia ficus-indica, Indian -fig prickly pear cactus. These results are encouraging and suggest that the cactus may have clinical application in treatment of enlarged prostate glands. If adopted for treatment, use of the Opuntia ficus-indica flowers could benefit patients affected with benign prostatic hypertrophy and provide a new market for farm-produced plant material.

A double blind crossover, placebo-controlled trial of 100 patients lasting 8 to 12 month is now in progress.