International Journal of Alternative and Complementary Medicine, September 1994 21

Treatment of Benign Prostatic Hypertrophy with Opuntia ficus-indica (L.) Miller

by Dan Palevitch, Gideon Earon and Israel Levin

ABSTRACT

Clinical Studies indicated 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 is not yet known.

ZUSAMMENFASSUNG

Klinische Studien mit einer Zubereitung aus den getrockneten Blüten des Kaktus Opuntia ficus indica (L.) Miller, allgemein bekannt unter dem Namen Feigenkaktus, haben eine Verbesserung verschiedener subjektiver Beschwerden der gutartigen Prostatahypertrophie gezeigt. Der Wirkmechanismus dieses Präparats ist noch nicht genau geklärt.

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

Schlüsselwörter: Feigenkaktus, Kaktusblüten, Heilpflanzen, Opuntia, Harnlassen (Miktionsstörungen).

INTRODUCTION

The prostate, an organ of the mammalian male reproduction system which contributes secretions to semen, surrounds the neck of the bladder and the proximal portion or the urethra. In 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 (8). 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 preparations are said to ease the situation. Of these remedies, the most widely used are fruit from saw palmetto (Serenoa repens), seeds from pumpkin (Curcubita pepo), vegetative tissue from horsetail (Equisetum arvense) and roots and fruit from parseley (Pet-roselinum crispum) (1,5,9). Urgenin (Madaus International), a commercial preparation of Echinacea angustifolia and Serenoa repens, is a highly praised, natural remedy used in ortho-dox medicine to relieve prostatic prob-lems and other urinary ailments (9).
Another plant that enjoys a reputation as a remedy for urination problems is Opuntia ficus-indica (L.) Miller. In Israel a decoction made from the flower of this plant is widely used as a strong diuretic (3). In North Africa the flowers of Opuntia ficus-indica are combined with barley seeds and cornsilk to treat urine obstruction (2). The Cladodes of Opuntia species are used in Mexico for treating diabetes, hyperlipidemia and obesity (4). Flowers of Opuntia species are recommended for treatment of benign prostatic hypertrophy in the British Herbal Pharmacopeia (1).

The genus Opuntia consists of 300 species of which the Indian-fig prickleypear, 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 the south western United States. In Israel the cactus, grown for centuries as a field edge or windbreak, is cultivated for the edible fruit. The cultivated plants, Opuntia ficus-indica cv. Offer become two to three metres tall with cladodes 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 (2), flowering usually starts in mid-May and lasts until mid-June but autumn flowering can also be achieved by fertilisation and irrigation (6). Flowers remain open for 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 seasons 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.

MATERIALS AND METHODS

Dried flowers of Opuntia ficus-indica were collected on May 24, 1988, from the Prior Plantation at Nizzanim in Israel. The collected flowers were sun-dried, ground to powder and packed into hard, gelatine capsules (supplied by Assutech, Inc., Rehovot, Israel) (250 mg dried flower/capsule) for use in treatment of patients.
The effectiveness of dried flowers for treatment of benign prostatic hypertrophy was evaluated in two clinical trials: 58 patients of a private clinic and 30 patients that visited the Urology outpatient Clinic of the Soroka Medical Centre. Each patient, three times per day, took orally two of the gelatine 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 of 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 control.
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 im-provement in the symptoms of benign prostatic hypertrophy following treat-ment with dries 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 dries 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 Opuntia ficus-indica flowers could benefit patients affected with benign prostatic hypertrophy and provide a new market for farmproduced plant material. A double-blind crossover, placebo controlled trial and 100 patients lasting eight to 12 months is now in progress.

References
(1) Anonymous, 1983. British Herbal Pharmacopeia. The British Medical Herbal association, West Yorks, Enland. 255p.
(2) Boulos, L. 1983. Medical Plants of Northern Africa. Reference Publications Inc., Algonac, Michigan, USA, p 40.
(3) Guiseppe, B., F. Carimi and P. Inglese, 1992. Past and present role of the Indian fig prickly-pear (Opuntia ficus-indica (L.) Miller, Cactaceae) in the agriculture of Sicily. Econ. Bot. 46: 10-20.
(4) Hedgewood, A.d. 1990. Human Health Discoveries with Opuntia spp. (Prickly-pear). Hort. Science 25: 1515-1516.
(5) Hoffmann, D. 1983. The Holistic Herbal. Findhorn Press, Moray, Scotland. p 271.
(6) Nerd, A., H. Karady and Y Mizrahl. 1991. Out-of-season pricklypear: Fruit characteristics and effect of fertilisation and short droughts on productivity. Hort. Science 26: 527-529.
(7) Slor, A. 1983. „Offer“, a commercial spineless cactus cultivar from local selec-tion. (In Hebrew). Hasadeh 63: 2368-2369, 2374.
(8) Walton, J., P.B. Bereseoln and R.B. Scott. 1986. The Oxford Companion to Medicine. Oxxford University Press, Ox-ford, England.
(9) Weiss, R.F. 1988 Herbal Medicine. AB Arcanum, Gothenberg, Sweden. 362p.

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