"P" is for prostate.

You find yourself waking throughout the night to go to the bathroom. It's disturbing your sleep. When you were a younger man, emptying your bladder was so effortless that you never gave it much thought. Now, it's a nuisance.

You're not alone.

"Most men eventually suffer from enlarged prostates," says Logan Holtgrewe, former president of the American Urological Association.

The condition is called BPH--benign prostatic hyperplasia (or hypertrophy). And while it's not life-threatening, it can be mighty unpleasant. If the swollen prostate gland presses against the urethra, the tube that carries urine from the bladder out the body, the simple act of urination can become hit-or-miss or painful.

Surgery can open up the flow--but not without the risk of incontinence or impotence. Prescription drugs provide some relief for some men--but not without the risk of diminished sex drive (Proscar) or dizziness (Hytrin). And there's no consistent evidence that diet matters.

Which is why it's not unusual for a BPH-sufferer to end up down at his local health food store, staring at the shelf of "men's" products. Is anything worth more than just a stare? Maybe.

"PROFIT FORMULAS"

"Prostex." "For Men Only." "ProsPower." Don't laugh. Despite their hokey names, these and other "men's formulas" look pretty good to someone who's just spent a sleepless night wearing out the carpet between the bedroom and bathroom.

Unfortunately, the names are often as close as a swollen prostate ever gets to relief. There's no good evidence that most of these herbs, vitamins, minerals, amino acids, or animal glands can ease the discomfort.

And there's nothing the Food and Drug Administration can do about it.

"Supplement manufacturers don't have to prove to us that their products provide any benefits," says an FDA spokesperson, "unless they make an explicit claim on the label that their product cures a disease." And they're far too smart to do that.

They don't even have to prove that their supplements are safe. "Herbs are not systematically evaluated for side effects the way the FDA requires prescription drugs to be investigated before their approval," says Varro Tyler, an herb authority at Purdue University.

And even if the herb is safe, he adds, "contamination with harmful ingredients, though rare, or adulteration with extraneous ingredients, which is more common, is always possible."

HUNTING FOR PROSTATE EVIDENCE

Since the FDA doesn't evaluate prostate products, we set out to. Calling the manufacturers was an exercise in frustration.

Advance Laboratories of Watertown, Massachusetts, twice promised to send us material about Prostex, its mixture of three amino acids. Zilch. Eventually, the company admitted that it stopped sending out information after the FDA warned it to refrain from making unproven health claims.

Next we tried Earth's Bounty of Santee, California. Its Proste-Forte is "Guaranteed to work within 30 days or your-money back!" So we asked to see the scientific studies that backed up the guarantee. "No, no. That's Western medicine's approach," said president Steven Kravitz.

Doctor's Best of San Clemente, California, seemed like a can't-miss. Its ads boast that the company "researched the top male support herbs known to man." What research? Company president Ken Halvorsrude would only talk to us for as long as it took him to call us "the enemy" and hang up.

We quickly realized that prostate supplement makers aren't the best people to ask about prostate supplements.

THE ENVELOPE, PLEASE

We decided to see for ourselves what--if anything--the research. shows.

We considered only double-blind, placebo-controlled studies that were published in enough detail to allow us to interpret their results. That meant that neither the researchers nor the men knew who was getting the real thing and who was getting the inactive lookalike (placebo).

"That's the only way to really determine whether a prostate medication works," says urologist Logan Holtgrewe. Why? Because it's not unusual for half the men with enlarged prostates to report relief from a placebo...at least at first.

When we discarded all the poor research, the scores of studies we started out with shrank to fewer than 20. And only one remedy--saw palmetto--seemed to work significantly better than a placebo.

Saw palmetto is the ripe berry of a low, scrubby palm tree that grows wild in the. southeastern United States. During the first half of this century, it was widely used for urinary and genital ailments, according to herb expert Varro Tyler.

Three good studies in France and Italy looked at a total of 280 men who were waking up to go to the bathroom an average of about four times a night. The 140 of them who took 320 mg of saw palmetto a day for one to three months averaged one less nightly trip to the bathroom than the 140 men who were given a placebo.(1)

The saw-palmetto-takers also said that urinating wasn't as painful or difficult as before, and they were able to empty more of their bladders.

A fourth good study, of 33 men, found no benefit from saw palmetto.(2) Conflicting results aren't unusual with small studies.

How does saw palmetto compare with Proscar, a prescription drug that causes a slight improvement in BPH symptoms in about a third of the men who take it?

In a comparison in 1,000 European men, "the two produced similar results," says University of Chicago urologist Glenn Gerber. But the results haven't been published yet, so it's too early to draw any conclusions.

CHECKING THE SAW

Don't stock up on saw palmetto supplements before checking with your doctor.

"Before you self-medicate for an enlarged prostate, have yourself checked out by a physician to make sure that the problem isn't something else like a kidney infection or prostate cancer," advises urologist Ken Goldberg of the Male Health Center in Dallas. Otherwise, you might be wasting precious time on something that won't help, while another disease causes irreparable damage.

Also, "if you're getting a PSA (prostate-specific antigen) test, make sure your physician knows you're taking saw palmetto, because it could affect the results," warns Goldberg.

A few other things to keep in mind:

* The evidence isn't ironclad. "The studies lasted only a few months at most, not enough time to judge whether saw palmetto really works," says urologist Jean L. Fourcroy, who helps evaluate prostate drugs at the FDA. "And they didn't use questionnaires that have been proven to identify real improvements in symptoms.

* Saw palmetto hasn't been tested for safety. "As far as we know, it appears to be safe, other than causing diarrhea in heavy users," says Ryan Huxtable of the University of Arizona, a leading authority on the toxicity of herbs. But even if saw palmetto isn't toxic, companies don't have to follow rigid manufacturing guidelines, so you always run the risk that the bottle you buy is contaminated.

* Look for "standardized" brands. "Plants can vary tremendously in their potencies," says former USDA herb expert James Duke. You're more likely to get the same amount of saw palmetto dose after dose if you buy a brand that's "standardized." Check the label. If you take 320 mg of saw palmetto that is "standardized to 85%-95% fatty acids," you'll be getting the amount that was used in the good studies.

RELATED ARTICLE: Prospecting for Relief

Saw palmetto aside, what's in popular prostate supplements?

* Pygeum africanum (also known as Prunus africana). In the two good studies that provided numbers, the "improvement" from taking 100 to 200 mg a day for six weeks to two months amounted to an average of one less visit to the bathroom every three nights.(1) Not very impressive.

* Pumpkin Seeds. In the only good study, it worked no better than a placebo.(2)

* Zinc. No studies have been done.

* Glycine, Glutamic Acid, and Alanine. The only two studies on these three amino acids were flawed.(3)

* Nettles. In the only good study, it worked no better than a placebo.(4)

* Animal Prostate Glands. Injections--not pills--are infrequently used in Eastern Europe to treat BPH. In the best study, they worked no better than a placebo.(5)

(1) Wiener Klinische Wochenschrift 102: 667, 1990. (2) Arztezeitschrift fur Naturheilverfahren 26: 178, 1985. (3) Journal of the American Geriatric Society 10: 426, 1962. (4) Urologe [A] 24: 49, 1985. (5) International Urology and Nephrology 22: 345, 1990.

RELATED ARTICLE: THE BOTTOM LINE

* Saw palmetto is the only over-the-counter ingredient that appears to relieve--but not eliminate--the symptoms of an enlarged prostate...at least in some men.

* Before treating yourself with saw palmetto, see a doctor to make sure that you don't have a more-serious problem like a kidney infection or prostate cancer.

(1) Urologia 55: 547, 1988. (2) British Journal of Urology 58: 36, 1986.