Phytotherapy for Benign Prostatic Hyperplasia

  • Aryeh Keehn
  • Jacob Taylor
  • Franklin C. LoweEmail author
Benign Prostatic Hyperlasia (K McVary, Section Editor)
Part of the following topical collections:
  1. Topical Collection on Benign Prostatic Hyperplasia



The use of complementary and alternative medications for symptomatic benign prostatic hyperplasia is a lucrative business in the USA with revenues reaching close to US$6.4 billion in sales for the 2014 fiscal year. Yet, despite its popularity, the evidence supporting the continued use of phytotherapy for symptomatic benign prostatic hyperplasia (BPH) is questionable and a topic worth investigation given its wide spread use.


A comprehensive literature search utilizing Medline and PubMed was conducted to identify literature pertaining to phytotherapy for the management of BPH. Agents with at least modest clinical data were selected for in-depth review including Seronoa repens, Pygeum africanum, Secale cereale, and Hypoxis rooperi.


Early clinical trials for each of the agents demonstrated mixed efficacy results with many studies pointing to a possible benefit for phytotherapy. On further examination of these studies, significant confounders such as poor product standardization, study design, and follow-up duration were identified. More recent, larger and more soundly constructed studies found no significant benefit for the use of phytotherapy in the treatment of BPH.


Twenty years ago, the urologic community was encouraged by trial results that suggested phytotherapy could effectively treat symptomatic benign prostatic hyperplasia. Since that time, several well-constructed studies have consistently demonstrated that these agents are no more efficacious than placebo, despite being largely safe for ingestion.


BPH Phytotherapy Seronoa repens Pygeum africanum Secale cereale Hypoxis rooperi 


Compliance with Ethical Standards

Conflict of Interest

Aryeh Keehn and Jacob Taylor each declare no potential conflicts of interest.

Franklin C Lowe is a consultant for Boerhinger Ingelheim.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.


Papers of particular interest, published recently, have been highlighted as: • Of importance

  1. 1.
    Mcvary KT. BPH: epidemiology and comorbidities. Am J Manag Care. 2006;12(5 Suppl):S122–8.PubMedGoogle Scholar
  2. 2.
    Fourcade RO, Théret N, Taïeb C. Profile and management of patients treated for the first time for lower urinary tract symptoms/benign prostatic hyperplasia in four European countries. BJU Int. 2008;101(9):1111–8.CrossRefPubMedGoogle Scholar
  3. 3.
    Smith T, L. M., Johnson J, Kawa K, Bauman H, and Blumenthal M. Herbal dietary supplement sales in US increase 6.8% in 2014. HerbalGram. 2015;107:7.Google Scholar
  4. 4.•
    Keehn A, Lowe FC. Complementary and alternative medications for benign prostatic hyperplasia. Can J Urol. 2015;22 Suppl 1:18–23. Recent review of the topic with chart showcasing almost 30 phytotheraputic agents and their origin.PubMedGoogle Scholar
  5. 5.
    Lowe FC, Ku JC. Phytotherapy in treatment of benign prostatic hyperplasia: a critical review. Urology. 1996;48(1):12–20.CrossRefPubMedGoogle Scholar
  6. 6.
    Barnes PM, Bloom B, Nahin RL. Complementary and alternative medicine use among adults and children: United States, 2007; CDC National Health Statistics Report: Hyattsville, MD, USA, December 2008; pp. 1–23. 2.Google Scholar
  7. 7.
    Lindstrom A, Ooyen C, Lynch ME, Blumenthal M. Herb supplement sales increase 5.5% in 2012: herbal supplement sales rise for 9th consecutive year; turmeric sales jump 40% in natural channel. J Am Bot Counc. 2013;99:5.Google Scholar
  8. 8.
    Buck AC. Is there a scientific basis for the therapeutic effects of Serenoa repens in benign prostatic hyperplasia? Mechanisms of action. J Urol. 2004;172(5 Pt 1):1792–9.CrossRefPubMedGoogle Scholar
  9. 9.
    Cheetham PJ. Role of complimentary therapy for male LUTS. Curr Urol Rep. 2013;14(6):606–13.CrossRefPubMedGoogle Scholar
  10. 10.
    Iehle C et al. Human prostatic steroid 5 alpha-reductase isoforms—a comparative study of selective inhibitors. J Steroid Biochem Mol Biol. 1995;54(5–6):273–9.CrossRefPubMedGoogle Scholar
  11. 11.
    Comhaire F, Mahmoud A. Preventing diseases of the prostate in the elderly using hormones and nutriceuticals. Aging Male. 2004;7(2):155–69.CrossRefPubMedGoogle Scholar
  12. 12.•
    Sirab N, Robert G, Fasolo V, et al. Lipidosterolic extract of Serenoa repens modulates the expression of inflammation related-genes in benign prostatic hyperplasia epithelial and stromal cells. Int J Mol Sci. 2013;14(7):14301–20. Excellent investigation demostrating that different SPB products contained differing FFA contents and thus no two brands of SPB are the same. A major problem for evaluating efficacy.CrossRefPubMedPubMedCentralGoogle Scholar
  13. 13.
    Yang Y, Ikezoe T, Zheng Z, Taguchi H, Koeffler HP, Zhu WG. Saw palmetto induces growth arrest and apoptosis of androgen-dependent prostate cancer LNCaP cells via inactivation of STAT 3 and androgen receptor signaling. Int J Oncol. 2007;31(3):593–600.PubMedGoogle Scholar
  14. 14.
    Vacherot F, Azzouz M, Gil-diez-de-medina S, et al. Induction of apoptosis and inhibition of cell proliferation by the lipido-sterolic extract of Serenoa repens (LSESr, Permixon in benign prostatic hyperplasia. Prostate. 2000;45(3):259–66.CrossRefPubMedGoogle Scholar
  15. 15.
    Cao N, Haynes JM, Ventura S. Saw palmetto is an indirectly acting sympathomimetic in the rat-isolated prostate gland. Prostate. 2006;66(2):115–23.CrossRefPubMedGoogle Scholar
  16. 16.
    Hill B, Kyprianou N. Effect of permixon on human prostate cell growth: lack of apoptotic action. Prostate. 2004;61(1):73–80.CrossRefPubMedGoogle Scholar
  17. 17.
    Habib FK, Wyllie MG. Not all brands are created equal: a comparison of selected components of different brands of Serenoa repens extract. Prostate Cancer Prostatic Dis. 2004;7:195–200.CrossRefPubMedGoogle Scholar
  18. 18.
    Breu W, Hagenlocher M, Redl K, Tittel G, Stadler F, Wagner H. Anti-inflammatory activity of sabal fruit extracts prepared with supercritical carbon dioxide. In vitro antagonists of cyclooxygenase and 5-lipoxygenase metabolism. Arzneimittelforschung. 1992;42(4):547–51.PubMedGoogle Scholar
  19. 19.
    De monte C, Carradori S, Granese A, GB D p, Leonardo C, De nunzio C. Modern extraction techniques and their impact on the pharmacological profile of Serenoa repens extracts for the treatment of lower urinary tract symptoms. BMC Urol. 2014;14:63.CrossRefPubMedPubMedCentralGoogle Scholar
  20. 20.
    Latil A, Libon C, Templier M, Junquero D, Lantoine-adam F, Nguyen T. Hexanic lipidosterolic extract of Serenoa repens inhibits the expression of two key inflammatory mediators, MCP-1/CCL2 and VCAM-1, in vitro. BJU Int. 2012;110(6 Pt B):E301–7.CrossRefPubMedGoogle Scholar
  21. 21.
    Booker A, Suter A, Krnjic A, et al. A phytochemical comparison of saw palmetto products using gas chromatography and (1) H nuclear magnetic resonance spectroscopy metabolomic profiling. J Pharm Pharmacol. 2014;66(6):811–22.PubMedPubMedCentralGoogle Scholar
  22. 22.
    Yang YC, Li J, Zu YG, Fu YJ, Luo M, Wu N, et al. Optimisation of microwave-assisted enzymatic extraction of corilagin and geraniin from Geranium sibiricum Linne and evaluation of antioxidant activity. Food Chem. 2010;122(1):373–80.CrossRefGoogle Scholar
  23. 23.
    Choi MP, Chan KK, Leung HW, Huie CW. Pressurized liquid extraction of active ingredients (ginsenosides) from medicinal plants using non-ionic surfactant solutions. J Chromatogr A. 2003;983(1–2):153–62.CrossRefPubMedGoogle Scholar
  24. 24.
    Wilt TJ, Ishani A, Stark G, Macdonald R, Lau J, Mulrow C. Saw palmetto extracts for treatment of benign prostatic hyperplasia: a systematic review. JAMA. 1998;280(18):1604–9.CrossRefPubMedGoogle Scholar
  25. 25.
    Boyle P, Robertson C, Lowe F, Roehrborn C. Updated meta-analysis of clinical trials of Serenoa repens extract in the treatment of symptomatic benign prostatic hyperplasia. BJU Int. 2004;93(6):751–6.CrossRefPubMedGoogle Scholar
  26. 26.
    Carraro JC, Raynaud JP, Koch G, Chisholm GD, Di Silverio F, Teillac P, et al. Comparison of phytotherapy (Permixon) with finasteride in the treatment of benign prostate hyperplasia: a randomized international study of 1,098 patients. Prostate. 1996;29(4):231–40.CrossRefPubMedGoogle Scholar
  27. 27.
    Wilt T, Ishani A, Mac donald R. Serenoa repens for benign prostatic hyperplasia. Cochrane Database Syst Rev. 2002;3:CD001423.PubMedGoogle Scholar
  28. 28.•
    Bent S, Kane C, Shinohara K, et al. Saw palmetto for benign prostatic hyperplasia. N Engl J Med. 2006;354(6):557–66. First study to use a single batch of SPB, adequate blinding, adequate power, and acceptable duration. They found only a 1-point improvement in American Urological Association Symptom Index (AUASI) score, 95% CI (−0.93 to 1.01), between the treatment and placebo group.CrossRefPubMedGoogle Scholar
  29. 29.•
    Barry MJ, Meleth S, Lee JY, et al. Effect of increasing doses of saw palmetto extract on lower urinary tract symptoms: a randomized trial. JAMA. 2011;306(12):1344–51. Dose escalation trial showing that SPB is safe, but is no more efficacious than placebo even in doses double and triple to the normal values. The placebo group had a higher proportion of individuals who achieved a three-point decrease in AUASI compared to those who took saw palmetto (44% vs. 43%).CrossRefPubMedPubMedCentralGoogle Scholar
  30. 30.
    Tacklind J, Macdonald R, Rutks I, Stanke JU, Wilt TJ. Serenoa repens for benign prostatic hyperplasia. Cochrane Database Syst Rev. 2012;12:CD001423.PubMedGoogle Scholar
  31. 31.
    Coulson S, Rao A, Beck SL, Steels E, Gramotnev H, Vitetta L. A phase II randomised double-blind placebo-controlled clinical trial investigating the efficacy and safety of ProstateEZE Max: a herbal medicine preparation for the management of symptoms of benign prostatic hypertrophy. Complement Ther Med. 2013;21(3):172–9.CrossRefPubMedGoogle Scholar
  32. 32.
    Morgia G, Russo GI, Voce S, et al. Serenoa repens, lycopene and selenium versus tamsulosin for the treatment of LUTS/BPH. An Italian multicenter double-blinded randomized study between single or combination therapy (PROCOMB trial). Prostate. 2014;74(15):1471–80.CrossRefPubMedGoogle Scholar
  33. 33.
    Ryu YW, Lim SW, Kim JH, Ahn SH, Choi JD. Comparison of tamsulosin plus serenoa repens with tamsulosin in the treatment of benign prostatic hyperplasia in Korean men: 1-year randomized open label study. Urol Int. 2015;94(2):187–93.CrossRefPubMedGoogle Scholar
  34. 34.
    Papaioannou M, Schleich S, Prade I, et al. The natural compound atraric acid is an antagonist of the human androgen receptor inhibiting cellular invasiveness and prostate cancer cell growth. J Cell Mol Med. 2009;13(8B):2210–23.CrossRefPubMedGoogle Scholar
  35. 35.
    Lawson RK. Role of growth factors in benign prostatic hyperplasia. Eur Urol. 1997;32 Suppl 1:22–7.PubMedGoogle Scholar
  36. 36.
    Paubert-braquet M, Cave A, Hocquemiller R, et al. Effect of Pygeum africanum extract on A23187-stimulated production of lipoxygenase metabolites from human polymorphonuclear cells. J Lipid Mediat Cell Signal. 1994;9(3):285–90.PubMedGoogle Scholar
  37. 37.
    Ishani A, Macdonald R, Nelson D, Rutks I, Wilt TJ. Pygeum africanum for the treatment of patients with benign prostatic hyperplasia: a systematic review and quantitative meta-analysis. Am J Med. 2000;109(8):654–64.CrossRefPubMedGoogle Scholar
  38. 38.
    Nakase K, Takenaga K, Hamanaka T, Kimura M. Inhibitory effect and synergism of cernitin pollen extract on the urethral smooth muscle and diaphragm of the rat. Nippon Yakurigaku Zasshi. 1988;91(6):385–92.CrossRefPubMedGoogle Scholar
  39. 39.
    Macdonald R, Ishani A, Rutks I, Wilt TJ. A systematic review of Cernilton for the treatment of benign prostatic hyperplasia. BJU Int. 2000;85(7):836–41.CrossRefPubMedGoogle Scholar
  40. 40.
    Xu J, Qian WQ, Song JD. A comparative study on different doses of cernilton for preventing the clinical progression of benign prostatic hyperplasia. Zhonghua Nan Ke Xue. 2008;14(6):533–7.PubMedGoogle Scholar
  41. 41.
    Wilt TJ, Macdonald R, Rutks I. WITHDRAWN: Tamsulosin for benign prostatic hyperplasia. Cochrane Database Syst Rev. 2011;9:CD002081.PubMedGoogle Scholar
  42. 42.
    Wilt T, Ishani A, Macdonald R, Stark G, Mulrow C, Lau J. Beta-sitosterols for benign prostatic hyperplasia. Cochrane Database Syst Rev. 2000;2:CD001043.PubMedGoogle Scholar
  43. 43.
    Kim SK, Seok H, Park HJ, et al. Inhibitory effect of curcumin on testosterone induced benign prostatic hyperplasia rat model. BMC Complement Altern Med. 2015;15:380.CrossRefPubMedPubMedCentralGoogle Scholar
  44. 44.
    Vyas BA, Desai NY, Patel PK, Joshi SV, Shah DR. Effect of Boerhaavia diffusa in experimental prostatic hyperplasia in rats. Indian J Pharm. 2013;45(3):264–9.CrossRefGoogle Scholar
  45. 45.
    Ammar AE, Esmat A, Hassona MD, Tadros MG, Abdel-naim AB, Guns ES. The effect of pomegranate fruit extract on testosterone-induced BPH in rats. Prostate. 2015;75(7):679–92.CrossRefPubMedGoogle Scholar
  46. 46.
    Said MM, Hassan NS, Schlicht MJ, Bosland MC. Flaxseed suppressed prostatic epithelial proliferation in a rat model of benign prostatic hyperplasia. J Toxicol Environ Health A. 2015;78(7):453–65.CrossRefPubMedGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2016

Authors and Affiliations

  1. 1.Department of UrologyAlbert Einstein College of MedicineBronxUSA

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