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Phytotherapy for benign prostatic hyperplasia

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Abstract

Phytotherapy has become a more popular treatment option among American men with benign prostatic hyperplasia (BPH). The most popular herbal agent is saw palmetto (Serenoa repens), which is derived from the berry of the American dwarf palm tree. Pygeum africanum and beta-sitosterol are also used by many patients with BPH, either alone or in combination with saw palmetto. A significant limiting factor to our understanding of the use and effectiveness of phytotherapy is the lack of standardization of these products. Despite this lack of standardization and the variation in results that may be seen with herbal products, there is growing evidence from well-conducted clinical trials that phytotherapeutic agents may lead to subjective and objective symptom improvement beyond a placebo effect in men with BPH. In addition, histologic evidence has been presented demonstrating that saw palmetto causes atrophy and epithelial contraction within the prostate gland. Overall, it is likely that herbal therapy will continue to be used by a growing number of Americans to treat a variety of ailments. Physicians should attempt to remain open-minded regarding alternative approaches and educate themselves so that they may counsel patients in an informed and credible fashion.

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References and Recommended Reading

  1. Lowe FC: Phytotherapy in the management of benign prostatic hyperplasia. Urology 2001, 58(Suppl 1):71–76. An excellent overview of the use of phytotherapy by men with BPH.

    Article  PubMed  CAS  Google Scholar 

  2. Champault G, Patel JC, Bonnard AM: A double-blind trial of an extract of the plant Serenoa repens in benign prostatic hyperplasia. Br J Clin Pharmacol 1984, 18:461–462.

    PubMed  CAS  Google Scholar 

  3. Cukier J, Ducassou J, Le Guillou M, et al.: Serenoa repens extract vs. placebo. Pharmacol Clin 1985, 4:15–21.

    Google Scholar 

  4. Emile E, LoCigno M, Petrone U: Clinical results on a new drug in the treatment of benign prostatic hyperplasia (Permixon). Urologia 1983, 50:1042–1049.

    Google Scholar 

  5. Smith HR, Memon A, Smart CJ, et al.: The value of Permixon in benign prostatic hypertrophy. Br J Urol 1986, 58:36–40.

    Google Scholar 

  6. Delos S, Iehle C, Martin PM: Inhibition of the activity of basic 5-alpha reductase (type 1) detected in DU 145 cells and expressed in insect cells. J Steroid Biochem Mol Biol 1994, 48:347–352.

    Article  PubMed  CAS  Google Scholar 

  7. Bayne CW, Grant ES, Chapman K, et al.: Characterisation of a new coculture model for BPH which expresses 5-alpha reductase types 1 and 2: the effects of Permixon on DHT formation [abstract]. J Urol 1997, 157(Suppl 4):755.

    Google Scholar 

  8. Sultan C, Terraza A, Devillier C, et al.: Inhibition of androgen metabolism and binding by liposterolic extract of “Serenoa repens B” in human foreskin fibroblasts. J Steroid Biochem 1984, 20:515–519.

    Article  PubMed  CAS  Google Scholar 

  9. Carilla E, Briley M, Fauran F, et al.: Binding of Permixon, a new treatment for prostatic benign hyperplasia, to the cytosolic androgen receptor in the rat prostate. J Steroid Biochem 1984, 20:521–523.

    Article  PubMed  CAS  Google Scholar 

  10. Di Silverio F, Sciarra A, D’Eramo G, et al.: Response to tissue androgen and epidermal growth factor concentrations to the administration of finasteride, flutamide and Serenoa repens in patients with BPH [abstract]. Eur Urol 1996, 30(Suppl 2):80.

    Google Scholar 

  11. Rhodes L, Primka RL, Berman C, et al.: Comparison of finasteride (Proscar), a 5-alpha reductase inhibitor, and various commercial plant extracts in vitro and in vivo 5-alpha reductase inhibition. Prostate 1993, 22:43–51.

    Article  PubMed  CAS  Google Scholar 

  12. Strauch G, Perles P, Vergult G, et al.: Comparison of finasteride (Proscar) and Serenoa repens (Permixon) in the inhibition of 5-alpha reductase in healthy male volunteers. Eur Urol 1994, 26:247–252.

    PubMed  CAS  Google Scholar 

  13. Carraro JC, Raynaud JP, Koch G, et al.: Comparison of phytotherapy (Permixon) with finasteride in the treatment of benign prostate hyperplasia: a randomized international study of 1098 patients. Prostate 1996, 29:231–240.

    Article  PubMed  Google Scholar 

  14. Gerber GS, Zagaja GP, Bales GT, et al.: Saw palmetto (Serenoa repens) in men with lower urinary tract symptoms: effects on urodynamic parameters and voiding symptoms. Urology 1998, 51:1003–1007.

    Article  PubMed  CAS  Google Scholar 

  15. Braeckman J: The extract of Serenoa repens in the treatment of benign prostatic hyperplasia: a multicenter open study. Curr Ther Res 1994, 55:776–785.

    Article  Google Scholar 

  16. Di Silverio F, D’Eramo G, Lubrano C, et al.: Evidence that Serenoa repens extract displays an antiestrogenic activity in prostatic tissue of benign prostatic hypertrophy patients. Eur Urol 1992, 21:309–314.

    PubMed  Google Scholar 

  17. Helpap B, Oehler U, Weisser H, et al.: Morphology of benign prostatic hyperplasia after treatment with sabal extract IDS 89 or placebo. J Urol Pathol 1995, 3:175–182.

    Google Scholar 

  18. Marks LS, Partin AP, Epstein JI, et al.: Effects of a saw palmetto herbal blend in men with symptomatic benign prostatic hyperplasia. J Urol 2000, 163:1451–1456. One of the first studies to convincingly demonstrate histologic changes in the prostate gland associated with saw palmetto use. This may begin to help explain the clinical effectiveness of saw palmetto in men with BPH.

    Article  PubMed  CAS  Google Scholar 

  19. Descotes JL, Rambeaud JJ, Deschaseaux P, et al.: Placebo controlled evaluation of the efficacy and tolerability of Permixon in benign prostatic hyperplasia after exclusion of placebo responders. Clin Drug Invest 1995, 9:291–297.

    Google Scholar 

  20. Plosker GL, Brogden RN: Serenoa repens (Permixon). A review of its pharmacology and therapeutic efficacy in benign prostatic hyperplasia. Drugs Aging 1996, 9:379–395.

    PubMed  CAS  Google Scholar 

  21. Smith HR, Memon A, Smart CJ, et al.: The value of Permixon in benign prostatic hypertrophy. Br J Urol 1986, 58:36–40.

    Google Scholar 

  22. Gerber GS, Kuznetsov D, Johnson BC, et al.: Randomized, double-blind, placebo-controlled trial of saw palmetto in men with lower urinary tract symptoms. Urology 2001, 58:960–965. The results of this trial indicated significant improvement in urinary symptoms using saw palmetto compared with placebo. No significant change in peak urinary flow rate was noted.

    Article  PubMed  CAS  Google Scholar 

  23. Wilt TJ, Ishani A, Stark G, et al.: Saw palmetto extracts for treatment of benign prostatic hyperplasia. A systematic review. JAMA 1998, 280:1604–1609. This meta-analysis of close to 3000 men concluded that saw palmetto was superior to placebo in relieving urinary symptoms in men with BPH. Although this study generated a great deal of coverage in the lay press, its findings are somewhat limited by the inclusion of many poorly conducted studies.

    Article  PubMed  CAS  Google Scholar 

  24. Boyle P, Robertson C, Lowe F, et al.: Meta-analysis of clinical trials of Permixon in the treatment of symptomatic benign prostatic hyperplasia. Urology 2000, 55:533–539. Significant improvement in urinary flow rates and symptoms were reported using a meta-analysis of 13 published trials of Permixon.

    Article  PubMed  CAS  Google Scholar 

  25. Chopin DK, Perrin P, Authie D, et al.: Prostatic volume does not correlate with efficacy of treatment for mild to moderate benign prostatic hyperplasia using either finasteride or phytotherapy (Permixon). Paper presented at the 4th International Consultation on BPH. Paris, July 2–5, 1997.

  26. Lepor H, Williford WO, Barry MJ, et al.: The efficacy of terazosin, finasteride, or both in benign prostatic hyperplasia. N Engl J Med 1996, 335:533–539.

    Article  PubMed  CAS  Google Scholar 

  27. Yablonsky F, Nicolas V, Riffaud JP, et al.: Antiproliferative effect of Pygeum africanum extract on rat prostatic fibroblasts. J Urol 1997, 157:2381–2387.

    Article  PubMed  CAS  Google Scholar 

  28. Paubert-Braquert M, Monboisse JC, Servent-Saez N, et al.: Inhibition of bFGF and EGF-induced proliferation of 3T3 fibroblasts by extract of Pygeum africanum (Tadenan). Biomed Pharmacother 1994, 48(Suppl 1):43–47.

    Google Scholar 

  29. Levin RM, Riffaud JP, Bellamy F, et al.: Effects of Tadenan pretreatment on bladder physiology and biochemistry following partial outlet obstruction. J Urol 1996, 156:2084–2088.

    Article  PubMed  CAS  Google Scholar 

  30. Krasnopolsky L, Zhao Y, Wein AJ: Protective effect of Tadenan on bladder function secondary to partial outlet obstruction. J Urol 1996, 155:1466–1470.

    Article  PubMed  Google Scholar 

  31. Choo MS, Bellamy F, Constantinou CE: Functional evaluation of Tadenan on micturition and experimental prostate growth induced with exogenous dihydrotestosterone. Urology 2000, 55:292–298.

    Article  PubMed  CAS  Google Scholar 

  32. Dufour B, Choquenet C, Revol M, et al.: Controlled study of the effects of Pygeum africanum extract on the functional symptoms of prostatic adenoma. Ann Urol 1984, 18:193–195. Small study of brief duration that suggested a significant improvement in urinary symptoms using Pygeum africanum compared with placebo.

    CAS  Google Scholar 

  33. Barlet A, Albrecht J, Aubert A, et al.: Wirksamkeit eines extraktes aus Pygeum africanum in der medikamentosen therapie von miktionsstorungen infolge einer benignen prostathyperplasi: betwertung objectiver und subjektiver parameter. Wien Klin Wochenschr 1990, 102:667–673.

    PubMed  CAS  Google Scholar 

  34. Carbin BE, Larsson B, Lindahl O: Treatment of benign prostatic hyperplasia with phytosterols. Br J Urol 1987, 66:639–641.

    Google Scholar 

  35. Berges RR, Windeier J, Trampisch HJ, et al.: Randomised, placebo-controlled, double-blind clinical trial of beta-sitosterol in patients with benign prostatic hyperplasia. Lancet 1995, 345:1529–1532.

    Article  PubMed  CAS  Google Scholar 

  36. Berges RR, Kassen A, Senge T: Treatment of symptomatic benign prostatic hyperplasia with beta-sitosterol: an 18 month follow-up. Br J Urol 2000, 85:842–846. This open-label extension study using Harzol demonstrated persistently positive results using this form of beta-sitosterol after an 18-month follow-up.

    CAS  Google Scholar 

  37. Dreikorn K, Richter R, Schnohofer PS: Konservative, nicht-hormonelle Behandlung der benignen prostata-hyperplasia. Urologe A 1990, 29:8–16.

    PubMed  CAS  Google Scholar 

  38. Klippel KF, Hiltl DM, Schipp B: Randomized, double blinded placebo controlled trial to evaluate the efficacy of B-sitosterol (phytosterol) in patients with obstructive and irritative symptoms due to BPH. Paper presented at the 4th International Consultation on BPH. Paris, July 2–5, 1997.

  39. Buck AC, Cox R, Rees WM, et al.: Treatment of outflow tract obstruction due to benign prostatic hyperplasia with the pollen extract, Cernilton. A double-blind, placebo-controlled study. Br J Urol 1990, 66:398–404.

    Article  PubMed  CAS  Google Scholar 

  40. Dutkiewicz S: Usefulness of Cernilton in the treatment of benign prostatic hyperplasia. Int Urol Nephrol 1996, 28:49–53.

    Article  PubMed  CAS  Google Scholar 

  41. Ito R, Ishii M, Yamashita S: Cernitin pollen-extract (Cernilton): antiprostatic hyperptrophic action of Cernitin pollenextract (Cernilton). Pharmacometrics 1986, 31:1–11.

    CAS  Google Scholar 

  42. Rugendorff EW, Weidner W, Ebeling L, et al.: Results of treatment with pollen extract (Cernilton N) in chronic prostatitis and prostatodynia. Br J Urol 1993, 71:433–438.

    PubMed  CAS  Google Scholar 

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  1. Section of Urology, University of Chicago, 5841 S. Maryland Avenue, MC 6038, 60637, Chicago, IL, USA

    Glenn S. Gerber MD

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  1. Glenn S. Gerber MD
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Gerber, G.S. Phytotherapy for benign prostatic hyperplasia. Curr Urol Rep 3, 285–291 (2002). https://doi.org/10.1007/s11934-002-0050-3

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  • DOI: https://doi.org/10.1007/s11934-002-0050-3

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