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Phytotherapeutic agents in the treatment of benign prostatic hyperplasia

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Abstract

The rationale and efficacy of phytotherapeutic agents in the treatment of lower urinary tract symptoms secondary to benign prostatic hyperplasia (BPH) are continuously debated. While plant extracts are prescribed and reimbursable treatment options in Europe, they are officially classified merely as dietary supplements in the United States. The most commonly used preparations originate from the species Serenoa repens, Pygeum africanum, hypoxis rooperi, pinus, picea, urtica dioica, and secale cereale. Combination extracts derived from two or more plants are also used. Various components have been suggested to be active, and different mechanisms of action are being supposed. Open trials and some short-term randomized studies, suggesting safety and efficacy, have been reported. However, if stringent criteria of evidence-based medicine are applied, the data are inconclusive. Therefore, the 4th International Consultation on BPH and the recent German guidelines have not (yet) recommended phytotherapy for the management of symptomatic BPH.

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References and Recommended Reading

  1. Bruskewitz R: Management of symptomatic BPH in the US: Who is treated and how? Eur Urol 1999, 36(suppl 3):7–13. Describes the current operative, instrumental, and medical management of BPH in the United States.

    Article  PubMed  Google Scholar 

  2. Chapple CR: Introduction and concluding remarks. Eur Urol 1999, 36(suppl 3):1–6.

    Article  PubMed  Google Scholar 

  3. Kurtzweil P: An FDA Guide to Dietary Supplements. US Food and Drug Administration 1999 htt://vm.cfsan.fda.gov/~dms/ fdsupp.html. Website of the US FDA with an FDA guide to dietary supplements, including current laws regulating the distribution of dietary supplements.

  4. Lowe FC, Fagelman E: Phytotherapy in the treatment of benign prostatic hyperplasia: an update. Urology 1999, 53:671–678.

    Article  PubMed  CAS  Google Scholar 

  5. Friedland DJ, Go AS, Davoren JB, et al.: Evidence-based Medicine. A Frame Work for Clinical Practice. Stamford: Appleton & Lange; 1998. Practical guide and textbook, covering all subjects of evidence-based medicine.

    Google Scholar 

  6. Speakman MJ: Who should be treated and how? Evidence-based medicine in symptomatic BPH. Eur Urol 1999, 36(suppl 3):40–51. Description of the need and significance of evidence-based medicine for treatment decisions in men with LUTS and BPH.

    Article  PubMed  Google Scholar 

  7. Dreikorn K, Schönhöfer PS: Stellenwert von Phytotherapeutika bei der Behandlung der benignen Prostatahyperplasie (BPH). Urologe A 1995, 34:119–129.

    PubMed  CAS  Google Scholar 

  8. Dreikorn K, Borkowski A, Braeckman J, et al.: Other Medical Therapies. Proceedings of the 4th International Consultation of Benign Prostatic Hyperplasia (BPH) 1997. Edited by Denis L, Griffiths K, Khoury S, et al. Plymouth: Plymbridge Distributors; 1998:633–659. Comprehensive review about BPH with diagnostic and treatment recommendations 1997.

    Google Scholar 

  9. Buck AC: Phytotherapy for the prostate. Br J Urol 1996, 78:325–336.

    PubMed  CAS  Google Scholar 

  10. Braeckmann 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 

  11. Lowe FC, Ku JC: Phytotherapy in treatment of benign prostatic hyperplasia: a critical review. Urology 1996, 48:12–20.

    Article  PubMed  CAS  Google Scholar 

  12. Plosker G, 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 

  13. Bayne CW, Grant ES, Chapman K, Habib FK: Characterisation of a new co-culture model for BPH which expresses 5 alphareductase types I and II: the effects of Permixon® on DHT formation [abstract]. J Urol 1997, 157:194.

    Google Scholar 

  14. Breu W, Hagenlocher M, Redl K, et al.: Antiphlogistische wirkung eines mit hyperkritischem kohlendioxid gewonnenen sabalfrucht-extraktes. In-vitro-hemmung des cyclooxygenase- und 5-lipoxygenase-metabolismus. Drug Res 1992, 42:547–551.

    CAS  Google Scholar 

  15. 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.

    Google Scholar 

  16. Paubert-Braquet M, Servent N, Serikoff A, et al.: Permixon® (lipido-sterol extract of Serenoa repens-LSESr) inhibits estrogen-androgen-induced prostate enlargement in the rat. Pharmacol Res 1995, 31(suppl):31.

    Article  Google Scholar 

  17. Paubert-Braquet M, Cousse H, Raynaud JP, Braquet P: Effect of the lipodosterolic extract of Serenoa repens (Permixon®) on the ionophore A23187-stimulated production of leukotriene B4 (LTB4) from human polymorphonuclear neutrophils. 4th Int Cons on BPH, Paris 1997, Abstract 72.

  18. Paubert-Braquet M, Raynaud JP, Braquet G, Cousse G: Permixon® (lipid sterolic extract of Serenoa repens) and some of its components inhibit b-FGF- and EGF-induced proliferation of human prostate organotypic cell lines [abstract]. J Urol 1997, 157(suppl 4):138.

    Google Scholar 

  19. Paubert-Braquet M, Raynand JP, Mencia-Huerta JM, Braquet P: Effect of the liposterolic extract of Serenoa repens (Permixon®) and its major components on basic fibroblast growth factor-induced proliferation of cultures of human prostate biopsies. Eur Urol 1998, 33:340–347.

    Article  PubMed  CAS  Google Scholar 

  20. Marks LS, Tyler VE: Saw palmetto extract: newest (and oldest) treatment alternative for men with symptomatic benign prostatic hyperplasia. Urology 1999, 53:457–461.

    Article  PubMed  CAS  Google Scholar 

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

    Article  PubMed  CAS  Google Scholar 

  22. Lowe FC, Dreikorn K, Borkowski A, et al.: Review of recent placebo-controlled trials utilizing phytotherapeutic agents for treatment of BPH. Prostate 1998, 37:187–193.

    Article  PubMed  CAS  Google Scholar 

  23. Gerber GS, Bales GT, Ghodak GW, Contreras BA: Serenoa repens (saw palmetto) in men with benign prostatic hyperplasia (BPH): effects on voiding symptoms, urodynamic parameters and serum prostate specific antigen (PSA) [abstract]. J Urol 1997, 157(suppl):331.

    Google Scholar 

  24. 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 

  25. Descotes JL, Rambeaud JJ, Deschaseaux P, Faure G: Placebocontrolled evaluation of the efficacy and tolerability of Permixon® in benign prostatic hyperplasia after exclusion of placebo responders. Clin Drug Invest 1996, 9:291–297.

    Google Scholar 

  26. Carraro JC, Raynaud JP, Koch G, et al.: Comparison of phytotherapy (Permixon®) with finasteride in the treatment of benign prostatic hyperplasia: a randomized international study of 1089 patients. Prostate 1996, 29:231–240.

    Article  PubMed  Google Scholar 

  27. Boyle P, Gould AL, Roehrborn G: Prostate volume predicts outcome of treatment of benign prostatic hyperplasia with finasteride: meta-analysis of randomised clinical trials. Urology 1996, 48:398–405.

    Article  PubMed  CAS  Google Scholar 

  28. 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 

  29. Lowe FC, Robertson C, Roehrborn CG, et al.: Meta-analysis of clinical trials of Permixon® [abstract]. J Urol 1998, 159(suppl):257.

    Google Scholar 

  30. 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. Systematic review (meta-analysis) of the evidence for the efficacy of saw palmetto in men with BPH.

    Article  PubMed  CAS  Google Scholar 

  31. Senge TH, Windeler J, Berges RR, Trampisch HJ: Wirksamkeit von β-sitosterin bei der Behandlung von BPH. Urologe A 1995, 34:130–131.

    PubMed  CAS  Google Scholar 

  32. Berges RR, Windeler J, Trampisch H, Senge TH, and the beta-sitosterol study group: 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 

  33. Klippel KF, Hiltl DM, Schipp B: A multicentric, placebocontrolled, double-blind clinical trial of beta-sitosterol (phytosterol) for the treatment of benign prostatic hyperplasia. Br J Urol 1997, 80:427–432. Six-month study demonstrating dramatic improvement of b-sitosterol-treated patients compared with placebo.

    PubMed  CAS  Google Scholar 

  34. Wilt TJ, MacDonald R, Ishani A: beta-Sitosterol for the treatment of benign prostatic hyperplasia: a systematic review. BJU Int 1999, 83:976–983. Systematic review (meta-analysis) of the evidence for the efficacy of b-sitosterol in men with BPH.

    Article  PubMed  CAS  Google Scholar 

  35. Andro MC, Riffaud JP: Pygeum Africanum extract for the treatment of patients with benign prostatic hyperplasia. A review of 25 years of published experience. Curr Ther Res 1995, 56:796–817.

    Article  Google Scholar 

  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, 9:285–290.

    PubMed  CAS  Google Scholar 

  37. 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 

  38. Levin RM, Riffaud, JP, Bellamy F, et al.: Protective effect of Tadenan® on bladder function secondary to partial outlet obstruction. J Urol 1996, 155:1466–1470.

    Article  PubMed  CAS  Google Scholar 

  39. Fitzpatrick JM, Dreikorn K, Khoury S, et al.: The medical management of BPH with agents other than hormones or alpha-blockers. In Proceedings of the 2nd International Consultation on benign prostatic hyperplasia (BPH), Paris, June 26–27, 1991. Edited by Cockett ATK, Aso Y, Chatelain C, et al. Flushing, NY: Scientific Communication International; 1991:195–199.

    Google Scholar 

  40. Fitzpatrick JM, Dreikorn K, Khoury S, et al.: The medical management of BPH with agents other than hormones or alpha-blockers. In Proceedings of the 2nd International Consultation on benign prostatic hyperplasia (BPH), Paris, June 27–30, 1993. Edited by Cocket ATK, Aso Y, Chatelain C, et al. Jersey: Scientific Communication International; 1993:445–450.

    Google Scholar 

  41. Fitzpatrick JM, Lynch TH: Phytotherapeutic agents in the management of symptomatic benign prostatic hyperplasia. Urol Clin North Am 1995, 22:400–412.

    Google Scholar 

  42. JM Fitzpatrick J Braeckman L Denis et al. (1996) NoChapterTitle ATK Cockett S Khoury Y Aso (Eds) The medical management of BPH with agents other than hormones or alpha-blockers ConfEventNameProceedings of the 3rd International Consultation on benign prostatic hyperplasia (BPH) ConfEventLocationMonaco Scientific Communication International Jersey 489–494

    Google Scholar 

  43. Engelmann U, Boos G, Kres H: Therapie der benignen prostatahyperplasie mit bazoton liquidum. Urologe B 1996, 36:287–291.

    Article  Google Scholar 

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

    Article  PubMed  CAS  Google Scholar 

  45. Dathe G, Schmid H: Phytotherapie der benignen prostatahyperplasie: doppelblindstudie mit extractum radicis urticae (ERU). Urologe B 1987, 27:233–226.

    Google Scholar 

  46. Habib FK, Ross M, Lewenstein A, et al.: The identification of a prostate inhibitory substance in a pollen extract. Prostate 1995, 26:133–139.

    Article  PubMed  CAS  Google Scholar 

  47. Becker H, Ebeling L: Konservative therapie der benignen prostatahyperplasie (BPH) mit cernilton. Urologe B 1988, 28:301–306.

    Google Scholar 

  48. Buck AC, Cox R, Rees RWM, et al.: Treatment of outflow tract obstruction due to benign prostatic hyperplasia with the pollen extract Cernilton. Br J Urol 1990, 66:398–404.

    PubMed  CAS  Google Scholar 

  49. Carbin BE, Larsson B, Lindahl O: Treatment of benign prostatic hyperplasia with phytosterols. Br J Urol 1990, 66:639–641.

    Article  PubMed  CAS  Google Scholar 

  50. Metzker M, Kieser M, Hölscher U: Wirksamkeit eines sabal-urtica-kombinationspräparates bei der behandlung der benignen Prostatahyperplasie (BPH). Urologe B 1996, 36:292–300.

    Article  Google Scholar 

  51. Metzker H, Martin C: Efficacy and safety of the Sabal Urtica combination PRO 160/120 in the treatment of patients with benign prostatic hyperplasia (a placebo-controlled doubleblind long-term clinical trial). 4th Int Cons on BPH, Paris 1997, Abstr 15.

  52. Sökeland J, Albrecht J: Kombination aus Sabal- und urticaextrakt mit finasterid bei BPH (Stad.I bis II nach Alken). Urologe A 1997, 6:327–333.

    Article  Google Scholar 

  53. Fitzpatrick JM: Phytotherapy for treatment of benign prostatic hyperplasia: Case not proven. Urology 1998, 53:462–464.

    Google Scholar 

  54. Denis L, McConnell J, Yoshida O, et al.: and the Members of the Committees: 4th International Consultation of BPH. Recommendations of the International Scientific Committee: the evaluation and treatment of lower urinary tract syndromes (LUTS) suggestive of benign prostatic obstruction. In Proceedings of the 4th International Consultation of Benign Prostatic Hyperplasia (BPH). Edited by Denis L, Griffiths K, Khoury S, et al. Plymouth: Plymbridge Distributors; 1998:669–684. Recommendations based on a thorough review of the available literature and the global subjective opinion of recognized experts serving on focused committees.

    Google Scholar 

  55. Altwein J, Aumüller G, Berges R, Dreikorn K, et al.: Leitlinien der Deutschen Urologen zur Therapie des BPH-Syndroms. Urologe A 1999, 38:529–536. Official guidelines of the German Urologists for the treatment of symptomatic BPH.

    Article  Google Scholar 

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  1. Department of Urology, ZKH St.-Juergenstrasse, 28355, Bremen, Germany

    Kurt Dreikorn MD

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Dreikorn, K. Phytotherapeutic agents in the treatment of benign prostatic hyperplasia. Curr Urol Rep 1, 103–109 (2000). https://doi.org/10.1007/s11934-000-0044-y

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