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Choi YJ, Fan M, Wedamulla NE, Tang Y, Bae SM, Hwang JY, Kim EK. Inhibitory effects of Centella asiatica (L.) Urban on enlarged prostate through androgen receptor and PI3K/Akt signaling pathways. Food Funct 2022; 13:10235-10247. [PMID: 36124918 DOI: 10.1039/d2fo00841f] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Centella asiatica (L.) Urban (C. asiatica) is a traditional herbal medicine that has been used for wound healing and anti-inflammation since ancient times. Various biological effects of C. asiatica ethanolic extract (CAE) were previously reported. However, in our previous study, C. asiatica aqueous extract (CAA) exhibited higher inhibitory activity on benign prostatic hyperplasia (BPH) than CAE. Therefore, the aim of this study was to investigate the effect of CAA on BPH, and elucidate the inhibitory mechanism through in vitro and in vivo experiments as well as metabolite analysis of CAA. A BPH rat model was induced by daily subcutaneous injection of testosterone propionate (TP, 3 mg kg-1) dissolved in corn oil for 4 weeks after castration. The experimental group, the CAA treatment group, was orally administered CAA (100 mg kg-1) for 4 weeks while inducing prostatic hyperplasia. Saw palmetto extract (Saw, 100 mg kg-1) and Finasteride (Fi, 1 mg kg-1) were used as positive controls and were administered orally for 4 weeks. CAA significantly inhibited androgen receptor signaling related factors overexpressed by dihydrotestosterone (DHT) treatment in prostate cell lines. Afterwards, the testosterone-induced BPH model was used to verify the alleviation efficacy of CAA in prostatic hyperplasia. Prostate size and the thickness of the prostate tissue epithelium were significantly decreased in the group treated with CAA compared to those in the BPH group. The results of protein expression in the prostate tissue confirmed that CAA inhibited androgen receptor signaling in BPH and decreased the expression of growth factors. Moreover, CAA suppressed the expression of the PI3K/Akt pathway and cell proliferation-related factors compared to the BPH group. Taken together, these results indicate that CAA improves the inhibitory efficacy of BPH by inhibiting the androgen receptor and PI3K/Akt pathways, suggesting that CAA may be a promising candidate for biopharmaceutical formulations of BPH.
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Affiliation(s)
- Young-Jin Choi
- Department of Food Science and Nutrition, Dong-A University, Busan 49315, Republic of Korea. .,Center for Silver-targeted Biomaterials, Brain Busan 21 Plus Program, Dong-A University, Busan 49315, Republic of Korea.,Department of Health Sciences, the Graduate School of Dong-A University, Busan 49315, Republic of Korea
| | - Meiqi Fan
- Division of Food Bioscience, College of Biomedical and Health Sciences, Konkuk University, Chungju 27478, Republic of Korea
| | - Nishala Erandi Wedamulla
- Department of Food Science and Nutrition, Dong-A University, Busan 49315, Republic of Korea. .,Center for Silver-targeted Biomaterials, Brain Busan 21 Plus Program, Dong-A University, Busan 49315, Republic of Korea.,Department of Health Sciences, the Graduate School of Dong-A University, Busan 49315, Republic of Korea.,Department of Export Agriculture, Faculty of Animal Science and Export Agriculture, Uva Wellassa University, Badulla 90000, Sri Lanka
| | - Yujiao Tang
- School of Bio-Science and Food Engineering, Changchun University of Science and Technology, Changchun 130600, China
| | - Sung Mun Bae
- Gyeongnam Agricultural Research and Extension Services, Jinju 52733, Korea
| | - Ji-Young Hwang
- Department of Food Science & Technology, Dong-Eui University, Busan 47340, Korea
| | - Eun-Kyung Kim
- Department of Food Science and Nutrition, Dong-A University, Busan 49315, Republic of Korea. .,Center for Silver-targeted Biomaterials, Brain Busan 21 Plus Program, Dong-A University, Busan 49315, Republic of Korea.,Department of Health Sciences, the Graduate School of Dong-A University, Busan 49315, Republic of Korea.,Center for Food & Bio Innovation, Dong-A University, Busan 49315, Korea
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Liu M, Yin H, Wang F, Tian Y. The Therapeutic Potential of Saw Palmetto Extract in Urological Disorders. Nat Prod Commun 2021. [DOI: 10.1177/1934578x211059635] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Saw palmetto extract (SPE) has been widely used as a therapeutic remedy for urinary dysfunction in western countries. Furthermore, as an herb drug, it can be used as an alternative therapy for benign prostatic hyperplasia (BPH) due to its safety and minimum adverse effects. Reportedly, SPE improves the urinary symptoms, which mainly depend on anti-androgenic effects and effects on autonomic receptors in the lower urinary tract. However, the mechanisms of action responsible for the therapeutic roles of SPE have not been fully elucidated. Relevant studies indicate that SPE has some positive effects on the treatment of urological diseases in animals, and clinical trials are ongoing. In this review, we summarize the pharmacological properties and discuss the possible therapeutic mechanisms of SPE in urological diseases, including anti-androgenic effects, effects on autonomic receptors in the lower urinary tract, anti-inflammatory activity, anti-proliferative and pro-apoptotic effects, and highlight a potential therapeutic approach in the clinical treatment of patients with BPH, prostate cancer, chronic prostatitis (CP) and erectile dysfunction (ED).
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Affiliation(s)
- Meng Liu
- Second Military Medical University, Shanghai, China
| | - Huirong Yin
- Changhai Hospital, Second Military Medical University, Shanghai, China
| | - Fang Wang
- Second Military Medical University, Shanghai, China
| | - Ying Tian
- Hebei Reproductive Hospital, Shijiazhuang, China
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Evron E, Juhasz M, Babadjouni A, Mesinkovska NA. Natural Hair Supplement: Friend or Foe? Saw Palmetto, a Systematic Review in Alopecia. Skin Appendage Disord 2020; 6:329-337. [PMID: 33313047 DOI: 10.1159/000509905] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2019] [Accepted: 06/25/2020] [Indexed: 11/19/2022] Open
Abstract
Saw palmetto (SP), a botanical extract with antiandrogenic properties, has gained commercial popularity for its purported benefits on hair regrowth. To summarize published evidence on the efficacy, safety, and tolerability of supplements containing SP in the treatment of alopecia, we conducted a PubMed, Google Scholar, and Cochrane database search using the following terms: (saw palmetto and hair loss), (saw palmetto and androgenetic alopecia), and (saw palmetto and natural supplement and alopecia). Five randomized clinical trials (RCTs) and 2 prospective cohort studies demonstrated positive effects of topical and oral supplements containing SP (100-320 mg) among patients with androgenetic alopecia (AGA) and telogen effluvium. Sixty percent improvement in overall hair quality, 27% improvement in total haircount, increased hair density in 83.3% of patients, and stabilized disease progression among 52% were noted with use of various topical and oral SP-containing supplements. SP was well tolerated and not associated with serious adverse events in alopecia patients. Although robust high-quality data are lacking, supplements containing SP may be a treatment option for patients with AGA, telogen effluvium, and self-perceived hair thinning. Further large-scale RCTs focusing on the sole contribution of SP to hair growth outcomes are needed to confirm efficacy and determine long-term adverse events.
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Affiliation(s)
- Evyatar Evron
- Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Margit Juhasz
- Department of Dermatology, University of California, Irvine, Irvine, California, USA
| | - Arash Babadjouni
- Arizona College of Osteopathic Medicine, Midwestern University, Glendale, Arizona, USA
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Cai T, Cui Y, Yu S, Li Q, Zhou Z, Gao Z. Comparison of Serenoa repens With Tamsulosin in the Treatment of Benign Prostatic Hyperplasia: A Systematic Review and Meta-Analysis. Am J Mens Health 2020; 14:1557988320905407. [PMID: 32274957 PMCID: PMC7153190 DOI: 10.1177/1557988320905407] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2019] [Revised: 01/05/2020] [Accepted: 01/13/2020] [Indexed: 12/16/2022] Open
Abstract
Studies reported that Serenoa repens was effective in relieving lower urinary tract symptoms (LUTS). This article carried out a systematic review and meta-analysis to compare Serenoa repens with tamsulosin in the treatment of benign prostatic hyperplasia (BPH) after at least 6-month treatment cycle. Four studies involving 1,080 patients (543 in the Serenoa repens group and 537 in the tamsulosin group) were included in the meta-analysis. The results were as follows: compared with tamsulosin, Serenoa repens had a same effect in treating BPH in terms of International Prostate Symptom Score (IPSS) (mean difference [MD] 0.63, 95% confidence interval [CI] [-0.33, 1.59], p = 0.20), quality of life (QoL) (MD 1.51, 95% CI [-1.51, 4.52], p = 0.33), maximum flow rate (Qmax) (MD 0.27, 95% CI [-0.15, 0.68], p = 0.21), postvoid residual volume (PVR) (MD -4.23, 95% CI [-22.97, 14.44], p = 0.65), prostate-specific antigen (PSA) (MD 0.46, 95% CI [-0.06, 0.97], p = 0.08) with the exception of prostate volume (PV) (MD -0.29, 95% CI [-0.41, -0.17], p < 0.00001). For side effects, Serenoa repens was well tolerated compared with tamsulosin especially in ejaculation disorders (odds ratio [OR] = 12.56, 95% CI [3.83, 41.18], p < 0.0001) and decreased libido (OR = 5.40; 95% CI [1.17, 24.87]; p = 0.03). This study indicated that Serenoa repens had the same effect in treating BPH compared with tamsulosin in terms of IPSS, QoL, and PVR after at least 6-month treatment cycle, however, the latter had a greater improvement in PV compared with the former. And Serenoa repens did not increase the risk of adverse events especially with respect to ejaculation disorders and libido decrease.
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Affiliation(s)
- Tong Cai
- Binzhou Medical University, Yantai, Shandong, China
- Department of Urology, The Affiliated Yantai Yuhuangding Hospital of Qingdao University, Yantai, Shandong, China
- Tong Cai, Yuanshan Cui, and Shaoxia Yu contributed equally to this work as co-first author
| | - Yuanshan Cui
- Department of Urology, The Affiliated Yantai Yuhuangding Hospital of Qingdao University, Yantai, Shandong, China
- Department of Urology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- Tong Cai, Yuanshan Cui, and Shaoxia Yu contributed equally to this work as co-first author
| | - Shaoxia Yu
- Department of Neurology, The Affiliated Yantai Yuhuangding Hospital of Qingdao University, Yantai, Shandong, China
- Tong Cai, Yuanshan Cui, and Shaoxia Yu contributed equally to this work as co-first author
| | - Qian Li
- Department of Research, The Affiliated Yantai Yuhuangding Hospital of Qingdao University, Yantai, Shandong, China
| | - Zhongbao Zhou
- Binzhou Medical University, Yantai, Shandong, China
- Department of Urology, The Affiliated Yantai Yuhuangding Hospital of Qingdao University, Yantai, Shandong, China
| | - Zhenli Gao
- Binzhou Medical University, Yantai, Shandong, China
- Department of Urology, The Affiliated Yantai Yuhuangding Hospital of Qingdao University, Yantai, Shandong, China
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de Abreu LCL, de Souza Furtado P, da Silva Honorio T, Hudson Hossy B, de Pádula M, Francielle Souza Domingos T, Almada do Carmo F, Campos de Oliveira Miguel N, Rangel Rodrigues C, de Sousa VP, Cunha Sathler P, Mendes Cabral L. A synergistic nanoformulation of babassu and copaiba oils as natural alternative for prevention of benign prostatic hyperplasia. J Drug Deliv Sci Technol 2018. [DOI: 10.1016/j.jddst.2018.07.013] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Kageyama S, Beppu M, Ohnogi H, Miyazaki S, Haruno A, Ito Y, Yamada S. Clinical Effects of Formulated Food of Peucedanum japonicum Extract and Saw Palmetto Extract in Male Patients with Lower Urinary Tract Symptoms. Low Urin Tract Symptoms 2017; 10:167-174. [PMID: 28160499 DOI: 10.1111/luts.12155] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2016] [Revised: 07/19/2016] [Accepted: 07/25/2016] [Indexed: 11/26/2022]
Abstract
OBJECTIVES To evaluate changes over time in subjective symptom scores and urination parameters before and after oral administration of formulated food containing a combination of Peucedanum japonicum (P. japonicum) extract and saw palmetto extract (SPE) in male patients with lower urinary tract symptoms (LUTS). METHODS This study was conducted in an open label manner on male patients with untreated LUTS. The urination state of patients was evaluated before and after administration of food formulated with P. japonicum extract and SPE for 4 weeks, based on urodynamic parameters and subjective symptom scores (International Prostate Symptom Score [IPSS and IPSS-QOL], Overactive Bladder Symptom Score [OABSS], Overactive Bladder Questionnaire [OAB-q], and International Index of Erectile Function [IIEF]). RESULTS After the administration of food formulated with these extracts, the following results were obtained: (i) Subjective findings: The IPSS-QOL score improved significantly; both parameters related to nocturia, i.e., frequency of nighttime urination and OABSS-2, improved significantly; other ratings for subjective symptoms slightly improved. (ii) Objective findings: Residual urine volume decreased significantly, and blood prostate specific antigen (PSA) and urinary 8-OHdG levels decreased slightly after the treatment. (iii) Other findings: Blood pressure decreased slightly. No adverse drug reactions were reported. (iv) Patient impressions: 75% of patients gave a rating of "Good" or higher, with 15 out of 20 patients wanting to continue treatment after the end of 4-week administration period. CONCLUSIONS Food formulated with P. japonicum extract and SPE may be useful to decrease frequency of nighttime urination and residual urine volume in male patients with LUTS.
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Affiliation(s)
| | | | | | - Sayaka Miyazaki
- Center for Pharma-Food Research, Graduate School of Pharmaceutical Sciences, University of Shizuoka, Shizuoka, Japan
| | - Akihiro Haruno
- Center for Pharma-Food Research, Graduate School of Pharmaceutical Sciences, University of Shizuoka, Shizuoka, Japan
| | - Yoshihiko Ito
- Center for Pharma-Food Research, Graduate School of Pharmaceutical Sciences, University of Shizuoka, Shizuoka, Japan
| | - Shizuo Yamada
- Center for Pharma-Food Research, Graduate School of Pharmaceutical Sciences, University of Shizuoka, Shizuoka, Japan
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Kaplan SA. Re: Comparison of Tamsulosin plus Serenoa repens with Tamsulosin in the Treatment of Benign Prostatic Hyperplasia in Korean Men: 1-Year Randomized Open Label Study. J Urol 2016; 196:503. [PMID: 27479407 DOI: 10.1016/j.juro.2016.05.021] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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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; 94:187-93. [PMID: 25614155 DOI: 10.1159/000366521] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2014] [Accepted: 08/11/2014] [Indexed: 11/19/2022]
Abstract
INTRODUCTION In Korea, increasing attention has recently been given to the use of phytotherapeutic agents to alleviate the symptoms of BPH. Serenoa repens has been shown to have an equivalent efficacy to Finasteride or Tamsulosin in the treatment of BPH in previous studies. The present study was designed to compare the efficacy and safety of Serenoa repens plus tamsulosin with tamsulosin only over 12 months in men with LUTS secondary to BPH. MATERIALS AND METHODS One hundred forty men with symptomatic BPH (IPSS≥10) were recruited in our hospital for a 12-month, open-label, randomized trial. Patients were randomly assigned to either tamsulosin 0.2 mg/day plus Serenoa repens 320 mg/day (n=60) or tamsulosin 0.2 mg/day only (n=60). Prostate volume and PSA were measured at baseline and at end-point, whereas total IPSS, and its storage and voiding subscores, LUTS-related QoL, Qmax, and PVR were evaluated at baseline and later every 6 months. RESULTS Total 103 patients were finally available: 50 in the TAM+SR group and 53 in the TAM group. At 12 months, total IPSS decreased by 5.8 with TAM+SR and 5.5 with TAM (p=0.693); the storage symptoms improved significantly more with TAM+SR (-1.7 vs. -0.8 with TAM, p=0.024). This benefit with regard to storage symptom in the TAM+SR group lasts at 12 months (-1.9 vs. -0.9, p=0.024). The changes of voiding subscore, LUTS-related QoL, Qmax, PVR, PSA, and prostate volume showed no significant differences between the TAM+SR and TAM groups. During the treatment period, 8 patients (16.9%) with TAM and 10 (20%) with TAM+SR had drug-related adverse reactions, which included ejaculatory disorders, postural hypotension, dizziness, headache, gastro-intestinal disorders, rhinitis, fatigue and asthenia. CONCLUSIONS The combination treatment of Serenoa repens and tamsulosin was shown to be more effective than tamsulosin monotherapy in reducing storage symptoms in BPH patients after 6 months and up to 12 months of treatment.
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Affiliation(s)
- Young Woo Ryu
- Department of Urology, KEPCO Medical Center, Seoul, Korea
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Heidari M, Hosseinabadi R, Anbari K, Pournia Y, Tarverdian A. Seidlitzia rosmarinus for lower urinary tract symptoms associated with benign prostatic hyperplasia: a pilot randomized controlled clinical trial. Complement Ther Med 2014; 22:607-13. [PMID: 25146062 DOI: 10.1016/j.ctim.2014.06.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2013] [Revised: 06/02/2014] [Accepted: 06/08/2014] [Indexed: 10/25/2022] Open
Abstract
OBJECTIVE This study was performed to investigate the effect of Seidlitzia rosmarinus on the clinical symptoms of benign prostatic hyperplasia. METHODS This single-blind clinical trial included 98 patients with voiding and storage symptoms in Shohada Ashayer Hospital of Khorramabad. The patients were randomly divided into two groups of treatment with prazosin 1mg/day plus Seidlitzia rosmarinus 3g/day and treatment with prazosin 1mg/day. The clinical symptoms were measured using the International Prostate Symptoms Score (IPSS) questionnaire. Serum prostate-specific antigen (PSA) level, prostate volume, and residual urine volume before and 2 months after the intervention were measured. RESULTS The results of the study before the intervention did not show significant differences between the prazosin and Seidlitzia rosmarinus plus prazosin groups for the scores of clinical symptoms, PSA level, prostate volume, and residual urine volume (p>0.05). However, significant differences were found between the two groups after the intervention for the mean change scores of clinical symptoms (6.8 scores in the Seidlitzia rosmarinus group vs. 2 scores in the control group) (p<0.001), while no significant differences were found for the mean change scores of PSA level, prostate volume, and residual urine volume (p>0.05). CONCLUSION The results of the study showed that the simultaneous consumption of Seidlitzia rosmarinus and prazosin, compared to the consumption of prazosin alone, results in significant improvements in the clinical symptoms of benign prostatic hyperplasia.
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Affiliation(s)
- Mohammad Heidari
- Razi Herbal Medicines Research Center, Lorestan University of Medical Sciences, Khorramabad, Iran
| | - Reza Hosseinabadi
- Social Determinants of Health Research Center, Lorestan University of Medical Sciences, Khorramabad, Iran.
| | - Khatereh Anbari
- Social Determinants of Health Research Center, Lorestan University of Medical Sciences, Khorramabad, Iran
| | - Yadollah Pournia
- Faculty of Medicine, Lorestan University of Medical Sciences, Khorramabad, Iran
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Bardaweel SK. Alternative and antioxidant therapies used by a sample of infertile males in Jordan: a cross-sectional survey. BMC COMPLEMENTARY AND ALTERNATIVE MEDICINE 2014; 14:244. [PMID: 25026980 PMCID: PMC4223394 DOI: 10.1186/1472-6882-14-244] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/13/2014] [Accepted: 06/30/2014] [Indexed: 11/16/2022]
Abstract
Background Complementary and alternative medicine (CAM) is frequently used in the Middle East, especially to treat chronic diseases such as infertility. We aimed to examine the prevalence, characteristics, and determinants of CAM use, particularly herbs and antioxidant therapies, among infertile males presenting for infertility evaluation in Jordan. Methods Demographic information, use of alternative and antioxidant therapies for infertility treatment, and patients’ belief in efficacy and safety of the therapies used were collected using a face-to-face questionnaire. Data were collected from 428 infertile male patients presenting at infertility clinics in Amman, the capital city of Jordan. The study was conducted between April 2013 and September 2013. Results Of the 428 men who completed the questionnaire, 184 (43%) used at least one of the alternative and antioxidant therapies specified in the questionnaire. Nutritional regime; vitamins, such as vitamins C and E; and medicinal herbs, such as ginger, saw palmetto, and ginseng were the most commonly used therapies reported. A correlation between the use of alternative and antioxidant therapies versus infertility duration was found. Additionally, the majority of males using CAM did not inform their health care providers about their usage. Conclusions The high prevalence of CAM use among infertile male patients underscores the urge to assimilate CAM into the education and training of health professionals, as well as to improve infertile patients’ knowledge of the safe use of CAM modalities.
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Chua T, Eise NT, Simpson JS, Ventura S. Pharmacological characterization and chemical fractionation of a liposterolic extract of saw palmetto (Serenoa repens): effects on rat prostate contractility. JOURNAL OF ETHNOPHARMACOLOGY 2014; 152:283-291. [PMID: 24463033 DOI: 10.1016/j.jep.2013.12.030] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/27/2013] [Revised: 12/06/2013] [Accepted: 12/18/2013] [Indexed: 06/03/2023]
Abstract
ETHNOPHARMACOLOGICAL RELEVANCE Saw palmetto (Serenoa repens) was first used medicinally by native American Indians to treat urological disorders. Nowadays, saw palmetto extracts are widely used in Europe and North America to treat the urinary symptoms associated with benign prostatic hyperplasia even though its mechanisms of action are poorly understood. This study aimed to characterize the bioactive constituents of a lipid extract of saw palmetto that are able to affect contractility of the rat prostate gland. The mechanism of action will also be investigated. MATERIALS AND METHODS A commercially available lipid extract of saw palmetto was subjected to fractionation using normal phase column chromatography. Composition of fractions was assessed by proton nuclear magnetic resonance spectroscopy ((1)H NMR) and mass spectrometry (MS). Contractile activities of these fractions were evaluated pharmacologically using isolated preparations of rat prostate gland and compared to the activity of the crude extract. RESULTS Saw palmetto extract inhibited contractions of the rat prostate gland which were consistent with smooth muscle relaxant activity. Only the ethyl acetate fraction resulting from chromatography inhibited contractions of isolated rat prostates similarly to the inhibition produced by the crude lipid extract. Comparison with authentic samples and analysis of NMR data revealed that this bioactivity was due to the fatty acid components present in the ethyl acetate fraction. Bioassay using various pharmacological tools identified multiple contractile mechanisms which were affected by the bioactive constituents. CONCLUSION A fatty acid component of saw palmetto extract causes inhibition of prostatic smooth muscle contractions via a non-specific mechanism.
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Affiliation(s)
- Thiam Chua
- Drug Discovery Biology, Monash Institute of Pharmaceutical Sciences, Monash University, 381 Royal Parade, Parkville, VIC 3052, Australia
| | - Nicole T Eise
- Drug Discovery Biology, Monash Institute of Pharmaceutical Sciences, Monash University, 381 Royal Parade, Parkville, VIC 3052, Australia; Medicinal Chemistry, Monash Institute of Pharmaceutical Sciences, Monash University, Parkville, VIC 3052, Australia
| | - Jamie S Simpson
- Medicinal Chemistry, Monash Institute of Pharmaceutical Sciences, Monash University, Parkville, VIC 3052, Australia
| | - Sabatino Ventura
- Drug Discovery Biology, Monash Institute of Pharmaceutical Sciences, Monash University, 381 Royal Parade, Parkville, VIC 3052, Australia.
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Andriole GL, McCullum-Hill C, Sandhu GS, Crawford ED, Barry MJ, Cantor A. The effect of increasing doses of saw palmetto fruit extract on serum prostate specific antigen: analysis of the CAMUS randomized trial. J Urol 2013; 189:486-92. [PMID: 23253958 PMCID: PMC3979451 DOI: 10.1016/j.juro.2012.09.037] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2012] [Accepted: 08/28/2012] [Indexed: 10/27/2022]
Abstract
PURPOSE Saw palmetto extracts are used to treat lower urinary tract symptoms in men despite level I evidence that saw palmetto is ineffective in reducing these lower urinary tract symptoms. We determined whether higher doses of saw palmetto as studied in the CAMUS (Complementary and Alternative Medicine for Urologic Symptoms) trial affect serum prostate specific antigen levels. MATERIALS AND METHODS The CAMUS trial was a randomized, placebo controlled, double-blind, multicenter, North American trial conducted between June 5, 2008 and October 10, 2012, in which 369 men older than 45 years with an AUA symptom score of 8 to 24 were randomly assigned to placebo or dose escalation of saw palmetto, which consisted of 320 mg for the first 24 weeks, 640 mg for the next 24 weeks and 960 mg for the last 24 weeks of this 72-week trial. Serum prostate specific antigen levels were obtained at baseline and at weeks 24, 48 and 72, and were compared between treatment groups using the pooled t test and Fisher's exact test. RESULTS Serum prostate specific antigen was similar at baseline for the placebo (mean ± SD 1.93 ± 1.59 ng/ml) and saw palmetto groups (2.20 ± 1.95, p = 0.16). Changes in prostate specific antigen during the study were similar, with a mean change in the placebo group of 0.16 ± 1.08 ng/ml and 0.23 ± 0.83 ng/ml in the saw palmetto group (p = 0.50). In addition, no differential effect on serum prostate specific antigen was observed between treatment arms when the groups were stratified by baseline prostate specific antigen. CONCLUSIONS Saw palmetto extract does not affect serum prostate specific antigen more than placebo, even at relatively high doses.
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Affiliation(s)
- Gerald L Andriole
- Division of Urologic Surgery, Washington University School of Medicine, St. Louis, Missouri 63110, USA.
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D. Lephart E. Severe & Moderate BPH Symptoms in Mid-Aged Men Improve with Isoflavonoid-Equol Treatment: Pilot Intervention Study. ACTA ACUST UNITED AC 2013. [DOI: 10.4236/oju.2013.31004] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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de Souza PAVR, Palumbo A, Alves LM, de Souza VP, Cabral LM, Fernandes PD, Takiya CM, Menezes FS, Nasciutti LE. Effects of a nanocomposite containing Orbignya speciosa lipophilic extract on Benign Prostatic Hyperplasia. JOURNAL OF ETHNOPHARMACOLOGY 2011; 135:135-146. [PMID: 21396436 DOI: 10.1016/j.jep.2011.03.003] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/29/2010] [Revised: 02/17/2011] [Accepted: 03/01/2011] [Indexed: 05/30/2023]
Abstract
ETHNOPHARMACOLOGICAL RELEVANCE Lower urinary tract symptoms (LUTS) are a common complaint among aging men and are usually caused by Benign Prostatic Hyperplasia (BPH). A number of medical treatments for LUTS/BPH exist, such as α-blockers, 5α-reductase inhibitors, phytotherapeutical drugs and combination therapies. Babassu is the common name of a Brazilian native palm tree called Orbignya speciosa, whose kernels are commonly used (eaten entirely or as a grounded powder), in parts of Brazil for the treatment of urinary disorders. This study investigates the effects of Orbignya speciosa nanoparticle extract, a newly developed phytotherapic formulation derived from the kernels of babassu, in the treatment of BPH. MATERIALS AND METHODS Orbignya speciosa extract was obtained from the kernels, a nanoparticulate system was developed and acute toxicity test was performed. BPH primary stromal cell and tissue cultures were established and treated with 300μg/mL Orbignya speciosa nanoparticle (NanoOse) extract in order to evaluate its effects on apoptosis induction, cytotoxicity, cell morphology and proliferation. RESULTS Our results indicated that NanoOSE shows no toxicity in animals and acts incisively by promoting morphological cell changes, reducing cell proliferation as well as inducing necrosis/apoptosis on BPH cells and tissues. CONCLUSIONS This study provided the first report of the successful use of NanoOSE on BPH treatment which corroborates with the popular use of the kernels of this plant. The results also suggest the potential of NanoOSE as a candidate new phytotherapeutic agent on the management of BPH.
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Affiliation(s)
- Pedro A V Reis de Souza
- Programa de Pesquisa em Biologia Celular e do Desenvolvimento, Instituto de Ciências Biomédicas, Universidade Federal do Rio de Janeiro, Cidade Universitária-Ilha do Fundão, 21941-590 Rio de Janeiro, RJ, Brazil
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Shah NB, Wittich CM. 82-year-old man with bilateral leg swelling. Mayo Clin Proc 2010; 85:859-62. [PMID: 20810796 PMCID: PMC2931621 DOI: 10.4065/mcp.2009.0654] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Affiliation(s)
- Neel B. Shah
- Resident in Internal Medicine, Mayo School of Graduate Medical Education, Mayo Clinic, Rochester, MN
| | - Christopher M. Wittich
- Adviser to resident and Consultant in General Internal Medicine, Mayo Clinic, Rochester, MN
- Individual reprints of this article are not available. Address correspondence to Christopher M. Wittich, MD, PharmD, Division of General Internal Medicine, Mayo Clinic, 200 First St SW, Rochester, MN 55905 ()
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Lee J, Andriole G, Avins A, Crawford ED, Foster H, Kaplan S, Kreder K, Kusek J, McCullough A, McVary K, Meleth S, Naslund M, Nickel JC, Nyberg L, Roehrborn C, Dale Williams O, Barry M. Redesigning a large-scale clinical trial in response to negative external trial results: the CAMUS study of phytotherapy for benign prostatic hyperplasia. Clin Trials 2009; 6:628-36. [PMID: 20007408 DOI: 10.1177/1740774509352199] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Benign prostatic hyperplasia (BPH), a common condition among older men, confers its morbidity through potentially bothersome lower urinary tract symptoms. Treatments for BPH include drugs such as alpha-adrenergic receptor blockers and 5-alpha reductase inhibitors, minimally invasive therapies that use heat to damage or destroy prostate tissue, and surgery including transurethral resection of the prostate. Complementary and alternative medicines are gaining popularity in the US. Two phytotherapies commonly used for BPH are extracts of the fruit of Serenoa repens, the Saw palmetto dwarf palm that grows in the Southeastern US, and extracts of the bark of Pygeum africanum, the African plum tree. PURPOSE The objective of the Complementary and Alternative Medicines for Urological Symptoms (CAMUS) clinical trial is to determine if phytotherapy is superior to placebo in the treatment of BPH. METHODS CAMUS was originally designed as a 3300-participant, four-arm trial of S. repens, P. africanum, an alpha-adrenergic blocking drug, and placebo with time to clinical progression of BPH, a measure of long-term efficacy, as the primary endpoint. Before enrollment started, a randomized, double-blind, placebo-controlled, single institution clinical trial showed that S. repens at the usual dose did not demonstrate any benefit over placebo with respect to symptom relief at 1 year. Consequently, the focus of CAMUS shifted from evaluating long-term efficacy to determining if any short-term (6-18 months) symptom relief could be achieved with increasing doses of S. repens, the phytotherapy most commonly used in the US for BPH. RESULTS Results are anticipated in 2011. CONCLUSIONS Trial design occurs in an environment of continually evolving information. In this case, emerging results from another trial suggested that a study of long-term efficacy was premature, and that an effective dose and preparation of S. repens had to be established before proceeding to a long-term clinical trial.
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Affiliation(s)
- Jeannette Lee
- Department of Biostatistics, University of Arkansas for Medical Sciences, Little Rock, AR 72205, USA.
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Cai T, Mazzoli S, Bechi A, Addonisio P, Mondaini N, Pagliai RC, Bartoletti R. Serenoa repens associated with Urtica dioica (ProstaMEV®) and curcumin and quercitin (FlogMEV®) extracts are able to improve the efficacy of prulifloxacin in bacterial prostatitis patients: results from a prospective randomised study. Int J Antimicrob Agents 2009; 33:549-53. [PMID: 19181486 DOI: 10.1016/j.ijantimicag.2008.11.012] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2008] [Revised: 11/25/2008] [Accepted: 11/26/2008] [Indexed: 10/21/2022]
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Baron A, Mancini M, Caldwell E, Cabrelle A, Bernardi P, Pagano F. Serenoa repensextract targets mitochondria and activates the intrinsic apoptotic pathway in human prostate cancer cells. BJU Int 2009; 103:1275-83. [DOI: 10.1111/j.1464-410x.2008.08266.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Shi R, Xie Q, Gang X, Lun J, Cheng L, Pantuck A, Rao J. Effect of Saw Palmetto Soft Gel Capsule on Lower Urinary Tract Symptoms Associated With Benign Prostatic Hyperplasia: A Randomized Trial in Shanghai, China. J Urol 2008; 179:610-5. [DOI: 10.1016/j.juro.2007.09.032] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2007] [Indexed: 10/22/2022]
Affiliation(s)
- Rong Shi
- School of Public Health, Shanghai, People’s Republic of China
| | - Qiungwen Xie
- School of Public Health, Shanghai, People’s Republic of China
| | - X. Gang
- School of Public Health, Shanghai, People’s Republic of China
| | - Jing Lun
- Ren Ji Hospital, Shanghai, People’s Republic of China
| | - Life Cheng
- Shanghai Jiao Tong University and Za Pu Community Health Service Center of Shanghai, Shanghai, People’s Republic of China
| | - Allan Pantuck
- Department of Urology, David Geffen School of Medicine, University of California-Los Angeles, Los Angeles, California
| | - Jianyu Rao
- Department of Pathology and Laboratory Medicine, David Geffen School of Medicine, University of California-Los Angeles, Los Angeles, California
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Wadsworth TL, Worstell TR, Greenberg NM, Roselli CE. Effects of dietary saw palmetto on the prostate of transgenic adenocarcinoma of the mouse prostate model (TRAMP). Prostate 2007; 67:661-73. [PMID: 17342743 DOI: 10.1002/pros.20552] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
BACKGROUND Several of the proposed mechanisms for the actions of the liposterolic extract of saw palmetto (SPE) are exerted on known risk factors for prostate cancer (CaP). This study investigated whether SPE could prevent the progression of CaP in a transgenic adenocarcinoma of the mouse prostate (TRAMP) model. METHODS Two different doses of SPE designed to deliver 50 mg/kg/day SPE and 300 mg/kg/day SPE were administered in a custom diet to TRAMP mice for 12 or 24 weeks. Body and organ weights were used to evaluate toxicity, and radioimmunoassay was used to measure plasma and tissue androgen levels to monitor effects of SPE on 5alpha reductase activity. Prostate tissues were evaluated histologically to determine the effect of treatment on tumor grade, cell proliferation, and apoptosis. RESULTS Treatment with 300 mg/kg/day SPE from 4 to 24 weeks of age significantly reduced the concentration of 5alpha-dihydrotestosterone (DHT) in the prostate and resulted in a significant increase in apoptosis and significant decrease in pathological tumor grade and frank tumor incidence. CONCLUSIONS Dietary supplementation with SPE may be effective in controlling CaP tumorigenesis. SPE suppression of prostatic DHT levels lends support to the hypothesis that inhibition of the enzyme 5alpha-reductase is a mechanism of action of this substance.
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Affiliation(s)
- Teri L Wadsworth
- Department of Physiology and Pharmacology, Oregon Health and Science University, Portland, OR 97239-3098, USA
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Messina BAM. Herbal Supplements: Facts and Myths—Talking to Your Patients About Herbal Supplements. J Perianesth Nurs 2006; 21:268-78; quiz 279-81. [PMID: 16935738 DOI: 10.1016/j.jopan.2006.05.004] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
The use of herbal supplements in the United States is steadily growing and raises concerns about safety, efficacy, and how they affect safe patient care. The direct health risks associated with herbal supplements include hypertension, prolonged bleeding, and the potential for drug-herb interactions. These potential drug interactions are of particular concern for patients undergoing anesthesia. This article provides a review of literature on the 10 most popular herbal supplements and addresses the herbal supplements' reported use, possible adverse effect(s), patient teaching, possible drug interaction(s), and recommendations regarding discontinuation before surgery.
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Affiliation(s)
- Barbara Ann M Messina
- School of Nursing, State University of New York at Stony Brook, Stony Brook, NY 11794-8240, USA.
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Maccagnano C, Salonia A, Briganti A, Teillac P, Schulman C, Montorsi F, Rigatti P. A Critical Analysis of Permixon™ in the Treatment of Lower Urinary Tract Symptoms Due to Benign Prostatic Enlargement. ACTA ACUST UNITED AC 2006. [DOI: 10.1016/j.eursup.2006.02.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Logan YT, Belgeri MT. Monotherapy versus combination drug therapy for the treatment of benign prostatic hyperplasia. ACTA ACUST UNITED AC 2005; 3:103-14. [PMID: 16129387 DOI: 10.1016/s1543-5946(05)00031-0] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/05/2005] [Indexed: 11/25/2022]
Abstract
BACKGROUND Benign prostatic hyperplasia (BPH) is a medical condition occurring in older men (ie, those aged >60 years) resulting from enlargement of the prostate gland. Consequently, affected men may experience bother-some urinary tract symptoms and diminished quality of life. The risk of lower urinary tract symptoms and complications such as acute urinary retention (AUR) may increase if BPH is untreated. Currently, 2 classes of drugs-alpha-adrenergic blockers (alpha-blockers) and 5alpha-reductase inhibitors-are indicated for the treatment of BPH. Although the 2 classes are commonly used in combination, the evidence has frequently not been supportive of this practice. Results from the Medical Therapy of Prostatic Symptoms (MTOPS) trial, the largest and longest clinical trial on this topic to date, revisited the role of combination therapy in the treatment of BPH. OBJECTIVE This review presents published trials evaluating alpha-blockers or 5alpha-reductase inhibitors used alone or in combination for the treatment of BPH. METHODS A MEDLINE search was conducted (December 1974 to November 2004) using the MeSH term prostatic hyperplasia limited to the subheading of drug therapy. These results were cross-referenced with the MeSH term combination drug therapy. An additional search was conducted using the MeSH terms finasteride and adrenergic alpha-antagonists limited to adverse effects and therapeutic uses. These results were cross-referenced with prostatic hyperplasia and combination drug therapy. Review articles and meta-analyses were also used. RESULTS The Veterans Affairs Cooperative Studies Benign Prostatic Hyperplasia Study Group and the Prospective European Doxazosin and Combination Therapy studies were well-designed trials that failed to support the theory that combination therapy is preferred over alpha-blockers alone. Finasteride was also shown to be no better than placebo for the outcomes of symptom score and peak urinary flow rates. Other trials suggested that combination therapy (which included finasteride) was more effective at reducing symptom scores in men with enlarged prostates at 1 year and that alpha-blockers may be successfully discontinued once patients are stabilized on finasteride. Although it was a prespecified secondary end point, the incidence of surgery or AUR was reduced by 51% using finasteride over placebo. The additive benefit finasteride provides in reducing symptoms, risk of AUR, and invasive surgery was observed within the first year of treatment and correlated with larger prostate sizes (mean [SD], approximately 55 [26] mL). The MTOPS trial further demonstrated a relative risk reduction of 66% in clinical progression rates for the combination-therapy group versus 39% for the doxazosin group compared with placebo (P < 0.001); the doxazosin group was not statistically different from the finasteride monotherapy group. Improvements in symptom scores were greater in the combination-therapy group versus the doxazosin (P = 0.006) and finasteride monotherapy (P < 0.001) groups. CONCLUSION Based on the literature, combination therapy has been proven to relieve symptoms and delay progression of BPH in men with moderate to severe symptoms and moderately enlarged prostate glands.
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Affiliation(s)
- Youlanda T Logan
- Department of Pharmacy Practice, Hampton University School of Pharmacy, Hampton, Virginia 23668, USA.
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Yang J, Te AE. Saw palmetto and finasteride in the treatment of category-III prostatitis/chronic pelvic pain syndrome. Curr Urol Rep 2005; 6:290-5. [PMID: 15978232 DOI: 10.1007/s11934-005-0026-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Chronic nonbacterial prostatitis/chronic pelvic pain syndrome is a common entity for which a standardized management has not been established. Patients often have a significant symptom complex and impact on quality of life, but very little is known about the efficacy of second- and third-line treatments, such as the use of herbal supplements. Many treatments studied in recent literature include antibiotics, alpha-blockade, anti-inflammatory agents, and cognitive behavioral interventions such as biofeedback and psychotherapy.
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Affiliation(s)
- Jennifer Yang
- Department of Urology, Weill Medical College of Cornell University, New York, NY 10021, USA
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Abstract
Benign prostatic hyperplasia (BPH) is common among aging men. Untreated BPH may lead to complications including urinary tract infection, acute urinary retention, and obstructive nephropathy. Diagnosing BPH can be challenging because lower urinary tract symptoms are found in conditions other than BPH, and prostate size correlates poorly with symptoms of obstruction. Nonetheless, a careful medical history and physical examination, along with prudent use of diagnostic tests, can yield an accurate diagnosis. We review the evaluation of men with suspected BPH and indications for referral to a urologist for invasive therapy. We also review supporting evidence and treatment considerations for saw palmetto and the 2 major classes of prescription medications, alpha1-adrenergic antagonists and 5alpha-reductase inhibitors.
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Affiliation(s)
- Thomas J Beckman
- Division of General Internal Medicine, Men's Health Center for Urology, and Department of Urology, Mayo Clinic College of Medicine, Rochester, MN 55905, USA.
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Buck AC. Is there a scientific basis for the therapeutic effects of serenoa repens in benign prostatic hyperplasia? Mechanisms of action. J Urol 2005; 172:1792-9. [PMID: 15540722 DOI: 10.1097/01.ju.0000140503.11467.8e] [Citation(s) in RCA: 81] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE The huge resurgence of interest in herbal remedies has spawned a global industry that now competes with conventional drugs as adjuncts and/or alternatives for various conditions. The medical treatment of benign prostatic hyperplasia (BPH) is no exception. Along with alpha-blockers and 5alpha-reductase inhibitors the extract of the American dwarf palm, Serenoa repens, is unquestionably the most widely used. Together with Pygeum africanum, an extract from the bark of the African plum tree, it is licensed in Germany, France and other European countries for symptomatic BPH. This review was done to analyze the large number of in vivo and in vitro laboratory studies that have been performed with extracts of Serenoa repens to elucidate mechanism(s) of action. MATERIALS AND METHODS A literature search (MEDLINE) revealed more than 30 publications relating to laboratory studies with extracts of Serenoa repens, addressing the question of a mechanism of action. It would appear that the n-hexane lipidosterolic extract of Serenoa repens, namely Permixon (Pierre Fabre Medicament, Boulogne, France), is a product that has uniquely been subjected to more scientific investigation than any other such preparation. RESULTS Placebo controlled and comparative clinical studies of Permixon indicate its efficacy for BPH/lower urinary tract symptoms. Numerous mechanisms of action have been proposed, including an antiandrogenic action, an anti-inflammatory effect and an antiproliferative influence through the inhibition of growth factors. CONCLUSIONS Set against the background of our current knowledge of the pathophysiology of the aging prostate, the results of these studies suggest a wide spectrum of activity. However, precise mechanism(s) of action remain obscure. Balance and caution are needed when extrapolating the results of in vitro laboratory studies to the complex human situation.
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Affiliation(s)
- A C Buck
- Glasgow Royal Infirmary, Glasgow, Scotland, United Kingdom.
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Abstract
African American men participated in a screening initiative and completed the 22-item Barriers to Prostate Cancer Screening Checklist. Forty-three men received a digital rectal exam (DRE) and prostate specific antigen (PSA) laboratory test. The age of the males was M = 56.4 (range = 45-76) years; 47% were compliant with the American Cancer Society annual screening guidelines for high-risk individuals. Nineteen men from the screened group completed a 22-item Response to Barriers Checklist. The barrier ranked a "big problem" for not getting a prostate exam, and the highest by 32% (n = 6) of the sample was "Too many things going on in their lives." The lowest ranked problem by 100% of the participants was "Takes too long to get an appointment." Two individuals reported taking the over-the-counter supplement, saw palmetto. It is important that when planning a health screening in the community, both barriers and advantages be evaluated during the planning and before the implementation phase of the project.
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Abstract
BACKGROUND Permixon, a phytotherapeutic agent derived from the saw palmetto or Serenoa repens plant, is a lipid/sterol extract that is believed to interfere with 5alpha-reductase activity, thus inhibiting prostate growth. In this study, we investigated the magnitude and specificity of the effect of Permixon on cell proliferation and apoptosis in human prostate cancer cells. METHODS The effect of Permixon was examined in androgen-independent PC-3 prostate cancer cells, androgen-sensitive LNCaP prostate cancer cells, and MCF-7 breast cancer cells in vitro. Cell growth, apoptosis induction, and cell proliferation was studied after exposure to Permixon at two concentrations (10 and 100 microg/ml). Cell proliferation and cell cycle progression were determined after 24 hr on the basis of (3)[H]-thymidine incorporation assay and flowcytometric analysis, respectively. Apoptosis induction was evaluated in treated and untreated cultures using the Hoescht staining and caspase-3 activation. RESULTS Exposure of prostate and breast cancer cells to a high dose of Permixon (100 microg/ml) resulted in a significant decrease in the rate of cell growth; an effect that was not time-dependent and was not associated with cell cycle arrest. Permixon treatment (at either high or low dose) had no effect on apoptosis induction in prostate cancer cell lines (P > 0.6). Furthermore, in vitro Permixon was a weak inhibitor of 5alpha-reductase activity type 2 in prostatic homogenates. CONCLUSIONS The results indicate the ability of Permixon to affect prostate cancer cell growth without inducing apoptosis or cell cycle arrest. This effect was not prostate-specific and was only manifested at high concentrations of Permixon. Furthermore our findings indicate that Permixon is weak inhibitor of 5alpha-reductase compared to finasteride. This study challenges previous evidence on the anti-growth effect of Permixon in the prostate and its ability to inhibit 5alpha-reductase activity, while questioning apoptosis as a mechanism of action of this phytotherapeutic against prostate growth, a concept that may have therapeutic significance.
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Affiliation(s)
- Brian Hill
- Division of Urology, University of Maryland School of Medicine, Baltimore, MD, USA
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Wadsworth TL, Carroll JM, Mallinson RA, Roberts CT, Roselli CE. Saw palmetto extract suppresses insulin-like growth factor-I signaling and induces stress-activated protein kinase/c-Jun N-terminal kinase phosphorylation in human prostate epithelial cells. Endocrinology 2004; 145:3205-14. [PMID: 15033918 DOI: 10.1210/en.2003-1716] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
A common alternative therapy for benign prostatic hyperplasia (BPH) is the extract from the fruit of saw palmetto (SPE). BPH is caused by nonmalignant growth of epithelial and stromal elements of the prostate. IGF action is important for prostate growth and development, and changes in the IGF system have been documented in BPH tissues. The main signaling pathways activated by the binding of IGF-I to the IGF-I receptor (IGF-IR) are the ERK arm of the MAPK cascade and the phosphoinositol-3-kinase (PI3K)/protein kinase B (PKB/Akt) cascade. We tested the hypothesis that SPE suppresses growth and induces apoptosis in the P69 prostate epithelial cell line by inhibiting IGF-I signaling. Treatment with 150 microg/ml SPE for 24 h decreased IGF-I-induced proliferation of P69 cells and induced cleavage of the enzyme poly(ADP-ribose)polymerase (PARP), an index of apoptosis. Treatment of serum-starved P69 cells with 150 microg/ml SPE for 6 h reduced IGF-I-induced phosphorylation of Akt (assessed by Western blot) and Akt activity (assessed by an Akt kinase assay). Western blot analysis showed that SPE reduced IGF-I-induced phosphorylation of the adapter protein insulin receptor substrate-1 and decreased downstream effects of Akt activation, including increased cyclin D1 levels and phosphorylation of glycogen synthase kinase-3 and p70(s6k). There was no effect on IGF-I-induced phosphorylation of MAPK, IGF-IR, or Shc. Treatment of starved cells with SPE alone induced phosphorylation the proapoptotic protein JNK. SPE treatment may relieve symptoms of BPH, in part, by inhibiting specific components of the IGF-I signaling pathway and inducing JNK activation, thus mediating antiproliferative and proapoptotic effects on prostate epithelia.
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Affiliation(s)
- Teri L Wadsworth
- Department of Physiology and Pharmacology L334, Oregon Health and Science University, 3181 Sam Jackson Park Road, Portland, Oregon 97239, USA
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Debruyne F, Boyle P, Calais Da Silva F, Gillenwater JG, Hamdy FC, Perrin P, Teillac P, Vela-Navarrete R, Raynaud JP, Schulman CC. Evaluation of the Clinical Benefit of Permixon and Tamsulosin in Severe BPH Patients—PERMAL Study Subset Analysis. Eur Urol 2004; 45:773-9; disucssion 779-80. [PMID: 15149751 DOI: 10.1016/j.eururo.2004.01.015] [Citation(s) in RCA: 56] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/05/2004] [Indexed: 11/23/2022]
Abstract
OBJECTIVE To compare the efficacy of the lipido-sterolic extract of Serenoa repens, Permixon, to that of the alpha-blocker, tamsulosin, in the treatment of severe low urinary tract symptoms (LUTS) of benign prostatic hyperplasia (BPH). METHODS In a 12-month, double-blind, randomized study that showed equivalent efficacy of Permixon 320 mg/day and tamsulosin 0.4 mg/day ("PERMAL study"), 685 BPH patients with IPSS > or =10 had been analyzed for efficacy. Of these, the 124 patients with severe LUTS (IPSS >19) at randomization were retained for this subset analysis. After a 4-week run-in period, 59 and 65 patients had been randomized to tamsulosin and Permixon groups, respectively. Both treatment groups were compared regarding the evolution from baseline of total IPSS and its irritative and obstructive subscores, LUTS-related QoL, prostate volume, Q(max) and MSF-4 (sexual activity questionnaire) at different time points over 1 year. An analysis of variance of changes from baseline to end point was performed for all the parameters. The over-time evolutions of total, irritative and obstructive IPSS were further compared using a variance analysis for repeated measurements. RESULTS At 12 months, total IPSS decreased by 7.8 with Permixon and 5.8 with tamsulosin (p=0.051); the irritative symptoms improved significantly more (p=0.049) with Permixon (-2.9 versus -1.9 with tamsulosin). The superiority of Permixon in reducing irritative symptoms appeared as soon as month 3 and was maintained up to month 12 (p=0.03). CONCLUSION Permixon 320 mg/day was shown to be slightly superior to tamsulosin 0.4 mg/day in reducing LUTS in severe BPH patients after 3 months and up to 12 months of treatment.
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Affiliation(s)
- Frans Debruyne
- Department of Urology, Academic Hospital Nijmegen, Geert Grooteplein Zuid 16, 426 Afdeling Urologie, 6500 HB Nijmegen, The Netherlands.
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Abstract
OBJECTIVES To examine the patterns of use of alternative and hormonal therapies in men presenting for infertility evaluation. METHODS We administered a questionnaire on the use of alternative and hormonal therapies to 500 consecutive men presenting for infertility evaluation at our male infertility clinic. The questionnaire asked about the use of specific therapies (eg, vitamins, herbal medicine, or hormones), the monthly cost of these therapies, and whether the principal healthcare provider had been made aware of the use of therapies. RESULTS Of the 481 men who completed the questionnaire, 147 (31%) admitted to using one or more alternative therapies. Most of the men using alternative therapies (92 of 147, 63%) were taking one or more antioxidant vitamins or minerals (ie, vitamins C, E, selenium, zinc), and 18 men admitted to using herbal medicines. Of concern, 25 men reported using agents with clear hormonal activity (testosterone, clomiphene citrate), and 6 of these men had not informed their principal healthcare provider of this. CONCLUSIONS Our data suggest that a significant percentage ( approximately 30%) of men presenting for infertility evaluation do use alternative therapies. It is important to inquire about the use of these therapies because some of these treatments may be toxic to the gonads.
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Affiliation(s)
- Armand Zini
- Division of Urology, Department of Surgery, Mount Sinai Hospital, University of Toronto, Toronto, Ontario, Canada
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Affiliation(s)
- Peter S Nelson
- Division of Human Biology, Fred Hutchinson Cancer Research Center, 1100 Fairview Avenue, Seattle, Washington 98105, USA.
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Abstract
OBJECTIVE To review and evaluate the literature relative to the use of herbal therapies in the treatment of benign prostatic hyperplasia. DATA SOURCES Literature was identified by MEDLINE, Embase, International Pharmaceutical Abstracts, and the International Bibliographic Information on Dietary Supplements searches and through cross-referencing of selected articles. STUDY SELECTION/DATA EXTRACTION All articles identified from the data sources were evaluated and all information deemed relevant was included in this review. DATA SYNTHESIS A large percentage of men >50 years old begin to experience signs and symptoms of benign prostatic hyperplasia (BPH). Herbs hold promise in the treatment of BPH. Serenoa repens, Pygeum africanum, Urtica dioica radix, and Cucurbita peponis semen are some of the botanical therapies used in the treatment of BPH. CONCLUSIONS There are many European studies examining efficacy, dose, and adverse effects of these plants in the treatment of BPH. However, numerous questions remain. These include issues concerning long-term beneficial and adverse effects of herbal therapy, prevention of complications, standardization of extracts, and concomitant use with "mainstream" medications. Based on the information available today, these botanical therapies can be used for treatment of a number of objective and subjective symptoms in patients with BPH, stages I and II.
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Affiliation(s)
- Lana Dvorkin
- Center for Integrative Therapies in Pharmaceutical Care, Massachusetts College of Pharmacy and Health Sciences, Boston, MA 02115-5896, USA.
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Feifer AH, Fleshner NE, Klotz L. Analytical Accuracy and Reliability of Commonly Used Nutritional Supplements in Prostate Disease. J Urol 2002. [DOI: 10.1016/s0022-5347(05)64850-1] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Andrew H. Feifer
- From the Department of Surgery, Division of Urology, Toronto Sunnybrook Regional Cancer Centre, Toronto, Ontario, Canada
| | - Neil E. Fleshner
- From the Department of Surgery, Division of Urology, Toronto Sunnybrook Regional Cancer Centre, Toronto, Ontario, Canada
| | - Laurence Klotz
- From the Department of Surgery, Division of Urology, Toronto Sunnybrook Regional Cancer Centre, Toronto, Ontario, Canada
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38
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Abstract
There are numerous plant extracts that have been used for the treatment of benign prostatic hyperplasia and lower urinary tract symptoms. While some extracts show promise, their efficacy has not been adequately proven in long-term, double-blind placebo-controlled trials monitored by an outside agency.
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Affiliation(s)
- Franklin C Lowe
- Department of Urology, Columbia College of Physicians and Surgeons, New York, New York, USA
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Affiliation(s)
- P N Schlegel
- Department of Urology, New York Presbyterian Hospital-Weill Cornell Medical Center, New York, USA
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40
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41
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Abstract
This article reviews complementary and alternative therapies for advanced prostate cancer. This is not a comprehensive survey of nontraditional therapies for prostate cancer. Rather, this review focuses on alternative and complementary therapies with published studies to evaluate efficacy and safety. Three areas are addressed: alternative forms of hormonal therapy, management of side effects of hormonal therapy, and management of skeletal complications.
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Affiliation(s)
- M R Smith
- Division of Hematology and Oncology, Massachusetts General Hospital Cancer Center, Boston, USA.
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42
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Marks LS, Hess DL, Dorey FJ, Luz Macairan M, Cruz Santos PB, Tyler VE. Tissue effects of saw palmetto and finasteride: use of biopsy cores for in situ quantification of prostatic androgens. Urology 2001; 57:999-1005. [PMID: 11337315 DOI: 10.1016/s0090-4295(00)01052-9] [Citation(s) in RCA: 55] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVES To determine the effects of a saw palmetto herbal blend (SPHB) compared with finasteride on prostatic tissue androgen levels and to evaluate needle biopsies as a source of tissue for such determinations. METHODS Prostate levels of testosterone and dihydrotestosterone (DHT) were measured on 5 to 10-mg biopsy specimens (18-gauge needle cores) in three groups of men with symptomatic benign prostatic hyperplasia: 15 men receiving chronic finasteride therapy versus 7 untreated controls; 4 men undergoing prostate adenomectomy to determine sampling variability (10 specimens each); and 40 men participating in a 6-month randomized trial of SPHB versus placebo, before and after treatment. RESULTS Prostatic tissue DHT levels were found to be several times higher than the levels of testosterone (5.01 versus 1.51 ng/g), that ratio becoming reversed (1.05 versus 3.63 ng/g) with chronic finasteride therapy. The finasteride effect was statistically significant for both androgens (P <0.01), and little overlap of individual values between finasteride-treated and control patients was seen. In the randomized trial, tissue DHT levels were reduced by 32% from 6.49 to 4.40 ng/g in the SPHB group (P <0.005), with no significant change in the placebo group. CONCLUSIONS For control versus finasteride-treated men, the tissue androgen values obtained with needle biopsy specimens were similar-both for absolute values and the percentage of change-to those previously reported using surgically excised volumes of prostatic tissue. The quantification of prostatic androgens by assay of needle biopsies is thus feasible and offers the possibility of serial studies in individual patients. The SPHB-induced suppression of prostatic DHT levels, modest but significant in a randomized trial, lends an element of support to the hypothesis that inhibition of the enzyme 5-alpha reductase is a mechanism of action of this substance.
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Affiliation(s)
- L S Marks
- Urological Sciences Research Foundation, Culver City, California, USA
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43
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Abstract
The standard medical therapy for symptomatic benign prostatic hyperplasia is still alpha-blockers and 5alpha-reductase inhibitors. Ongoing studies demonstrate the long-term safety and efficacy of these two classes of therapeutic approaches. Although there have been no new Food and Drug Administration approved medical therapies for the treatment of benign prostatic hyperplasia over the past year, interest in and the use of phytotherapeutic agents continues to increase. In this review, we will discuss the developments that have occurred over the past year in the medical management of benign prostatic hyperplasia. In addition, we present ongoing efforts at our center to obtain a better understanding of and manipulate the apoptotic pathway as it pertains to the pathophysiology of benign prostatic hyperplasia.
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Affiliation(s)
- D C Cuellar
- Department of Surgery, Division of Urology, The University of Maryland Medical System, Baltimore 21201, USA
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