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Katsimperis S, Kapriniotis K, Manolitsis I, Bellos T, Angelopoulos P, Juliebø-Jones P, Somani B, Skolarikos A, Tzelves L. Early investigational agents for the treatment of benign prostatic hyperplasia'. Expert Opin Investig Drugs 2024; 33:359-370. [PMID: 38421373 DOI: 10.1080/13543784.2024.2326023] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2023] [Accepted: 02/28/2024] [Indexed: 03/02/2024]
Abstract
INTRODUCTION Benign prostatic hyperplasia (BPH), as a clinical entity that affects many people, has always been in the forefront of interest among researchers, pharmaceutical companies, and physicians. Patients with BPH exhibit a diverse range of symptoms, while current treatment options can occasionally cause adverse events. All the aforementioned have led to an increased demand for more effective treatment options. AREAS COVERED This review summarizes the outcomes of new medications used in a pre-clinical and clinical setting for the management of male lower urinary tract symptoms (LUTS)/BPH and provides information about ongoing trials and future directions in the management of this condition. More specifically, sheds light upon drug categories, such as reductase‑adrenoceptor antagonists, drugs interfering with the nitric oxide (NO)/cyclic guanosine monophosphate (GMP) signaling pathway, onabotulinumtoxinA, vitamin D3 (calcitriol) analogues, selective cannabinoid (CB) receptor agonists, talaporfin sodium, inhibitor of transforming growth factor beta 1 (TGF-β1), drugs targeting the hormonal control of the prostate, phytotherapy, and many more. EXPERT OPINION Clinical trials are being conducted on a number of new medications that may emerge as effective therapeutic alternatives in the coming years.
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Affiliation(s)
- Stamatios Katsimperis
- 2nd University Department of Urology, Sismanoglio Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | | | - Ioannis Manolitsis
- 2nd University Department of Urology, Sismanoglio Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Themistoklis Bellos
- 2nd University Department of Urology, Sismanoglio Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Panagiotis Angelopoulos
- 2nd University Department of Urology, Sismanoglio Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Patrick Juliebø-Jones
- Department of Urology, Haukeland University Hospital, Bergen, Norway
- Department of Clinical Medicine, University of Bergen, Bergen, Norway
| | - Bhaskar Somani
- Department of Urology, University Hospital Southampton, Southampton, UK
| | - Andreas Skolarikos
- 2nd University Department of Urology, Sismanoglio Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Lazaros Tzelves
- 2nd University Department of Urology, Sismanoglio Hospital, National and Kapodistrian University of Athens, Athens, Greece
- Department of Urology, University College of London Hospitals (UCLH), London, UK
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Samir H, Mahgoub S, Badr JM, El-Gendy A, Hadad GM, Ibrahim EA. A UPLC- MS/MS Method to Quantify β-Sitosterol and Ferulic Acid of Pygeum Africanum Extract in Bulk and Pharmaceutical Preparation. J Chromatogr Sci 2023; 61:619-624. [PMID: 36097799 DOI: 10.1093/chromsci/bmac077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Revised: 05/25/2022] [Accepted: 08/21/2022] [Indexed: 11/13/2022]
Abstract
This study uses a liquid chromatography-electrospray ionization-tandem mass spectrometry method to determine β-Sitosterol and Ferulic acid in Pygeum africanum extract. Chromatographic separation of the two analytes was performed on an ACQUITY UPLC H-Class system coupled with Xevo TQD mass spectrometer and HSS T3 C18 column (2.1 X 50 mm, 1.8 μm). Mobile phase A consisted of an aqueous solution of 0.1% formic acid (v/v), and mobile phase B was 0.1% formic acid (v/v) in methanol pumped through a gradient elution mode. Mass spectrometer parameters were optimized using an electrospray ionization source in the positive and negative ionization modes. The quantification of the two analytes was performed using multiple reaction monitoring transitions. The method was fully validated per (FDA) guidelines regarding linearity, accuracy, precision, carryover and selectivity. The proposed method was applied successfully to determine the two investigated compounds in commercially available pharmaceutical products.
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Affiliation(s)
- Hanan Samir
- Medical administration, students' hospital, Zagazig University, Sharkia 44519, Egypt
| | - Sebaey Mahgoub
- Food Analysis Laboratory, Ministry of Health, Zagazig 44511, Egypt
| | - Jihan M Badr
- Pharmacognosy Department, Faculty of Pharmacy, Suez Canal University, Ismailia 41522, Egypt
| | - Alaa El-Gendy
- Pharmaceutical Analytical Chemistry Department, Faculty of Pharmacy, Suez Canal University, Ismailia 41522, Egypt
| | - Ghada M Hadad
- Pharmaceutical Analytical Chemistry Department, Faculty of Pharmacy, Suez Canal University, Ismailia 41522, Egypt
| | - Elsayed A Ibrahim
- Pharmaceutical Analytical Chemistry Department, Faculty of Pharmacy, Suez Canal University, Ismailia 41522, Egypt
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Role of Phytotherapy in the Management of BPH: A Summary of the Literature. J Clin Med 2023; 12:jcm12051899. [PMID: 36902686 PMCID: PMC10003922 DOI: 10.3390/jcm12051899] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2022] [Revised: 02/19/2023] [Accepted: 02/23/2023] [Indexed: 03/08/2023] Open
Abstract
Benign prostatic hyperplasia (BPH) describes the non-malignant enlargement of the prostate. It is both common and growing in incidence. Treatment is multimodal, involving conservative, medical, and surgical interventions. This review aims to examine the evidence base for phytotherapies, specifically analyzing their role in treating lower urinary tract symptoms (LUTS) attributable to BPH. A literature search was completed, specifically looking for randomized control trials (RCTs) and systematic reviews involving phytotherapy treating BPH. Specific emphasis was placed on exploring substance origin, the proposed mechanism of action, evidence of efficacy, and the side-effect profile. Several phytotherapeutic agents were evaluated. These included serenoa repens, cucurbita pepo, and pygeum Africanum, among others. For most of the reviewed substances, only modest effectiveness was reported. Generally, though, all treatments were tolerated well with minimal side effects. None of the treatments discussed in this paper form part of the recommended treatment algorithm in either European or American guidelines. We, therefore, conclude that phytotherapies, in the treatment of LUTS attributable to BPH, do provide a convenient option for patients, with minimal side effects. At present, however, the evidence for the usage of phytotherapy in BPH is inconclusive, with some agents having more backing than others. This remains an expansive field of urology whereby there is still more research to be done.
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Csikós E, Horváth A, Ács K, Papp N, Balázs VL, Dolenc MS, Kenda M, Kočevar Glavač N, Nagy M, Protti M, Mercolini L, Horváth G, Farkas Á, on behalf of the OEMONOM. Treatment of Benign Prostatic Hyperplasia by Natural Drugs. Molecules 2021; 26:7141. [PMID: 34885733 PMCID: PMC8659259 DOI: 10.3390/molecules26237141] [Citation(s) in RCA: 46] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2021] [Revised: 11/19/2021] [Accepted: 11/20/2021] [Indexed: 12/08/2022] Open
Abstract
Benign prostatic hyperplasia (BPH) is one of the most common urinary diseases affecting men, generally after the age of 50. The prevalence of this multifactorial disease increases with age. With aging, the plasma level of testosterone decreases, as well as the testosterone/estrogen ratio, resulting in increased estrogen activity, which may facilitate the hyperplasia of the prostate cells. Another theory focuses on dihydrotestosterone (DHT) and the activity of the enzyme 5α-reductase, which converts testosterone to DHT. In older men, the activity of this enzyme increases, leading to a decreased testosterone/DHT ratio. DHT may promote prostate cell growth, resulting in hyperplasia. Some medicinal plants and their compounds act by modulating this enzyme, and have the above-mentioned targets. This review focuses on herbal drugs that are most widely used in the treatment of BPH, including pumpkin seed, willow herb, tomato, maritime pine bark, Pygeum africanum bark, rye pollen, saw palmetto fruit, and nettle root, highlighting the latest results of preclinical and clinical studies, as well as safety issues. In addition, the pharmaceutical care and other therapeutic options of BPH, including pharmacotherapy and surgical options, are discussed, summarizing and comparing the advantages and disadvantages of each therapy.
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Affiliation(s)
- Eszter Csikós
- Department of Pharmacognosy, Faculty of Pharmacy, University of Pécs, H-7624 Pécs, Hungary; (E.C.); (K.Á.); (N.P.); (V.L.B.); (G.H.)
| | - Adrienn Horváth
- Department of Pharmaceutical Biology, Faculty of Pharmacy, University of Pécs, H-7624 Pécs, Hungary;
| | - Kamilla Ács
- Department of Pharmacognosy, Faculty of Pharmacy, University of Pécs, H-7624 Pécs, Hungary; (E.C.); (K.Á.); (N.P.); (V.L.B.); (G.H.)
| | - Nóra Papp
- Department of Pharmacognosy, Faculty of Pharmacy, University of Pécs, H-7624 Pécs, Hungary; (E.C.); (K.Á.); (N.P.); (V.L.B.); (G.H.)
| | - Viktória Lilla Balázs
- Department of Pharmacognosy, Faculty of Pharmacy, University of Pécs, H-7624 Pécs, Hungary; (E.C.); (K.Á.); (N.P.); (V.L.B.); (G.H.)
| | - Marija Sollner Dolenc
- University of Ljubljana, Department of Pharmaceutical Chemistry, Faculty of Pharmacy, SI-1000 Ljubljana, Slovenia; (M.S.D.); (M.K.)
| | - Maša Kenda
- University of Ljubljana, Department of Pharmaceutical Chemistry, Faculty of Pharmacy, SI-1000 Ljubljana, Slovenia; (M.S.D.); (M.K.)
| | - Nina Kočevar Glavač
- University of Ljubljana, Department of Pharmaceutical Biology, Faculty of Pharmacy, SI-1000 Ljubljana, Slovenia;
| | - Milan Nagy
- Department of Pharmacognosy and Botany, Faculty of Pharmacy, Comenius University in Bratislava, SK-832-32 Bratislava, Slovakia;
| | - Michele Protti
- Research Group of Pharmaco-Toxicological Analysis (PTA Lab), Department of Pharmacy and Biotechnology (FaBiT), Alma Mater Studiorum—University of Bologna, 40126 Bologna, Italy; (M.P.); (L.M.)
| | - Laura Mercolini
- Research Group of Pharmaco-Toxicological Analysis (PTA Lab), Department of Pharmacy and Biotechnology (FaBiT), Alma Mater Studiorum—University of Bologna, 40126 Bologna, Italy; (M.P.); (L.M.)
| | - Györgyi Horváth
- Department of Pharmacognosy, Faculty of Pharmacy, University of Pécs, H-7624 Pécs, Hungary; (E.C.); (K.Á.); (N.P.); (V.L.B.); (G.H.)
| | - Ágnes Farkas
- Department of Pharmacognosy, Faculty of Pharmacy, University of Pécs, H-7624 Pécs, Hungary; (E.C.); (K.Á.); (N.P.); (V.L.B.); (G.H.)
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Abreu-Mendes P, Silva J, Cruz F. Pharmacology of the lower urinary tract: update on LUTS treatment. Ther Adv Urol 2020; 12:1756287220922425. [PMID: 32489425 PMCID: PMC7238773 DOI: 10.1177/1756287220922425] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2019] [Accepted: 03/30/2020] [Indexed: 12/12/2022] Open
Abstract
The number of compounds used in the pharmacological treatment of lower urinary tract symptoms (LUTS) of patients who do not respond to conservative measures has been relatively stable during the last decade, with the exception of the introduction of the new class of β3 adrenoceptor agonists. However, different combinations have been investigated, and the long-term use of these compounds has raised new concerns about adherence and safety. This review summarizes the current state of pharmacology for LUTS, and presents a thorough discussion of the possible challenges concerning their future use. In this narrative review, we analyze the most recent articles related to LUTS pharmacotherapy, after an initial review of mechanisms of bladder function relevant in present clinical practice. The main problems with pharmacotherapy in LUTS are associated with its moderate efficacy, low persistence on treatment, and the incidence of short- and long-term adverse events (AE) associated with some compounds. The long-term AE, such as cognitive impairment in the elderly vulnerable patients associated with antimuscarinic drugs or persistent erectile dysfunction in sexually active men after treatment with 5-α-reductase inhibitors (5-ARI), are some of the problems addressed in this review. Combination therapy taking advantage of the synergistic mechanisms of action between some classes of compounds may overcome AE associated with dose escalation. LUTS pharmacotherapy offers moderate results to most patients but not a full cure. The use of combination drugs to achieve better clinical results, reduce AE and improve both efficacy and adherence, will be used more frequently in the future. The recently raised concern on potential long-term irreversible AE associated with some of these drugs, like antimuscarinics and 5-ARI, are critically important and require further investigation.
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Affiliation(s)
- Pedro Abreu-Mendes
- Department of Urology in Hospital de São João, Alameda Professor Hernâni Monteiro, Porto, 4200-319, Portugal
| | - João Silva
- Department of Urology, Hospital São João, Porto, Portugal
| | - Francisco Cruz
- Department of Urology, Hospital São João, Porto, Portugal
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Review of the experience and evidence of Pygeum africanum in urological practice. Actas Urol Esp 2020; 44:9-13. [PMID: 31627963 DOI: 10.1016/j.acuro.2019.08.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2019] [Revised: 08/04/2019] [Accepted: 08/27/2019] [Indexed: 11/22/2022]
Abstract
CONTEXT Pygeum africanum(P. africanum) is still being employed in urology practice for the treatment of lower urinary tract symptoms secondary to benign prostate hyperplasia. EVIDENCE ACQUISITION A non-exhaustive review has been carried out about P. africanum, its mechanisms of action "in vitro" as well as "in vivo", clinical trials and routine clinical practice. EVIDENCE SYNTHESIS The conclusions of the review and the reflections of the authors on the use of P. africanum are described. CONCLUSIONS Although with an evidence level IV (based on expert opinion) the use of P. africanum seems to be an option in the urological therapeutic arsenal.
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Ikeyi AP, Okagu IU, Ezeanyika LUS, Alumanah EO. Zapoteca portoricensis root crude methanol extract and its fractions normalizes aberrations associated with benign prostatic hyperplasia in rats. ALL LIFE 2020. [DOI: 10.1080/26895293.2020.1788653] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
Affiliation(s)
- Adachukwu Pauline Ikeyi
- Medical Parasitology, Toxicology and Drug Discovery Unit, Department of Biochemistry, University of Nigeria, Nsukka, Nigeria
| | - Innocent Uzochukwu Okagu
- Medical Parasitology, Toxicology and Drug Discovery Unit, Department of Biochemistry, University of Nigeria, Nsukka, Nigeria
| | | | - Edwin Olisah Alumanah
- Medical Parasitology, Toxicology and Drug Discovery Unit, Department of Biochemistry, University of Nigeria, Nsukka, Nigeria
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Eleazu C, Eleazu K, Kalu W. Management of Benign Prostatic Hyperplasia: Could Dietary Polyphenols Be an Alternative to Existing Therapies? Front Pharmacol 2017; 8:234. [PMID: 28503148 PMCID: PMC5408066 DOI: 10.3389/fphar.2017.00234] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2017] [Accepted: 04/12/2017] [Indexed: 02/05/2023] Open
Abstract
The incidence of benign prostatic hyperplasia (BPH) is gradually on the increase. While conventional drugs such as the α1-adrenergic receptor antagonists and 5α-reductase inhibitors have been found to be useful in the treatment of BPH, the adverse side effects associated with their usage, have led to increased search for alternative means of managing this disease. Furthermore, although surgery has also been suggested to be a sure method, the cost and risks associated with it excludes it as a routine treatment. Dietary polyphenols have gained public interest in recent times due to their roles in the prevention of various diseases that implicate free radicals/reactive oxygen species. However, their roles in the management of BPH have not been explored. Hence, this review on their prospects in the management of BPH and their mechanisms of action. Literature search was carried out in several electronic data bases such as PubMed, Google Scholar, Medline, Agora, and Hinari from1970 to 2017 to identify the current status of knowledge on this concept. The findings from these data bases suggest that while dietary polyphenols may not replace the need for the existing therapies in the management of BPH, they hold promise in BPH management which could be explored by researchers working in this field.
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Affiliation(s)
- Chinedum Eleazu
- Department of Chemistry/Biochemistry, Federal University Ndufu-Alike, IkwoAbakaliki, Nigeria
| | - Kate Eleazu
- Department of Biochemistry, Ebonyi State UniversityAbakaliki, Nigeria
| | - Winner Kalu
- Department of Biochemistry, Michael Okpara University of AgricultureUmudike, Nigeria
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Đorđević I, Milutinović M, Kostić M, Đorđević B, Dimitrijević M, Stošić N, Ranđelović M, Banković S, Kitić D. PHYTOTHERAPEUTIC APPROACH TO BENIGN PROSTATIC HYPERPLASIA TREATMENT BY PUMPKIN SEED (CUCURBITA PEPO L., CUCURBITACEAE). ACTA MEDICA MEDIANAE 2016. [DOI: 10.5633/amm.2016.0310] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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10
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What do we know about phytotherapy of benign prostatic hyperplasia? Life Sci 2015; 126:42-56. [DOI: 10.1016/j.lfs.2015.01.023] [Citation(s) in RCA: 58] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2014] [Revised: 12/22/2014] [Accepted: 01/21/2015] [Indexed: 02/08/2023]
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Bodeker G, van 't Klooster C, Weisbord E. Prunus africana (Hook.f.) Kalkman: the overexploitation of a medicinal plant species and its legal context. J Altern Complement Med 2014; 20:810-22. [PMID: 25225776 DOI: 10.1089/acm.2013.0459] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
The linkage between herbal medicines and the sustainability of medical plants from which they are manufactured is increasingly being understood and receiving attention through international accords and trade labeling systems. However, little attention is paid to the fair trade aspects of this sector, including the issue of benefit-sharing agreements with traditional societies whose knowledge and resources are being exploited for commercial herbal medicine development and production. This article examines the case of Prunus africana (Hook.f.) Kalkman, from equatorial Africa. While the conservation and cultivation dimension of the trade in P. africana has been much discussed in literature, no research appears to have focused on the traditional resource rights and related ethical dimensions of this trade in traditional medicine of Africa. Serving as a cautionary tale for the unbridled exploitation of medicinal plants, the history of P. africana extraction is considered here in the context of relevant treaties and agreements existing today. These include the Nagoya Protocol, a supplementary agreement to the Convention on Biological Diversity, the Trade-Related Aspects of Intellectual Property Rights agreement from the World Trade Organization, and two African regional frameworks: the Swakopmund Protocol and the Organisation Africaine de la Propriété Intellectuelle Initiative. In the context of strengthening medicinal plant research in Africa, a novel international capacity-building project on traditional medicines for better public health in Africa will be discussed, illustrating how access and benefit sharing principles might be incorporated in future projects on traditional medicines.
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Affiliation(s)
- Gerard Bodeker
- 1 Department of Primary Care Health Sciences, Division of Medical Sciences, University of Oxford , Oxford, United Kingdom
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Cambio AJ, Evans CP. Outcomes and quality of life issues in the pharmacological management of benign prostatic hyperplasia (BPH). Ther Clin Risk Manag 2011; 3:181-96. [PMID: 18360626 PMCID: PMC1936299 DOI: 10.2147/tcrm.2007.3.1.181] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Benign prostatic hyperplasia (BPH) is a common disease of the aging male population. BPH treatment includes a variety of pharmacological and surgical interventions. The goal of this paper is to review the natural history of BPH, outcomes of pharmacological management, effects on quality of life (QoL), future pharmacotherapies, and associated patient-focused perspectives. MATERIALS AND METHODS Medline searches for the keywords benign prostatic hyperplasia, BPH, alpha blockers, 5 alpha-reductase, and quality of life were performed. Relevant literature was reviewed and analyzed. RESULTS Alpha blockers, 5 alpha-reductase inhibitors, and phytotherapy are the three categories of pharmaceutical interventions currently available for BPH. Various clinical trials have shown that alpha blockers and 5 alpha-reductase inhibitors are safe, efficacious, and improve QoL in patients with BPH. The evidence for phytotherapeutics is not as convincing. The current armamentarium of pharmaceutical interventions are encompassed in these three classes of medications. New pharmacotherapies based on novel mechanisms are on the horizon. CONCLUSION There are a variety of safe and efficacious medical therapies available for the management of BPH and it is important for the practicing physician to have an understanding of these pharmacotherapies and their potential impact on the patient. There is not enough evidence to make a recommendation regarding phytotherapy use. New classes of drugs for BPH will likely find their way into routine use.
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Affiliation(s)
- Angelo J Cambio
- Department of Urology [A.J.C., C.P.E.], University of California Davis, Sacramento, CA, USA
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Roell D, Baniahmad A. The natural compounds atraric acid and N-butylbenzene-sulfonamide as antagonists of the human androgen receptor and inhibitors of prostate cancer cell growth. Mol Cell Endocrinol 2011; 332:1-8. [PMID: 20965230 DOI: 10.1016/j.mce.2010.09.013] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2010] [Revised: 09/03/2010] [Accepted: 09/27/2010] [Indexed: 11/17/2022]
Abstract
Extracts from the plant Pygeum africanum are widely used in the therapy of benign prostate hyperplasia (BPH) and in combinational therapy for prostate cancer, the second leading cause of cancer death and the mostly diagnosed form of cancer in men. The androgen receptor (AR) plays a crucial role in the development of the prostate as well as in prostate diseases. Even though the extracts from P. africanum are considered as beneficial for prostate diseases in clinical trials, and some active compounds for treatment of BPH could be identified, compounds responsible for AR inhibition and the molecular mechanism for inhibition of prostatitis need to be identified. Recently, atraric acid and N-butylbenzene-sulfonamide were isolated from a selective dichlormethane extract of P. africanum as two novel AR antagonistic compounds. The molecular mechanisms of AR inhibition were analyzed and are summarized here. Both compounds are the first known natural, complete and specific AR antagonist.
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Affiliation(s)
- Daniela Roell
- Institute of Human Genetics, Jena University Hospital, Kollegiengasse 10, D-07743 Jena, Germany
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Abstract
Benign prostatic syndrome (BPS) is considered a diagnosis of exclusion and needs a thorough work-up. One of the pitfalls for a tailored medical treatment scheme is the objective evaluation of benign prostatic obstruction. Characteristics of the various medical therapy options and the multifactorial origin of LUTS in BPH patients imply an individualized approach. LUTS involving mostly urine storage disorders and a small prostate are suitably managed with alpha(1)-receptor antagonists, which may be combined with antimuscarinics if OAB symptoms predominate. Long-term treatment addressing clinical progression may favor combination therapy of alpha(1)-receptor antagonists with 5alpha-reductase inhibitors if prostate size is sufficient. Age, symptom severity at baseline, a large prostate volume, or a high PSA value are indicative of progression. However, combination therapy aggravates side effects, and thus a risk-benefit analysis is essential. The potential of any medication for BPS to treat obstruction is rather low. If deobstruction is the main aim of therapy, medical treatment is not suitable.
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Affiliation(s)
- R Berges
- PAN-Klinik, Zeppelinstrasse 1, 50667 Köln.
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15
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Park J, Shin DW, Ahn TY. Complementary and alternative medicine in men’s health. JOURNAL OF MENS HEALTH 2008. [DOI: 10.1016/j.jomh.2008.08.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Zhang W, Wang X, Liu Y, Tian H, Flickinger B, Empie MW, Sun SZ. Effects of dietary flaxseed lignan extract on symptoms of benign prostatic hyperplasia. J Med Food 2008; 11:207-14. [PMID: 18358071 DOI: 10.1089/jmf.2007.602] [Citation(s) in RCA: 48] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
A flaxseed lignan extract containing 33% secoisolariciresinol diglucoside (SDG) was evaluated for its ability to alleviate lower urinary tract symptoms (LUTS) in 87 subjects with benign prostatic hyperplasia (BPH). A randomized, double-blind, placebo-controlled clinical trial with repeated measurements was conducted over a 4-month period using treatment dosages of 0 (placebo), 300, or 600 mg/day SDG. After 4 months of treatment, 78 of the 87 subjects completed the study. For the 0, 300, and 600 mg/day SDG groups, respectively, the International Prostate Symptom Score (IPSS) decreased -3.67 +/- 1.56, -7.33 +/- 1.18, and -6.88 +/- 1.43 (mean +/- SE, P = .100, < .001, and < .001 compared to baseline), the Quality of Life score (QOL score) improved by -0.71 +/- 0.23, -1.48 +/- 0.24, and -1.75 +/- 0.25 (mean +/- SE, P = .163 and .012 compared to placebo and P = .103, < .001, and < .001 compared to baseline), and the number of subjects whose LUTS grade changed from "moderate/severe" to "mild" increased by three, six, and 10 (P = .188, .032, and .012 compared to baseline). Maximum urinary flows insignificantly increased 0.43 +/- 1.57, 1.86 +/- 1.08, and 2.7 +/- 1.93 mL/second (mean +/- SE, no statistical significance reached), and postvoiding urine volume decreased insignificantly by -29.4 +/- 20.46, -19.2 +/- 16.91, and -55.62 +/- 36.45 mL (mean +/- SE, no statistical significance reached). Plasma concentrations of secoisolariciresinol (SECO), enterodiol (ED), and enterolactone (EL) were significantly raised after the supplementation. The observed decreases in IPSS and QOL score were correlated with the concentrations of plasma total lignans, SECO, ED, and EL. In conclusion, dietary flaxseed lignan extract appreciably improves LUTS in BPH subjects, and the therapeutic efficacy appeared comparable to that of commonly used intervention agents of alpha1A-adrenoceptor blockers and 5alpha-reductase inhibitors.
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Affiliation(s)
- Wei Zhang
- Tumor Hospital and Institute, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People's Republic of China
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Colon I, Payne RE. Benign prostatic hyperplasia and lower urinary tract symptoms in African Americans and Latinos: treatment in the context of common comorbidities. Am J Med 2008; 121:S18-26. [PMID: 18675613 DOI: 10.1016/j.amjmed.2008.05.023] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Benign prostatic hyperplasia (BPH), with accompanying lower urinary tract symptoms (LUTS), is a common age-related condition associated with a variety of cardiovascular, metabolic, and sexual comorbidities. While there is debate, in the United States race and ethnicity, particularly among Latinos and African American men, may confer an elevated risk for BPH and LUTS. Hypertension and deficits in sexual health are more common among African American men, while both Latino and African American men experience more metabolic-related disorders, including diabetes mellitus, insulin resistance, and end-stage renal disease. Although socioeconomic factors may play a significant role in these disparities, pathological and genetic variations between patients of different races and ethnicities are additional factors in the development of BPH. The proliferation of available treatments for BPH demands greater discernment in treatment selection, and comorbidities represent a central criterion upon which choice of appropriate BPH therapy should be based. This article reviews common comorbidities in minority populations, describes challenges to BPH management, and discusses medical, surgical, and phytotherapeutic treatment options.
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Affiliation(s)
- Ivan Colon
- Department of Urology, Downstate Medical Center, Brooklyn, NY 11203, USA.
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Phytotherapy for Lower Urinary Tract Symptoms Secondary to Benign Prostatic Hyperplasia. J Urol 2008; 179:2119-25. [DOI: 10.1016/j.juro.2008.01.094] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2007] [Indexed: 11/22/2022]
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Affiliation(s)
- Changhee Yoo
- Department of Urology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Choung-Soo Kim
- Department of Urology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
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Capodice JL, Katz AE. What patients take without telling you: holistic approach for BPH. World J Urol 2006; 24:378-82. [PMID: 16738853 DOI: 10.1007/s00345-006-0093-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2006] [Accepted: 04/11/2006] [Indexed: 11/27/2022] Open
Abstract
The use of botanicals and supplements have markedly increased in men that are seeking increased protection against the potential onset and symptomatic relief of lower urinary tract symptoms that are commonly experienced with benign prostatic hyperplasia (BPH). While this implies a positive trend and considers that men are taking a more active role in health and prevention, dialog between the patient and the clinician is often deficient. This may be due to a number of factors including both the patients' inability to report about the use of certain agents and the clinicians' inability to ask. Moreover, the sense that natural agents may lack side effects coupled with ineffective communication between the doctor and patient could result in potential adverse interactions. We have performed a comprehensive search of articles published from 1990 to 2005 using the Medline databases in order examine clinical data on the most commonly researched herbs for BPH. We provide a brief update on the state of the research.
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Affiliation(s)
- Jillian L Capodice
- Center for Holistic Urology, Department of Urology, Columbia University Medical Center, New York, NY 10032, USA.
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Yamanishi T, Yasuda K, Kamai T, Tsujii T, Sakakibara R, Uchiyama T, Yoshida KI. Single-blind, randomized controlled study of the clinical and urodynamic effects of an alpha-blocker (naftopidil) and phytotherapy (eviprostat) in the treatment of benign prostatic hyperplasia. Int J Urol 2004; 11:501-9. [PMID: 15242359 DOI: 10.1111/j.1442-2042.2004.00844.x] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
AIM The aim of our study was to examine the efficacy of naftopidil in terms of the international prostate symptom score (IPSS) and urodynamic parameters in the treatment of benign prostatic hyperplasia (BPH). Eviprostat was used as a control to study the efficacy of naftopidil. METHODS Forty-nine patients with BPH (mean age 67.9 +/- 7.8 years) were involved in the study. Patients were randomly assigned either to the naftopidil group, which was treated with the alpha-blocker naftopidil (50-75 mg daily, 36 patients), or the eviprostat group, which was treated with phytotherapy (six tablets of eviprostat daily, 13 patients). RESULTS The mean total IPSS, the total storage and voiding symptom scores, and the quality of life score decreased significantly (P < 0.0001 for each variable) in the naftopidil group, but not in the eviprostat group. In the naftopidil group, analyses showed significant increases in average and maximum flow rate and bladder capacity at first desire to void (P < 0.001, P = 0.001 and P = 0.024, respectively), and significant decreases in the postvoid residual, the percent of residual and the Abrams-Griffiths number (P = 0.009, P = 0.008 and P = 0.042, respectively). However, in the eviprostat group, no significant changes were noted in terms of these symptomatic and urodynamic parameters. In the pressure/flow study, an improvement in the International Continence Society nomogram grade was noted in 29% of the naftopidil group, but in only 16% of the eviprostat group. Among the 14 patients in the naftopidil group, detrusor overactivity disappeared in 21% and cystometric capacity increased in 36%, but no improvement in detrusor overactivity was noted in the eviprostat group. CONCLUSIONS Naftopidil appears to have been effective in this short-term treatment of BPH.
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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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23
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Effect of Oral Tadenan Treatment on Rabbit Bladder Structure and Function After Partial Outlet Obstruction. J Urol 2002. [DOI: 10.1016/s0022-5347(05)65138-5] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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Effect of Oral Tadenan Treatment on Rabbit Bladder Structure and Function After Partial Outlet Obstruction. J Urol 2002. [DOI: 10.1097/00005392-200205000-00081] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Kapadia GJ, Azuine MA, Tokuda H, Hang E, Mukainaka T, Nishino H, Sridhar R. Inhibitory effect of herbal remedies on 12-O-tetradecanoylphorbol-13-acetate-promoted Epstein-Barr virus early antigen activation. Pharmacol Res 2002; 45:213-20. [PMID: 11884218 DOI: 10.1006/phrs.2001.0936] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
For the past several years we have been evaluating natural products as potential cancer chemopreventive agents in a short term in vitro assay involving Epstein--Barr virus early antigen (EBV-EA) activation in Raji cells promoted by phorbol ester, 12-O-tetradecanoylphorbol-13-acetate (TPA). Because of the current interest in the use of herbal remedies, we considered examining them for their cancer chemopreventive activities, using their extracts with a view to uncovering such benefits (if any) these remedies might possess. Thirty-six extracts of 32 herbs belonging to 27 families in use as herbal remedies including those of gingko, black cohosh, echinacea, kava-kava, saw palmetto, turmeric, angelica, wild yam, cat's claw, passion flower, muira puama, feverfew, blueberry, chasteberry, licorice, nettle, golden seal, pygeum, ginger, valerian and hops were prepared and evaluated. Turmeric at a concentration of 10 microg x ml (-1)exhibited the most potent anti-EBV-EA activity, which is ten times more than passionflower, that is next in the order of activity. At the concentration level of 100 microg ml (-1), several of the herbal remedies tested inhibited the EBV-EA in Raji cells exposed to the tumor promoter TPA (32 pM) by more than 90%. We also report for the first time the activities of 16 new medicinal plants as potential cancer chemopreventive agents. Since inhibitors of EBV-EA promoted by TPA in vitro have been shown to be effective anti-tumor promoting agents in laboratory animal models, our results indicate new and potential applications of these herbal remedies as cancer chemopreventive agents since they are already in clinical use in the human population.
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Affiliation(s)
- Govind J Kapadia
- Department of Pharmaceutical Sciences, School of Pharmacy, Howard University, 2300 4 thStreet, NW, Washington, DC 20059, USA.
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Fagelman E, Lowe FC. Herbal medications in the treatment of benign prostatic hyperplasia (BPH). Urol Clin North Am 2002; 29:23-9, vii. [PMID: 12109350 DOI: 10.1016/s0094-0143(02)00015-0] [Citation(s) in RCA: 35] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Herbal medications are used widely in the treatment of BPH. Recent studies suggest a benefit for some of these products with few side effects. The results of these studies are summarized and the possible mechanism of action of these medications are reviewed.
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Affiliation(s)
- Elliot Fagelman
- Department of Urology, St. Luke's Roosevelt Hospital Center, Columbia University, College of Physicians and Surgeons, New York, NY, USA
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Wilt T, Ishani A, Mac Donald R, Rutks I, Stark G. Pygeum africanum for benign prostatic hyperplasia. Cochrane Database Syst Rev 2002; 1998:CD001044. [PMID: 11869585 PMCID: PMC7032619 DOI: 10.1002/14651858.cd001044] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
BACKGROUND Benign prostatic hyperplasia (BPH), nonmalignant enlargement of the prostate, can lead to obstructive and irritative lower urinary tract symptoms (LUTS). The pharmacologic use of plants and herbs (phytotherapy) for the treatment of LUTS associated with BPH has been growing steadily. The extract of the African prune tree, Pygeum africanum, is one of the several phytotherapeutic agents available for the treatment of BPH. OBJECTIVES To investigate the evidence whether extracts of Pygeum africanum (1) are more effective than placebo in the treatment of Benign Prostatic Hyperplasia (BPH), (2) are as effective as standard pharmacologic BPH treatments, and (3) have less side effects compared to standard BPH drugs. SEARCH STRATEGY Trials were searched in computerized general and specialized databases (MEDLINE (1966-2000), EMBASE, Cochrane Library, Phytodok), by checking bibliographies, and by contacting relevant manufacturers and researchers. SELECTION CRITERIA Trials were eligible if they (1) were randomized (2) included men with BPH (3) compared preparations of Pygeum africanum (alone or in combination) with placebo or other BPH medications (4) included clinical outcomes such as urologic symptom scales, symptoms, or urodynamic measurements. Eligibility was assessed by at least two independent observers. DATA COLLECTION AND ANALYSIS Information on patients, interventions, and outcomes were extracted by at least two independent reviewers using a standard form. The main outcome measure for comparing the effectiveness of Pygeum africanum with placebo and standard BPH medications was the change in urologic symptoms scale scores. Secondary outcomes included change in urologic symptoms including nocturia and urodynamic measures (peak and mean urine flow, prostate size). The main outcome measure for adverse effects was the number of men reporting adverse effects. MAIN RESULTS A total of 18 randomized controlled trials involving 1562 men met inclusion criteria and were analyzed. Only one of the studies reported a method of treatment allocation concealment, though 17 were double-blinded. There were no studies comparing Pygeum africanum to standard pharmacologic interventions such as alpha-adrenergic blockers or 5-alpha reductase inhibitors. The mean study duration was 64 days (range, 30-122 days). Many studies did not report results in a method that permitted meta-analysis. Compared to men receiving placebo, Pygeum africanum provided a moderately large improvement in the combined outcome of urologic symptoms and flow measures as assessed by an effect size defined by the difference of the mean change for each outcome divided by the pooled standard deviation for each outcome (-0.8 SD [95% confidence interval (CI), -1.4, -0.3 (n=6 studies)]). Men using Pygeum africanum were more than twice as likely to report an improvement in overall symptoms (RR=2.1, 95% CI = 1.4, 3.1). Nocturia was reduced by 19%, residual urine volume by 24% and peak urine flow was increased by 23%. Adverse effects due to Pygeum Africanum were mild and comparable to placebo. The overall dropout rate was 12% and was similar between Pygeum Africanum (13%), placebo (11%) and other controls (8%). REVIEWER'S CONCLUSIONS A standardized preparation of Pygeum africanum may be a useful treatment option for men with lower urinary symptoms consistent with benign prostatic hyperplasia. However, the reviewed studies were small in size, were of short duration, used varied doses and preparations and rarely reported outcomes using standardized validated measures of efficacy. Additional placebo-controlled trials are needed as well as studies that compare Pygeum africanum to active controls that have been convincingly demonstrated to have beneficial effects on lower urinary tract symptoms related to BPH. These trials should be of sufficient size and duration to detect important differences in clinically relevant endpoints and use standardized urologic symptom scale scores.
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Affiliation(s)
- T Wilt
- General Internal Medicine (111-0), Minneapolis VA/VISN 13 Center for Chronic Disease Outcomes Research, One Veterans Drive, Minneapolis, Minnesota 55417, USA.
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Abstract
Phytotherapeutic agents have gained widespread usage in the treatment of benign prostatic hyperplasia/lower urinary tract symptoms. They are marketed as over-the-counter medications in the United States and by prescription in many European countries. Although numerous mechanisms of action have been postulated, it is uncertain which of these are responsible for their clinical response. The efficacy of these agents has not been conclusively proven. Almost all the studies with these products have not been placebo-controlled, double-blind trials of at least 6 months' duration. Thus, the magnitude of the clinical effect is uncertain. It is impossible to compare the phytotherapeutic agents-either the single or multiple extract products-because manufacturers use different extraction processes. So each agent/product must be studied individually. Until more appropriately conducted trials are undertaken, the efficacy of phytotherapeutic agents will remain unproven.
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Affiliation(s)
- F C Lowe
- Department of Urology, St. Luke's/Roosevelt Hospital Center, New York, New York 10023, USA
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Ishani A, MacDonald R, Nelson D, Rutks I, Wilt TJ. Pygeum africanum for the treatment of patients with benign prostatic hyperplasia: a systematic review and quantitative meta-analysis. Am J Med 2000; 109:654-64. [PMID: 11099686 DOI: 10.1016/s0002-9343(00)00604-5] [Citation(s) in RCA: 85] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
PURPOSE To conduct a systematic review and quantitative meta-analysis of the therapeutic efficacy and tolerability of Pygeum africanum in men with symptomatic benign prostatic hyperplasia. METHODS Studies were identified through the search of Medline (1966 to 2000), Embase, Phytodok, the Cochrane Library, bibliographies of identified trials and review articles, and contact with relevant authors and drug companies. Randomized trials were included if participants had symptomatic benign prostatic hyperplasia, the intervention was a preparation of P. africanum alone or in combination with other phytotherapeutic agents, a control group received placebo or other pharmacologic therapies for benign prostatic hyperplasia, and treatment duration was at least 30 days. Two investigators independently extracted key data on design features, subject characteristics, and therapy allocation. RESULTS A total of 18 randomized controlled trials involving 1,562 men met the inclusion criteria and were analyzed. Many studies did not report results in a method that permitted meta-analysis. Only 1 of the studies reported a method of treatment allocation concealment, although 17 were double-blinded. The mean study duration was 64 days (range 30 to 122). Compared with placebo in 6 studies, P. africanum provided a moderately large improvement in the combined outcome of urologic symptoms and flow measures as assessed by an effect size defined by the difference of the mean change for each outcome divided by the pooled standard deviation for each outcome (-0.8 SD [95% confidence interval (CI): -1.4 to -0.3]). Summary estimates of individual outcomes were also improved by P. africanum. Men were more than twice as likely to report an improvement in overall symptoms (risk ratio = 2.1, 95% CI: 1.40 to 3.1). Nocturia was reduced by 19% and residual urine volume by 24%; peak urine flow was increased by 23%. Adverse effects due to P. africanum were mild and similar to placebo. The overall dropout rate was 12% and was similar for P. africanum (13%), placebo (11%), and other controls (8%; P = 0.4 versus placebo and P = 0.5 versus other controls). CONCLUSIONS The literature on P. africanum for the treatment of benign prostatic hyperplasia is limited by the short duration of studies and the variability in study design, the use of phytotherapeutic preparations, and the types of reported outcomes. However, the evidence suggests that P. africanum modestly, but significantly, improves urologic symptoms and flow measures. Further research is needed using standardized preparations of P. africanum to determine its long-term effectiveness and ability to prevent complications associated with benign prostatic hyperplasia.
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Affiliation(s)
- A Ishani
- Minneapolis Veterans Affairs Center for Chronic Disease Outcomes Research and the VA Coordinating Center for the Cochrane Review Group in Prostate Diseases and Urologic Malignancies, Minneapolis, Minnesota, USA
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Solano RM, García-Fernández MO, Clemente C, Querol M, Bellamy F, Sanchez-Chapado M, Prieto JC, Carmena MJ. Effects of Pygeum africanum extract (Tadenan) on vasoactive intestinal peptide receptors, G proteins, and adenylyl cyclase in rat ventral prostate. Prostate 2000; 45:245-52. [PMID: 11074527 DOI: 10.1002/1097-0045(20001101)45:3<245::aid-pros7>3.0.co;2-t] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
BACKGROUND Tadenan (a Pygeum africanum extract) is a drug used in the treatment of benign prostatic hyperplasia. Its effects on prostate fibroblast proliferation and bladder function after partial outlet obstruction have been demonstrated in various pharmacological studies. However, its effects at the molecular level are poorly documented. METHODS Tadenan was dissolved in peanut oil. Rats were orally given two daily doses of the drug (1 or 10 mg/kg b.w.) for 4 days. Vasoactive intestinal peptide (VIP) binding, adenylyl cyclase stimulation, and expression of G-protein subunits were studied in rat prostatic membranes by established procedures. RESULTS Tadenan treatment of castrated/testosterone-replaced rats was performed in order to interfere with prostatic cell proliferation. This experimental approach resulted in increases of: 1) VIP effect on adenylyl cyclase stimulation through alpha(s) G-subunit; 2) alpha(i) activation by low Gpp[NH]p doses (in the presence of forskolin); and 3) alpha(s), alpha(i1/2), and alpha(i3/0) levels. However, there were no modifications in membranes from quiescent, nonproliferating prostates (untreated rats). CONCLUSIONS The observed regulatory role of Tadenan on various prostatic components of the adenylyl cyclase system, together with previous findings on protein kinase C-mediated signal transduction, open a complex array of possibilities of direct actions of this phytotherapeutic agent in the prostate.
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Affiliation(s)
- R M Solano
- Unidad de Neuroendocrinología Molecular, Departamento de Bioquímica y Biología Molecular, Universidad de Alcalá, Alcalá de Henares, Spain
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