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Franco JV, Trivisonno L, Sgarbossa NJ, Alvez GA, Fieiras C, Escobar Liquitay CM, Jung JH. Serenoa repens for the treatment of lower urinary tract symptoms due to benign prostatic enlargement. Cochrane Database Syst Rev 2023; 6:CD001423. [PMID: 37345871 PMCID: PMC10286776 DOI: 10.1002/14651858.cd001423.pub4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/23/2023]
Abstract
BACKGROUND Benign prostatic hyperplasia (BPH) is a non-malignant enlargement of the prostate, which 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 is common. The extract of the berry of the American saw palmetto or dwarf palm plant, Serenoa repens (SR), which is also known by its botanical name of Sabal serrulatum, is one of several phytotherapeutic agents available for the treatment of BPH. OBJECTIVES To assess the effects of Serenoa repens in the treatment of men with LUTS consistent with BPH. SEARCH METHODS We performed a comprehensive search of multiple databases (the Cochrane Library, MEDLINE, Embase, Scopus, Web of Science, and LILACS), trials registries, other sources of grey literature, and conference proceedings published up to 16 September 2022, with no restrictions on language or publication status. SELECTION CRITERIA We included randomized controlled trials of participants with BPH who were treated with Serenoa repens or placebo/no treatment. DATA COLLECTION AND ANALYSIS Two review authors independently assessed studies for inclusion at each stage and undertook data extraction and risk of bias assessment and GRADE assessment of the certainty of the evidence. We considered review outcomes measured up to 12 months after randomization as short term, and beyond 12 months as long term. Our main outcomes included urologic symptom scores, quality of life, and adverse events. MAIN RESULTS For this update, we narrowed the review question to only comparisons with placebo. We included 27 studies (of which 9 were new) involving a total of 4656 participants, 19 studies comparing Serenoa repens with placebo, and 8 studies comparing Serenoa repens in combination with other phytotherapeutic agents versus placebo. Most studies included men aged > 50 (mean age range 52 to 68) with moderate urologic symptoms (International Prostate Symptom Score [IPSS] range 8 to 19). Ten studies were funded by the pharmaceutical industry; two studies were funded by government agencies; and the remaining studies did not specify funding sources. Serenoa repens versus placebo or no intervention Results for this comparison are based on predefined sensitivity analyses limited to studies at low risk of bias. Serenoa repens results in little to no difference in urologic symptoms at short-term follow-up (3 to 6 months; IPSS score range 0 to 35, higher scores indicate worse symptoms; mean difference (MD) -0.90, 95% confidence interval (CI) -1.74 to -0.07; I2 = 68%; 9 studies, 1681 participants; high-certainty evidence). Serenoa repens results in little to no difference in the quality of life at short-term follow-up (3 to 6 months; IPSS quality of life domain range 0 to 6, higher scores indicate worse quality of life; MD -0.20, 95% CI -0.40 to -0.00; I2 = 39%; 5 studies, 1001 participants; high-certainty evidence). Serenoa repens probably results in little to no difference in adverse events (1 to 17 months; risk ratio (RR) 1.01, 95% CI 0.77 to 1.31; I2 = 18%; 12 studies, 2399 participants; moderate-certainty evidence). Based on 164 cases per 1000 men in the placebo group, this corresponds to 2 more (38 fewer to 51 more) per 1000 men in the Serenoa repens group. Serenoa repens results in little to no difference in urologic symptoms at long-term follow-up (12 to 17 months, IPSS score, MD 0.07, 95% CI -0.75 to 0.88; I2 = 34%; 3 studies, 898 participants; high-certainty evidence). Serenoa repens results in little to no difference in quality of life at long-term follow-up (12 to 17 months, IPSS quality of life, MD -0.11, 95% CI -0.41 to 0.19; I2 = 65%; 3 studies, 882 participants; high-certainty evidence). There were no data on long-term adverse events for this comparison. Serenoa repens in combination with other phytotherapy versus placebo or no intervention Different phytotherapeutic agents that include Serenoa repens may result in little to no difference in urologic symptoms compared to placebo at short-term follow-up (12 to 24 weeks, IPSS score, MD -2.41, 95% CI -4.54 to -0.29; I2 = 67%; 4 studies, 460 participants; low-certainty evidence). We are very uncertain about the effects of these agents on quality of life (very low-certainty evidence). These agents may result in little to no difference in the occurrence of adverse events; however, the CIs included substantial benefits and harms (12 to 48 weeks, RR 0.91, 95% CI 0.58 to 1.41; I2 = 0%; 4 studies, 481 participants; low-certainty evidence). Based on 132 cases per 1000 men in the placebo group, this corresponds to 12 fewer (55 fewer to 54 more) per 1000 men in the combined phytotherapeutic agents with Serenoa repens group. AUTHORS' CONCLUSIONS Serenoa repens alone provides little to no benefits for men with lower urinary tract symptoms due to benign prostatic enlargement. There is more uncertainty about the role of Serenoa repens in combination with other phytotherapeutic agents.
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Affiliation(s)
- Juan Va Franco
- Institute of General Practice, Medical Faculty, Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany
| | - Leonel Trivisonno
- Department of Health Science, Universidad Nacional de La Matanza, San Justo, Argentina
| | - Nadia J Sgarbossa
- Department of Health Science, Universidad Nacional de La Matanza, San Justo, Argentina
| | - Gustavo Ariel Alvez
- Medical School, Instituto Universitario Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - Cecilia Fieiras
- Medical School, Instituto Universitario Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | | | - Jae Hung Jung
- Department of Urology, Yonsei University Wonju College of Medicine, Wonju, Korea, South
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Lipid Profile and 5α-Reductase Inhibition Activity of Proprietary Ultrahigh-Pressure Supercritical Carbon Dioxide and Hexane Saw Palmetto Extracts. URO 2023. [DOI: 10.3390/uro3010005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Inhibition of 5α-reductase (5αR), which blocks the conversion of testosterone to its active metabolite, dihydrotestosterone, has been shown to impact further prostate enlargement (benign prostatic hyperplasia, or BPH). Clinical trials of standardized lipidosterolic extracts of Serenoa repens (LSESr), also known as standardized extracts of saw palmetto, have demonstrated improvement in lower urinary tract symptoms (LUTS) and delayed progression of BPH. The aim of this preclinical study was to compare two standardized LSESr, a proprietary ultrahigh-pressure supercritical carbon dioxide extract of S. repens (UHP-sCESr) and the well-established hexanic extract of S. repens (HESr), for both 5αR inhibition activity and lipid profiles. UHP-sCESr and HESr had nearly identical inhibition curves and comparable IC50 values for 5αR-1 (9.25 ± 0.87 and 9.86 ± 0.11 μg/mL, respectively; p = 0.43) and 5αR-2 (7.47 ± 0.07 and 7.72 ± 0.05 μg/mL, respectively; p = 0.0544). UHP-sCESr and HESr also had comparable lipid profiles based on similar total fatty acid levels (87.7% and 91.5%, respectively), weight/weight comparisons of individual fatty acids, and individual fatty acid ratios to lauric acid. In addition, UHP-sCESr meets the standard set by the United States Pharmacopeia (USP) monograph for authenticity and purity for a supercritical carbon dioxide (SCCO2) extract of saw palmetto, whereas HESr meets the standard set by the European Medicines Agency (EMA) for a well-established medicinal product. In conclusion, based on enzyme inhibition curves and IC50 values, a standardized lipid profile is important to achieve comparable mechanisms of action for lipidosterolic extracts of saw palmetto. UHP-sCESr offers a comparable, standardized LSESr for men with LUTS/BPH in regions where the proprietary HESr is not available.
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De Nunzio C, Salonia A, Gacci M, Ficarra V. The Role of Combination Therapy with α-Blockers and Hexanic Extract of Serenoa repens in the Treatment of LUTS/BPH. J Clin Med 2022; 11:7169. [PMID: 36498751 PMCID: PMC9736252 DOI: 10.3390/jcm11237169] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2022] [Revised: 11/17/2022] [Accepted: 12/01/2022] [Indexed: 12/12/2022] Open
Abstract
The hexanic extract of Serenoa repens (HESr) has been in use for decades as an effective, safe and well-tolerated therapy for relieving bothersome lower urinary tract symptoms (LUTS) associated with benign prostate hyperplasia (BPH). This manuscript gives an overview of HESr as monotherapy for LUTS/BPH treatment and focuses on the currently available literature investigating the possible clinical benefits of HESr combination therapy with α-blockers. Combination therapy of HESr with α-blockers has been gaining significant interest in recent years, as an increasing body of evidence shows the beneficial pharmacological effects that HESr treatment can add to standard first-line treatment with α-blockers. By reducing persistent Prostatic Inflammatory Status (PIS), commonly present in LUTS/BPH patients, HESr complements the relaxation of prostate smooth muscle induced by α-blockers, thus providing additional symptom relief. Data suggest that patients harbouring PIS and having a specific clinical profile might especially benefit from the combination therapy. Future therapeutic efforts may take advantage of more personalised strategies for LUTS/BPH management.
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Affiliation(s)
- Cosimo De Nunzio
- Department of Urology, Sant’Andrea Hospital, Sapienza University of Rome, 00185 Rome, Italy
| | - Andrea Salonia
- Department of Urology, University Vita-Salute San Raffaele, 20132 Milan, Italy
- Division of Experimental Oncology, Unit of Urology, Urological Research Institute, IRCCS Ospedale San Raffaele, 20132 Milan, Italy
| | - Mauro Gacci
- Department of Minimally Invasive and Robotic Urologic Surgery and Kidney Transplantation, Careggi University Hospital (AOUC), University of Florence, 50134 Florence, Italy
| | - Vincenzo Ficarra
- Department of Human and Pediatric Pathology “Gaetano Barresi”, Urologic Section, University of Messina, 98122 Messina, Italy
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Luciani LG, Mattevi D, Vattovani V, Cai T, Giusti G, Malossini G. Phytotherapy for male luts: What happens then? 10-year research. Actas Urol Esp 2022; 46:442-446. [PMID: 35337768 DOI: 10.1016/j.acuroe.2022.03.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2021] [Accepted: 09/26/2021] [Indexed: 12/13/2022]
Abstract
INTRODUCTION AND OBJECTIVES Our objective is to assess the long-term results of phytotherapy, focusing on the interval between phytotherapy and pharmacological treatment and the predisposing risk factors to such switch on a 10-year follow-up. MATERIAL AND METHODS The data of patients taking phytotherapy for mild to moderate male lower urinary tract symptoms (LUTS) from January to December 2010 were retrospectively reviewed from a prospectively maintained database. Patients were followed for 10 years through medical visits and telephone consultations. RESULTS 102 patients underwent at least one cycle of phytotherapy for LUTS. Twenty (19.6%) patients resolved their symptoms after one phytotherapy cycle and stopped any treatment, 27 (26.4%) continued phytotherapy, and 52 (51%) switched to alpha-blockers and/or 5a-reductase inhibitors after a median interval of 24 months. The reasons for treatment switch were symptoms (n = 45) or clinical progression (increased residual volume n = 15; urinary retention, n = 5). Patients switching to synthetic drugs had median higher age (60 vs 49), prostate volume (40 vs 26 cc), prostate specific antigen (PSA) (1.9 vs 0.9 ng/ml), residual volume (40 vs 0 cc), and a lower maximum flow rate (Qmax) (12 vs 15 ml/s) at presentation. CONCLUSIONS 46% patients with mild to moderate LUTS undergoing phytotherapy will be either free of treatment or still on phytotherapy at 10 years from disease presentation. Older patients with larger prostates, increased residual volume and PSA, should be informed regarding their higher risk of symptomatic or clinical progression: the risk of a treatment switch to alpha-blockers or 5a-reductase inhibitors becomes an actual fact after an average span of 2 years.
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Affiliation(s)
- L G Luciani
- Departamento de Urología, Hospital Santa Chiara, Trento, Italy
| | - D Mattevi
- Departamento de Urología, Hospital Santa Chiara, Trento, Italy.
| | - V Vattovani
- Departamento de Urología, Hospital Santa Chiara, Trento, Italy
| | - T Cai
- Departamento de Urología, Hospital Santa Chiara, Trento, Italy
| | - G Giusti
- Departamento de Urología, IRCCS Hospital San Raffaele, División Ville Turro, Milán, Italy
| | - G Malossini
- Departamento de Urología, Hospital Santa Chiara, Trento, Italy
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Alcaraz A, Castro-Díaz D, Gacci M, Salonia A, Ficarra V, Carballido-Rodríguez J, Rodríguez-Antolín A, Medina-Polo J, Fernández-Gómez JM, Cózar-Olmo JM, Búcar-Terrades S, Pérez-León N, Brenes-Bermúdez FJ, Molero-García JM, Fernández-Pro-Ledesma A, Herdman M, Angulo JC, Manasanch J. Efficacy and Tolerability of 6-Month Treatment with Tamsulosin Plus the Hexanic Extract of Serenoa repens versus Tamsulosin Plus 5-Alpha-Reductase Inhibitors for Moderate-to-Severe LUTS-BPH Patients: Results of a Paired Matched Clinical Study. J Clin Med 2022; 11:jcm11133615. [PMID: 35806900 PMCID: PMC9267652 DOI: 10.3390/jcm11133615] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2022] [Revised: 06/13/2022] [Accepted: 06/16/2022] [Indexed: 02/01/2023] Open
Abstract
The objective of this subset analysis was to evaluate and compare the efficacy and tolerability of two combination treatments for men with moderate-to-severe lower urinary tract symptoms associated with benign prostatic hyperplasia (LUTS/BPH). Data were from a real-world, open-label, prospective, and multicenter study performed in outpatient urology clinics. Men with moderate-to-severe LUTS/BPH received 6-month treatment with tamsulosin (TAM) in combination with either the hexanic extract of S. repens (HESr) or a 5-alpha-reductase inhibitor (5ARI). Changes in urinary symptoms and quality of life were measured using the IPSS and BII questionnaires, respectively. Treatment tolerability was assessed by recording adverse effects (AEs). Patients in the two study groups were matched using iterative and propensity score matching approaches. After iterative matching, data were available from 136 patients (n = 68 treated with TAM + 5ARI, n = 68 with TAM + HESr). After 6 months of treatment, mean (SD) IPSS total score improved by 7.7 (6.3) and 6.7 (5.0) points in the TAM + 5ARI and TAM + HESr groups, respectively (p = 0.272); mean BII total scores improved by 3.1 (2.9) and 2.9 (2.4) points (p = 0.751), respectively. AEs were reported by 26.5% and 10.3% of patients in the same groups, mostly affecting sexual function (p < 0.027). When used in a real-world setting to treat patients with moderate-severe LUTS/BPH, 6-month treatment with TAM + HESr was as effective as TAM + 5ARI, but with better tolerability.
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Affiliation(s)
- Antonio Alcaraz
- Urology Department, Hospital Clínic, Universitat de Barcelona, IDIBAPS (Institut d’Investigacions Biomèdiques August Pi i Sunyer), 08036 Barcelona, Spain;
| | - David Castro-Díaz
- Urology Department, Hospital Universitario de Canarias, 38320 Tenerife, Spain;
| | - Mauro Gacci
- Unit of Minimally Invasive and Robotic Urologic Surgery and Kidney Transplantation, Careggi University Hospital (AOUC), University of Florence, 50134 Florence, Italy;
- Department of Experimental and Clinical Medicine, University of Florence, 50134 Florence, Italy
| | - Andrea Salonia
- Division of Experimental Oncology/Unit of Urology, URI, IRCCS Ospedale San Raffaele, 20132 Milan, Italy;
| | - Vincenzo Ficarra
- Department of Human and Pediatric Pathology “Gaetano Barresi”, Urology Section, University of Messina, 98125 Messina, Italy;
| | | | - Alfredo Rodríguez-Antolín
- Urology Department, Research Institute i + 12, Hospital Universitario 12 de Octubre, 28041 Madrid, Spain; (A.R.-A.); (J.M.-P.)
| | - José Medina-Polo
- Urology Department, Research Institute i + 12, Hospital Universitario 12 de Octubre, 28041 Madrid, Spain; (A.R.-A.); (J.M.-P.)
- Urology Unit, HM Hospital, 28050 Madrid, Spain
- ROC Clinic, 28010 Madrid, Spain
| | | | - José M. Cózar-Olmo
- Urology Department, Hospital Universitario Virgen de las Nieves, 18014 Granada, Spain;
| | | | | | | | | | | | - Michael Herdman
- Insight Consulting and Research, 08301 Mataró, Spain;
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore 117549, Singapore
| | - Javier C. Angulo
- Clinical Department, Universidad Europea de Madrid, 28905 Getafe, Spain;
- Urology Department, Hospital Universitario de Getafe, 28905 Getafe, Spain
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Fitoterapia para los síntomas del tracto urinario inferior en el varón: ¿qué ocurre después? Diez años de investigación. Actas Urol Esp 2022. [PMID: 35337768 DOI: 10.1016/j.acuro.2021.09.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Alcaraz A, Gacci M, Ficarra V, Medina-Polo J, Salonia A, Fernández-Gómez JM, Ciudin A, Castro-Díaz D, Rodríguez-Antolín A, Carballido-Rodríguez J, Cózar-Olmo JM, Búcar-Terrades S, Pérez-León N, Brenes-Bermúdez FJ, Molero-García JM, Ledesma AFP, Herdman M, Manasanch J, Angulo JC, Group OBOTQUALIPROSTS. Efficacy and Safety of the Hexanic Extract of Serenoa repens vs. Watchful Waiting in Men with Moderate to Severe LUTS-BPH: Results of a Paired Matched Clinical Study. J Clin Med 2022; 11:jcm11040967. [PMID: 35207238 PMCID: PMC8878824 DOI: 10.3390/jcm11040967] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Revised: 01/24/2022] [Accepted: 02/09/2022] [Indexed: 02/01/2023] Open
Abstract
We investigated changes in symptoms and quality of life (QoL) in men with moderate-to-severe lower urinary tract symptoms associated with benign prostatic hyperplasia (LUTS/BPH) receiving the hexanic extract of Serenoa repens (HESr) and compared results with a matched group on watchful waiting (WW). Data was from a real-world, open-label, prospective, multicenter study. This sub-group analysis included patients with moderate-to-severe symptoms receiving either the HESr 320 mg/daily for six months (HESr) or who remained untreated for LUTS/BPH (WW). Changes in urinary symptoms and QoL were measured by IPSS and BII questionnaires. Two statistical approaches (iterative matching and propensity score pairing) were used to maximize between-group comparability at baseline. Tolerability was assessed in the HESr group. After iterative matching, data for analysis was available for 783 patients (102 WW, 681 HESr). IPSS scores improved by a mean (SD) of 3.8 (4.4) points in the HESr group and by 2.2 (4.5) points in the WW group (p = 0.002). Changes in BII score were 1.8 (2.4) points and 1.0 (2.2) points, respectively (p < 0.001). Three patients (0.9%) treated with the HESr reported mild adverse effects. Moderate-severe LUTS/BPH patients treated for six months with the HESr showed greater improvements in symptoms and QoL than matched patients on WW, with a very low rate of adverse effects.
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Affiliation(s)
- Antonio Alcaraz
- Urology Department, Hospital Clínic, Universitat de Barcelona, IDIBAPS, 08036 Barcelona, Spain;
| | - Mauro Gacci
- Unit of Minimally Invasive and Robotic Urologic Surgery and Kidney Transplantation, Careggi University Hospital (AOUC), University of Florence, 50134 Florence, Italy;
- Department of Experimental and Clinical Medicine, University of Florence, 50134 Florence, Italy
| | - Vincenzo Ficarra
- Department of Human and Pediatric Pathology “Gaetano Barresi”, Urology Section, University of Messina, 98125 Messina, Italy;
| | - José Medina-Polo
- Urology Department, Research Institute Hospital 12 de Octubre (i+12), 28041 Madrid, Spain; (J.M.-P.); (A.R.-A.)
- Urology Unit, HM Hospital, 28050 Madrid, Spain
- ROC Clinic, 28010 Madrid, Spain
| | - Andrea Salonia
- Division of Experimental Oncology, URI, IRCCS Ospedale San Raffaele, University Vita-Salute San Raffaele, 20132 Milan, Italy;
- Unit of Urology, URI, IRCCS Ospedale San Raffaele, University Vita-Salute San Raffaele, 20132 Milan, Italy
| | | | | | - David Castro-Díaz
- Urology Department, Hospital Universitario de Canarias, 38320 Tenerife, Spain;
| | - Alfredo Rodríguez-Antolín
- Urology Department, Research Institute Hospital 12 de Octubre (i+12), 28041 Madrid, Spain; (J.M.-P.); (A.R.-A.)
| | | | - José M. Cózar-Olmo
- Urology Department, Hospital Universitario Virgen de las Nieves, 18014 Granada, Spain;
| | | | | | | | | | | | - Michael Herdman
- Insight Consulting and Research, 08301 Mataró, Spain;
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore 117549, Singapore
| | | | - Javier C. Angulo
- Clinical Department, Universidad Europea de Madrid, 28905 Getafe, Spain
- Urology Department, Hospital Universitario de Getafe, 28905 Getafe, Spain
- Correspondence: ; Tel.: +34-699-497-569
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A comprehensive review of medical therapy on benign prostatic hyperplasia. SEXOLOGIES 2022. [DOI: 10.1016/j.sexol.2021.07.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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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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Gong YC, Chen X, Song QT, Gan Y, Zhang B, Li BS, Chen Z, He Y. A randomized placebo-controlled study: Phellodendron Bawei tablets combined with standard management can improve storage symptoms, sleep quality, and medication compliance in patients with benign prostatic hyperplasia compared to placebo with standard management. Transl Androl Urol 2021; 10:3423-3431. [PMID: 34532267 PMCID: PMC8421819 DOI: 10.21037/tau-21-588] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2021] [Accepted: 08/16/2021] [Indexed: 12/02/2022] Open
Abstract
Background Benign prostatic hyperplasia (BPH) is a common micturition disorder in middle-aged and elderly males, and it is one of the most common urology-related diseases worldwide. However, standard therapeutic drugs (α1-receptor blockers + 5α reductase inhibitors) do not provide anti-inflammatory or anti-infective effects. The Phellodendron Bawei tablet is a proprietary Chinese medicine with anti-inflammatory and anti-infective effects. Here, we analyzed whether the combination of standard therapeutic drugs and Phellodendron Bawei tablets has more advantages than placebo with standard management in improving the lower urinary tract symptoms (LUTs), sleep quality, sexual function, and medication compliance in patients with BPH. Methods This study was a prospective, double-blind, single-center, 6-month clinical trial in patients with BPH. Male patients, 45–75 years old, a history of moderate-to-severe BPH/LUTs for more than 6 months, moderate-to-severe LUTs [International Prostate Symptom Score (IPSS) ≥8], maximum urine flow rate (Qmax) of <15 mL/s, and prostate volume (PV) of >30 mL. All patients were randomly divided into two cohorts at baseline. The standard management (SM) group was treated with tamsulosin + finasteride + placebo, while the experimental group was treated with tamsulosin + finasteride + Phellodendron Bawei tablets. The clinical indicators were as follows: Age, body mass index (BMI), blood prostate-specific antigen (PSA), PV, Qmax, IPSS; IPSS voiding subscore (IPSS-V), IPSS storage subscore (IPSS-S), and IPSS quality of life (IPSS-QOL)], five-item version of the International Index of Erectile Function (IEFF-5) score, Athens Insomnia Scale (AIS) score, and the Medication Adherence Questionnaire (MAQ). And adverse drug reactions were observed. Student’s t-test was used to analyze results. Results We randomly divided 120 patients into two groups, with 60 patients in each group, and a total of 105 patients completed the study. IPSS-S (P=0.027) and AIS scores (P<0.001) improved more significantly in the Phellodendron Bawei tablets + SM group, and the MAQ score in this group was lower (P=0.003). Conclusions Phellodendron Bawei tablets combined with α1-receptor blockers and 5α-reductase inhibitors can improve lower urinary tract symptoms associated with urine storage, sleep quality, and medication compliance in patients with benign prostatic hyperplasia compared to placebo with standard management. Trial Registration Chinese Clinical Trial Registry ChiCTR2100046463.
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Affiliation(s)
- Yu-Chen Gong
- Department of Urology, Xiangya Hospital, Central South University, Changsha, China
| | - Xiang Chen
- Department of Urology, Xiangya Hospital, Central South University, Changsha, China
| | - Qing-Tian Song
- Department of Urology, Xiangya Hospital, Central South University, Changsha, China
| | - Yu Gan
- Department of Urology, Xiangya Hospital, Central South University, Changsha, China
| | - Bo Zhang
- Department of Urology, Xiangya Hospital, Central South University, Changsha, China
| | - Bing-Sheng Li
- Department of Urology, Xiangya Hospital, Central South University, Changsha, China
| | - Zhi Chen
- Department of Urology, Xiangya Hospital, Central South University, Changsha, China
| | - Yao He
- Department of Urology, Xiangya Hospital, Central South University, Changsha, China
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Quiros-Roldan E, Carriero C, Paghera S, Degli Antoni M, Fiorini C, Quaresima V, Castelli F, Imberti L. Symptoms and quality of life in HIV-infected patients with benign prostatic hyperplasia are improved by the consumption of a newly developed whole tomato-based food supplement. A phase II prospective, randomized double-blinded, placebo-controlled study. J Funct Foods 2021. [DOI: 10.1016/j.jff.2021.104495] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
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