Phytomedicines outperform synthetics in treating enlarged prostate
One of the great success stories in botanical medicine
is the European use of phytomedicines in treating enlarged prostate,
or benign prostatic hyperplasia (BPH). The condition, which affects
roughly half of men over 70 years of age, reduces quality of life
by causing frequent urination, nighttime awakenings, and other urinary
difficulties. Standard American therapy consists primarily of treatment
with synthetic prescription drugs, which can have significant side
effects. In contrast, European treatment frequently substitutes the
use of medicinal plants with very good clinical support and a superior
safety record.
This comparative review discusses results of a number of studies investigating
the effectiveness and safety of phytomedicines and synthetic drugs
in the treatment of BPH., with a focus on saw palmetto (Serona
repens Bartram, Palmaceae, formerly Sabal serrulata). During
the course of one three year trial involving 309 men, saw palmetto
was associated with a significant increase in urinary flow rate (6.1
ml per second) and a 50% decrease in residual urine volume. In comparison,
the American prescription drug ProscarT (finasteride) showed a 30%
decrease in symptom scores over three years, but urine flow improved
only slightly, and residual urine volume was almost unchanged. Further,
10.7% of finasteride patients discontinued treatment because of side
effects, compared to only 1.8% of those taking saw palmetto. Perhaps
most important is the reported improvement in quality of life, "which
was reflected in the over 80% 'good' to 'very good' efficacy judgements."
Saw palmetto is approved by the German government as a treatment for
BPH, as are extracts of nettle roots (Urtica dioica L., Urticaceae)
and pumpkin seeds (Cucurbita pepo L., Cucurbitaceae). The proposed
mechanisms of actions for these phytomedicines are regulation of hormone
metabolism, immune system mediation, anticongestive actions, and effects
on the muscles of the bladder.
The authors conclude that in terms of increasing urinary flow rate,
" the data show a clear superiority of the sabal [saw palmetto]
extract in comparison to the synthetic drugs." For Proscar®
(finasteride), only one-third of the treated patients had "clinically
relevant improvement," and only after at least six months of
treatment (n=533). They also note that one of the drugs used in conventional
medicine, alfuzosin, produced a short-term improvement in the first
year of the study, followed by a "striking" decline in the
second year.
Clearly, saw palmetto offers superior symptomatic relief in prostate
disease, as defined by the most common clinical tests. In addition,
it improves quality of life and has a "practically negligible
side effect risk." This review makes a compelling case for the
use of saw palmetto as treatment of choice among physicians and patients
concerned with meaningful improvement and greater safety compared
with conventional synthetic drugs. (While cost was not a consideration
in this review, saw palmetto extract is also significantly less expensive
than conventional prescription drugs.) -- Rob McCaleb, HRF
[Bach, D., Schmitt, M., and Ebeling, L. 1997. Phytopharmaceutical
and synthetic agents in the treatment of benign prostatic hyperplasia
(BPH). Phytomedicine 3(4): 309-313.]
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© 1998 by Herb Research Foundation, Boulder,
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