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.] |
