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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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