Phytotherapy for Lower Urinary Tract Symptoms Secondary to Benign Prostatic Hyperplasia

Purpose

We examined the available data from clinical trials for certain botanicals used for lower urinary tract symptoms secondary to benign prostatic hyperplasia, including Serenoa repens (saw palmetto), Pygeum africanum (African plum), Secale cereale (rye pollen) and Hypoxis rooperi (South African star grass).

Materials and Methods

MEDLINE® and The Cochrane Library searches were done in June 2007 using the terms benign prostatic hyperplasia, lower urinary tract symptoms, phytotherapy, saw palmetto, Serenoa, Permixon®, Pygeum africanum, Tadenan®, Cernilton®, Cernitin^™ and Hypoxis. Search results were assessed for relevance and the inclusion of placebo controlled trials.

Results

Two systematic reviews and 3 clinical trials were examined in the evaluation of Serenoa repens. Data from the systematic reviews showed an improvement in flow rates and symptoms. The results of 1 clinical trial were equivocal and the remaining 2 trials clearly showed equivalence to placebo. Systematic reviews were used in the evaluation of P. africanum, Secale cereale and Hypoxis rooperi. P. africanum and H. rooperi showed an improvement in flow rates and symptoms compared to placebo, while S. cereale showed an improvement in symptoms but not flow rates compared to placebo.

Conclusions

Most clinical trials of investigating the efficacy of botanicals suffer from well documented methodological flaws. Saw palmetto has been clearly shown as comparable to placebo in a trial of sound methodology. While preliminary results appear promising, to our knowledge the remaining botanicals have yet to be evaluated in a trial of similar quality.

Key Words: prostate, prostatic hyperplasia, urination disorders, phytotherapy, complementary therapies

Abbreviations and Acronyms: 5-ARI, 5α-reductase inhibitor, BPH, benign prostatic hyperplasia, CAMUS, Complementary and Alternative Medicine for Urological Symptoms, DHT, dihydrotestosterone, I-PSS, International Prostate Symptom Score, LUTS, lower urinary tract symptoms, N/A, not available, PSA, prostate specific antigen, PV, prostate volume, PVR, post-void residual urine, Qmax, peak urinary flow rate, WMD, weighted mean difference