Leonard S. Marks, M.D.

Spring, 1997 - Health food stores have had a "Prostate Section" for years, and many men claim to have benefitted from the alternatives offered there. However, until very recently, no scientific data were available to support or deny the possiblity that herbal, or phytotherapy could have an objective value.Now, in several studies published in the peer-reviewed medical literature, the scentific process has finally been applied to several of the more popular health food alternatives. The findings are of considerable interest to many men with symptomatic benign prostatic hyperplasia (BPH).

Three studies and one review article, dealing with herbal therapy for BPH, were published in respected medical journals during 1995 and 1996. All of the studies are from Europe and Japan. Two of the studies feature a control group. In the only placebo-controlled study, BPH patients treated with beta-sitosterol had improvements in their symptoms and flow, which though modest, exceeded the placebo patients (Lancet 345: 1529-1532 (1995).

In another study, which compared the effects of the saw palmetto extract Permixon against that of finasteride (Proscar), the two seemed to have nearly equal effects on symptoms and flows (Prostate 29: 231-240 , 1996). In a third published study, cerniton also seemed to be of some benefit in men with BPH, but no control data were included (Clin Ther 17: 82-87 (1995).

The significance of these studies is somewhat problematic, since they are all short-term studies and the actual medicinal content of each of the preparations is not clear. However, the symptomatic and flow rate improvements are encouraging in a preliminary way; and the lack of sexual (or other) side effects, when compared against finasteride or the alpha-blockers, will make these products appealing to many. Further study may be warranted, but the well-known placebo effect, accounting for up to a 30% benefit in symptom score and uroflow, must be kept in mind by all investigators and potential buyers of these products.

As Dr. Lowe of Columbia University published recently in his excellent review of phytotherapy for BPH:

...the different composition of the agents tested... is a major confounding factor in this field of study, especially because the active ingredients are unknown. Standardization of the compounds is needed to compare and assess accurately the effect of the different extracts.

We conclude that phytotherapy is probably safe, might be of some benefit, and acts via unknown mechanisms to a variable degree on men with mild to moderate BPH. Definitive studies are currently lacking.

Breaking News: Saw palmetto

References

1. Clin Ther 17: 82-87 (1995)
   Clinical evaluation of long-term treatment using cernitin pollen extract in patients with benign prostatic hyperplasia.
   Yasumoto R, Kawanishi H, Tsujino T, Tsujita M, Nishisaka N, Horii A, Kishimoto T
   Department of Urology and Andrology, Osaka Municipal Juso Citizens' Hospital,Japan.
   
   
2. Lancet 345: 1529-1532 (1995).
   Randomised, placebo-controlled, double-blind clinical trial of beta-sitosterol in patients with benign prostatic hyperplasia. Beta-sitosterol Study Group.
   Berges RR, Windeler J, Trampisch HJ, Senge T
   Department of Urology, Ruhr-University, Bochum, Germany.
   
   
3. Prostate 29: 231-240 (1996)
   Comparison of phytotherapy (Permixon) with finasteride in the treatment of benign prostate hyperplasia: a randomized international study of 1,098 patients.
   Carraro JC, Raynaud JP, Koch G, Chisholm GD, Di Silverio F, Teillac P, Da Silva FC, Cauquil J, Chopin DK, Hamdy FC, Hanus M, Hauri D, Kalinteris A, Marencak J, Perier A, Perrin P
   Pierre Fabre Medicament, La Chartreuse, Castres, France.
   
   
4. Urology 48: 12-20 (1996)
   Phytotherapy in treatment of benign prostatic hyperplasia: a critical review.
   Lowe FC, Ku JC
   Department of Urology, St. Luke's/Roosevelt Hospital Center, New York, New York 10019, USA.