Department of Urology Chungnam National University School...
Transcript of Department of Urology Chungnam National University School...
100 different preparations generated from 30 different plants are in clinical use.
in US, medical therapy for BPH phytotherapy alone: 14% prescribed drugs and phytotherapy: 20%
30–50% in Austria, Germany and France
Common agents Serenoa repens (saw palmetto) Pygeum africaneum (african plum) Secale cereale (rye pollen) Hypoxis rooperi (South African star grass)
EAU-guidelines phytotherapeutic agents are not recommended for the treatment of
elderly men with LUTS suggestive of benign prostatic obstruction AUA-guidelines
Phytotherapeutic agents cannot be recommended for treatment of BPH at this time
Phytotherapeutic agents good tolerability, sexually active men who want to avoid sexual side
effects of a1-blockers and 5ARIs without significant benign prostatic obstruction and a low risk of progression
Patients should be instructed that the definitive proof of their efficacy is still lacking and that they are currently not recommended by BPH-guidelines
Stephan et al. EAU update series 2007;5:107-205
Inhibition in vitro of the biosynthesis of cyclooxygenase and 5-lipoxygenase via its acid lipophilic components
Inhibition in vitro 5-reductase activity in the epithelium and stroma of human BPH
: weak in comparison to that of finasteride
Induction of apoptosis and inhibition of cellular proliferation
: increased the bax-to-bcl-2 expression ratio and caspase-3 activity in patients with BPH after administering Permixon3 months before surgery
Smooth muscle relaxation via α1-adrenergic receptors
: recent evidence indicates that S. repens does not block α1-adrenoceptors in vivo
: other current literatures indicate that S. repens inhibit indirect α1-adrenoceptor mediated contractions in the rat prostate gland.
Bax-to-Bcl-2 expression ratio
• Bcl-2 and Bax protein expression were detected by Western blot: In Permixon group, Bax protein expression tended to be higher than in control group
Western blot of caspase-3 activity in prostatic tissue
• The level of the intact 116 kDa PARP form was significantly decreased in the prostatic tissue of Serenoa repens treated patients: suggesting that treated patients had increased caspase-3 activity
Vela-Navarrete R et al. J Urol. 2005
Cheema et al described a patient in whom phytotherapy appeared responsible for increased intraoperative bleeding time
Saw palmetto induced pancreatitis in a 55-yearold man with a history of alcoholism
growth factor inhibition : Inhibition of basal growth of cultured human prostaticmyofibroblasts and fibroblasts
anti-inflammatory action: inhibition of leukotriene synthesis in humanpolymorphonuclear cell cultures in vitro
anti-androgenic action: decrease the obstructive effects of DHT on micturition
and reduce prostate weight
• DHT-treated group indicating more frequent voiding of lower volumes of urine
• TAD-treated group showing low frequency of micturitionat larger urine volumes
inhibition of prostatic cell growth and smooth musclerelaxation via the inhibition of α-adrenergic receptors
in vivo evidence for interference with rat androgen metabolism
action mechanism of β-sitosterol
anti-inflammatory effects through interferencewith prostaglandin metabolism
alteration in cholesterol metabolism
direct inhibition of prostate growth
anti-androgenic effect
decreased availability of SHBG
• The current evidence appears hopeful because improvement in I-PSS and Qmax has been demonstrated
• But, the data remain difficult to interpret, given the poor methodology of the trials: the short trial duration, lack of placebocontrol, relatively small sample size and lack of standardized materials.