department of urology chungnam national university school...
TRANSCRIPT
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.