Botanicals for benign prostatic hyperplasia.

Abstract

Abstract Benign prostatic hyperplasia (BPH) is the most common neoplastic condition afflicting the elderly male. Men living with BPH most often seek medical treatment for lower urinary tract symptoms (LUTS) associated with BPH. LUTS include, among others, symptoms such as urinary hesitancy, incomplete emptying, nocturia and incontinence. Conventional medical intervention includes prescription of alpha-adrenergic blockers and/or 5-alpha reductase inhibitors (5-ARIs) while surgical resection is reserved for patients who fail to respond to such medication or have other underlying conditions. The use of botanical (or phytotherapeutic) compounds for relief from BPH-associated LUTS has been documented as early as the 18th century. Currently, phytotherapies for BPH enjoy widespread use in parts of Europe often serving as the first line of treatment. In particular, Serenoa repens (saw palmetto) and Pygeum africanum (African plum) have received approval from health officials in France and Germany for the treatment of BPH. Serenoa repens is the most widely administered phytotherapy throughout Europe as well as in the USA and P. africanum represents the second most popular botanical. Five other phytotherapies aimed at LUTS relief include: pumpkin seed (Curcurbita pepo), South African star grass (Hypoxis rooperi), cactus flower extract (Opuntia), rye pollen (Secale cereale) and stinging nettle root (Urtica dioica). In an age of evidence-based medicine, one must examine the evidence pertaining to the botanical's clinical efficacy prior to its recommendation. Clinical trials must satisfy both efficacy and trial design guidelines in order for the results to be considered legitimate. The application of these guidelines to clinical trials allows one to correctly interpret trial results. While all seven phytotherapies have been tested in clinical investigations, the trials suffer from one too many methodological flaws. At present, therefore, phytotherapies for the relief of symptomatic BPH cannot be recommended with confidence in clinical practice.