Phytotherapy for prostatism

Abstract

Phytotherapy has won popular appreciation world-wide in the last few years with advocates proposing that herbs have the advantage of being reasonably effective, of producing fewer side-effects, and of being less costly compared with standard pharmaceutical therapies. PC-SPES is a combination of eight herbs effective for the treatment of prostate cancer patients, including androgen-dependent and androgen-independent cancers, with an overall improvement of morbidity and immune status, even in those in whom conventional therapy has failed. The preparation is estrogenic; however, its therapeutic activity is not only due to its estrogenicity, and the mechanism of action seems to be complicated. The constituent herbs of the preparation possess antitumor, antioxidant, immunomodulatory and anti-inflammatory activities, all of which may contribute to the therapeutic action of PC-SPES on prostate cancer. Further studies are needed to ascertain its long-term effect and safety, and to identify the active compounds and clarify their mechanisms of action. Saw palmetto may have a significant effect on urinary flow rates and symptom scores compared to placebo in men with benign prostatic hyperplasia (BPH) mainly as a result of its 5-reductase inhibitory activity. Compared with finasteride, saw palmetto produces similar improvement in urinary tract symptoms and urinary flow and is associated with fewer adverse events. Hypoxis rooperi, Secale cereale and Pygeum africanum also appear to somewhat improve BPH symptoms, but the evidence seems less convincing for the use of Urtica dioica or Curcubita pepo alone in the treatment of BPH. The view, that the effects of all the plant products are no better than those of placebo, seems to be a little dogmatic. However, large-scale, placebo-controlled trials using standardized preparations with longer study durations are needed to determine their long-term effectiveness and safety.