Rationale for the Use of Serenoa Repens Extract for Inflammatory Processes in the Prostate

Abstract

Phytotherapy remains one of the most popular methods of treating the initial stages of benign prostatic hyperplasia (BPH). One of the main mechanisms of action of herbal remedies is antiproliferative and anti-inflammatory effects of biologically active substances, which occur in the form of reducing the percentage of inflammatory infiltrates in intraoperative samples of prostate tissue. The main direction of treatment of the initial stages of BPH is the appointment of plant inhibitors of 5α-reductase, the most famous of which is the extract of Serenoa repens (SESr). This plant extract has become widespread in the world and has one of the most reliable evidence bases based on many years of research. In modern meta-analyzes of SESr, the mechanisms of action and evidence of its high clinical efficacy are quite clear. Scientific studies have shown that Serenoa repens can have selective antiandrogenic, anti-inflammatory, anti-edematous, prolactin-modulating and antiproliferative effects, the implementation of which in total can affect both the reduction of nodular hyperproliferation and prostate volume. The mechanisms of realization of the effects of Serenoa repens extract in people with BPH are multifactorial, and some of them are not defined at all. In addition to the recognized antiphlogenic effects of inhibition of cyclooxygenase-2 and 5-lipoxygenases, modern studies have established the phenomenon of exposure at the level of apoptosis regulators in prostate cells. The histological aspect of the combination of foci of benign hyperplasia with foci of chronic inflammation in prostate tissues is a factor of mutual burden, which causes rapid progression of BPH stages and the risk of prostate cancer (PC). The role of inflammation in the development of PC may be due to the presence of long-term elevated local levels of its mediators, which contribute to the formation of both genetic and metabolic conditions of acute apoptosis regulation. This is consistent with the assumption that changes in genes involved in inflammatory cascades can promote carcinogenesis, so the strategy of attempts to correct genetic polymorphism under BPH should contain a strong antiphlogenic component. The pharmacological effects of Serenoa repens fully correspond to the pathogenetic essence of the prevention of the main prostate diseases of inflammatory and hyperplastic origin, as they are aimed at reducing the severity of two key processes: hyperproliferation and chronic inflammatory response, which successfully demonstrates the clinical use of Serenoa repens extract in long-term hypertensive therapy.