Department of UrologyChungnam National University School of Medicine

Jae-Sung Lim

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

Manufactured in France and sold as Permixon®

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

• Saw palmetto did not improve symptoms or objective measuresof BPH in the recent literatures.

Bent S et al. NEJM 2006;354:557–66

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

Tea made from the powdered bark

France, Germany and Austria (Tadenan®)

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

active ingredient of South African star grass is β-sitosterol.

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.

Thank you for your attention !!