Microsoft word - 12 saw palmetto.doc
Saw Palmetto Extracts for Treatment of Benign Prostatic Hyperplasia
A Systematic Review
Timothy J. Wilt, MD, MPH; Areef Ishani, MD; Gerold Stark, MD; Roderick MacDonald, MS; Joseph
To conduct a systematic review and, where possible, quantitative meta-analysis of
the existing evidence regarding the therapeutic efficacy and safety of the saw palmetto
extract, Serenoa repens
, in men with symptomatic benign prostatic hyperplasia (BPH).
Studies were identified through the search of MEDLINE (1966-1997), EMBASE,
Phytodok, the Cochrane Library, bibliographies of identified trials and review articles, and contact
with relevant authors and drug companies.
Randomized trials were included if participants had symptomatic BPH, the
intervention was a preparation of S repens
alone or in combination with other phytotherapeutic
agents, a control group received placebo or other pharmacological therapies for BPH, and the treatment duration was at least 30 days.
Two investigators for each article (T.J.W., A.I., G.S., and R.M.) independently
extracted key data on design features, subject characteristics, therapy allocation, and outcomes of the studies.
A total of 18 randomized controlled trials involving 2939 men met inclusion
criteria and were analyzed. Many studies did not report results in a method that permitted meta-analysis. Treatment allocation concealment was adequate in 9 studies; 16 were double-blinded. The
mean study duration was 9 weeks (range, 4-48 weeks). As compared with men receiving placebo, men treated with S repens
had decreased urinary tract symptom scores (weighted mean difference
[WMD], -1.41 points [scale range, 0-19] [95% confidence interval (CI), -2.52 to -0.30] [n=1 study]), nocturia (WMD, -0.76 times per evening [95% CI, -1.22 to -0.32] [n=10 studies]), and improvement in self-rating of urinary tract symptoms; risk ratio for improvement (1.72 [95% CI,
1.21-2.44] [n=6 studies]), and peak urine flow (WMD, 1.93 mL/s [95% CI, 0.72-3.14] [n=8 studies]). Compared with men receiving finasteride, men treated with S repens
improvements in urinary tract symptom scores (WMD, 0.37 International Prostate Symptom Score points [scale range, 0-35] [95% CI, -0.45 to 1.19] [n=2 studies]) and peak urine flow (WMD, -0.74
mL/s [95% CI, -1.66 to 0.18] [n=2 studies]). Adverse effects due to S repens
were mild and infrequent; erectile dysfunction was more frequent with finasteride (4.9%) than with S repens
<.001). Withdrawal rates in men assigned to placebo, S repens
, or finasteride were 7%, 9%, and 11%, respectively.
The existing literature on S repens
for treatment of BPH is limited in terms of the
short duration of studies and variability in study design, use of phytotherapeutic preparations, and reports of outcomes. However, the evidence suggests that S repens
improves urologic symptoms and flow measures. Compared with finasteride, S repens
produces similar improvement in urinary
tract symptoms and urinary flow and was associated with fewer adverse treatment events. Further research is needed using standardized preparations of S repens
to determine its long-term
effectiveness and ability to prevent BPH complications.
From the Department of Veterans Affairs Coordinating Center of the Cochrane Collaborative Review Group in Prostatic Diseases and Urologic Malignancies and Minneapolis/Veterans Integrated Service
Network 13 Center for Chronic Diseases Outcomes Research, Minneapolis Veterans Affairs Medical Center, Minneapolis, Minn (Drs Wilt, Ishani, and Stark and Mr MacDonald); New England Medical
Center, Boston, Mass (Dr Lau); and the Department of Veterans Affairs San Antonio Cochrane Center, San Antonio, Tex (Dr Mulrow).
THIS ARTICLE HAS BEEN CITED BY OTHER ARTICLES
Proven and Unproven Therapy for Benign Prostatic Hyperplasia
DiPaola and Morton
Access To Conventional Medical Care And The Use Of Complementary And Alternative
Pagan and Pauly
Health Aff (Millwood)
2005;24:255-262. ABSTRACT | FULL TEXT
Phytochemical Assays of Commercial Botanical Dietary Supplements
Krochmal et al. Evid Based Complement Alternat Med
2004;1:305-313. ABSTRACT | FULL TEXT
Current Management of Urinary Incontinence
Knight-Klimas Journal of Pharmacy Practice
Internet Marketing of Herbal Products
Morris and Avorn
2003;290:1505-1509. ABSTRACT | FULL TEXT
Advising Patients Who Seek Complementary and Alternative Medical Therapies for
Weiger et al.
ANN INTERN MED
2002;137:889-903. ABSTRACT | FULL TEXT
Tomatoes, Lycopene, and Prostate Cancer: Progress and Promise
Hadley et al. Exp. Biol. Med.
Potential Physician Malpractice Liability Associated with Complementary and Integrative
Cohen and Eisenberg ANN INTERN MED
Dietary Supplement Use: Consumer Characteristics and Interests
2001;131:1339S-1343. ABSTRACT | FULL TEXT
Research into complementary and alternative medicine: problems and potential
Nahin and Straus BMJ
Herbal medicines: where is the evidence?
Immediate Hormonal Therapy Compared with Observation after Radical Prostatectomy
and Pelvic Lymphadenectomy in Men with Node-Positive Prostate Cancer
Messing et al.
1999;341:1781-1788. ABSTRACT | FULL TEXT
Saw Palmetto for Benign Prostatic Hyperplasia
Alternative Medicine Meets Science
Fontanarosa and Lundberg JAMA
management'S diSCUSSion & analYSiS Years ended March 31, 2010 and 2009 results of operations Currently, one of the Group’s immediate priorities is to realize During the fiscal year under review, the Japanese economy as a competitive advantages through the early completion of multiple whole remained subdued. Although some sectors registered an double tracks construction, and as such
Dentists on tour, Auvergne, 12. – 17.09.2010• Teil 1: Seniorenmedizin im engeren Sinne Folgende Postenarbeit: Erarbeiten von Hilfsmitteln bringen häufiger Probleme der Wechslwirkung• neurologische Störungen• Immunsuppression• AugenleidenInsuffizienzKranzgefässeVitienRhythmusstörungenTransplantationam häufigsten coronareoder hypertensive CardiopathieBeachte: häufig weitereBeg