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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).
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