Serenoa repens for Lower Urinary Tract Symptoms/Benign Prostatic Hyperplasia: Current Evidence and Its Clinical Implications in Naturopathic Medicine.
OBJECTIVES
Benign prostatic hyperplasia (BPH) commonly affects men above 40 years old. The progression of BPH is often accompanied with lower urinary tract symptoms (LUTS) that can significantly affect the quality of life of the patients. Serenoa repens (saw palmetto) is a popular herbal remedy indicated for LUTS/BPH. We reviewed the current research on the efficacy of S. repens on LUTS/BPH as a monotherapy as well as combination therapies.


DESIGN
Non-systematic searches were performed in PubMed for human studies and systematic reviews on the topic.


RESULTS
The latest evidence, based largely on the Cochrane review, suggests that S. repens is not superior to placebo in treating LUTS/BPH as a monotherapy, even at double and triple doses. Initial clinical trials on treatment of LUTS/BPH using S. repens with lycopene and selenium, as well as S. repens with Urtica Dioica, have shown positive results. S. repens is safe in its application. However, there is a high level of heterogeneity in the quality of S. repens products. We suggest that strong placebo effect, potentially influenced by positive patients' expectation on S. repens, shapes both the clinical practice outcomes and the findings of clinical trials. Hitherto, the totality of evidence continues to suggest that S. repens is a prudent therapeutic option as part of the naturopathic treatment for LUTS/BPH.


CONCLUSIONS
The totality of evidence includes favorable patients' response from clinical experience, impact of placebo effect, early positive studies, subjective nature of symptom reporting, pharmacological properties of S. repens, and potential synergistic effects when combined with other therapies.
['Ooi|Soo Liang|SL|', 'Pak|Sok Cheon|SC|']
D000328:Adult D000368:Aged D000369:Aged, 80 and over D006801:Humans D059411:Lower Urinary Tract Symptoms D008297:Male D008875:Middle Aged D009324:Naturopathy D010936:Plant Extracts D011470:Prostatic Hyperplasia D028024:Serenoa
Serenoa repens lower urinary tract symptoms benign prostatic hyperplasia monotherapy combination therapy phytotherapy