RESUMO
PURPOSE: To assess the effects of Serenoa repens alone or in combination with other phytotherapy compared to placebo in men with LUTS due to benign prostatic enlargement. MATERIALS AND METHODS: Following a registered protocol (CRD42021226655), we searched (December 2020) MEDLINE, CENTRAL, Embase, ClinicalTrials.gov, WHO-ICTRP trials platform and other sources with no restrictions on language, publication date or status. We included randomized controlled trials, and we critically appraised them using the Cochrane Tool for Risk of Bias Assessment (RoB 2). We conducted random-effects meta-analysis when appropriate. The primary outcomes included urinary symptoms score, quality of life, and adverse events. The certainty of the evidence was rated using GRADE. RESULTS: We included 27 trials with 4,853 participants. S. repens results in little to no difference in urinary symptoms, quality of life, and adverse events at short- and long-term follow-up. S. repens combined with other phytotherapy may slightly reduce urinary symptoms at short-term follow-up, but the results are uncertain. The results on quality of life and adverse events are also very uncertain. CONCLUSIONS: S. repens alone may result in no clinical benefits for men with LUTS. There is greater uncertainty in the effects of S. repens in combination with other phytotherapy.
Assuntos
Sintomas do Trato Urinário Inferior/tratamento farmacológico , Sintomas do Trato Urinário Inferior/etiologia , Fitoterapia , Hiperplasia Prostática/complicações , Serenoa , Humanos , MasculinoRESUMO
BACKGROUND: Obesity is associated with increased risk of a number of serious medical conditions, including urological disorders. This study investigated the effect of lipidic extracts of saladette tomato pomace (STP) and Serenoa repens (SR) on the prostate and bladder in a rat obese model induced by high-carbohydrate diet. RESULTS: High-sucrose-fed rats showed higher prostate weight as well as increased contractility and stromal and epithelial hyperplasia in the prostate. Treatment with STP and SR improved contractility and diminished hyperplasia and hypertrophy in the prostate. Obese animals also showed impaired bladder contractility, but neither extract reversed this deterioration. In the histological study, a disarray in the process of smooth muscle cell proliferation with non-parallel fibers was observed; interestingly, treatment with STP and SR led to improvement in this derangement. CONCLUSION: These findings indicated impaired contractility and hyperplasia in the prostate and bladder of obese rats induced by high sucrose. STP and SR could enhance prostate function by reducing contractility and hyperplasia and improve smooth muscle fiber structure and decrease cell proliferation in the bladder, suggesting their possible health-beneficial effects on lower urinary tract symptoms. © 2017 Society of Chemical Industry.
Assuntos
Obesidade/complicações , Extratos Vegetais/administração & dosagem , Próstata/efeitos dos fármacos , Serenoa/química , Solanum lycopersicum/química , Bexiga Urinária/efeitos dos fármacos , Animais , Humanos , Masculino , Obesidade/metabolismo , Próstata/fisiopatologia , Doenças Prostáticas/tratamento farmacológico , Doenças Prostáticas/etiologia , Doenças Prostáticas/metabolismo , Doenças Prostáticas/fisiopatologia , Ratos , Ratos Wistar , Bexiga Urinária/fisiopatologia , Doenças da Bexiga Urinária/tratamento farmacológico , Doenças da Bexiga Urinária/etiologia , Doenças da Bexiga Urinária/metabolismo , Doenças da Bexiga Urinária/fisiopatologiaRESUMO
Serenoa repens has been widely used to treat benign prostatic hyperplasia and lower urinary tract symptoms; however, most of the studies have been conducted in individuals with normal weight and not obese. In this study, the effects of a lipidic extract of S. repens, in markers of oxidative stress, inflammation, and growth factors, in obese rats with testosterone-induced prostatic hyperplasia, were investigated. Total nitrites, malondialdehyde, total glutathione, superoxide dismutase (SOD), and catalase activity were measured; in addition, assays for inflammatory cytokines TNF-α, IL-1ß, IL-6 and the growth factors basic fibroblast growth factor (FGFb) and vascular endothelial growth factor (VEGF) were performed. The obese rats had a higher prostate weight compared with controls. S. repens significantly decreased prostate weight, total nitrites, and malondialdehyde; improved total glutathione, SOD, and catalase activity; and significantly reduced inflammatory (TNF-α, IL-1ß and IL-6) and growth factors (VEGF and FGFb). S. repens showed high antioxidant and antiinflammatory activity in obese rats, suggesting that their use could be beneficial in the treatment of benign prostatic hyperplasia.
Assuntos
Obesidade/tratamento farmacológico , Hiperplasia Prostática/tratamento farmacológico , Antagonistas de Androgênios/uso terapêutico , Animais , Anti-Inflamatórios/uso terapêutico , Antioxidantes/uso terapêutico , Humanos , Inflamação/tratamento farmacológico , Interleucina-6 , Masculino , Obesidade/complicações , Estresse Oxidativo , Fitoterapia , Extratos Vegetais , Hiperplasia Prostática/complicações , Ratos , Ratos Wistar , Serenoa , Fator de Necrose Tumoral alfa , Fator A de Crescimento do Endotélio VascularRESUMO
OBJECTIVES: This report assesses participant perception of treatment assignment in a randomized, double-blind, placebo-controlled trial of saw palmetto for the treatment of benign prostatic hyperplasia (BCM). DESIGN: Participants randomized to receive saw palmetto were instructed to take one 320 mg gelcap daily for the first 24 weeks, two 320 mg gelcaps daily for the second 24 weeks, and three 320 mg gelcaps daily for the third 24 weeks. Study participants assigned to placebo were instructed to take the same number of matching placebo gelcaps in each time period. At 24, 48, and 72 weeks postrandomization, the American Urological Association Symptom Index (AUA-SI) was administered and participants were asked to guess their treatment assignment. SETTINGS: The study was conducted at 11 clinical centers in North America. PARTICIPANTS: Study participants were men, 45 years and older, with moderate to low severe BPH symptoms, randomized to saw palmetto (N=151) or placebo (N=155). OUTCOME MEASURES: Treatment arms were compared with respect to the distribution of participant guesses of treatment assignment. RESULTS: For participants assigned to saw palmetto, 22.5%, 24.7%, and 29.8% correctly thought they were taking saw palmetto, and 37.3%, 40.0%, and 44.4% incorrectly thought they were on placebo at 24, 48, and 72 weeks, respectively. For placebo participants, 21.8%, 27.4%, and 25.2% incorrectly thought they were on saw palmetto, and 41.6%, 39.9%, and 42.6% correctly thought they were on placebo at 24, 48, and 72 weeks, respectively. The treatment arms did not vary with respect to the distributions of participants who guessed they were on saw palmetto (p=0.823) or placebo (p=0.893). Participants who experienced an improvement in AUA-SI were 2.16 times more likely to think they were on saw palmetto. CONCLUSIONS: Blinding of treatment assignment was successful in this study. Improvement in BPH-related symptoms was associated with the perception that participants were taking saw palmetto.
Assuntos
Extratos Vegetais/administração & dosagem , Ensaios Clínicos Controlados Aleatórios como Assunto/psicologia , Sujeitos da Pesquisa/psicologia , Idoso , Método Duplo-Cego , Humanos , Masculino , Pessoa de Meia-Idade , Placebos , Hiperplasia Prostática/tratamento farmacológico , SerenoaRESUMO
OBJECTIVE: To evaluate the efficacy of Profluss® on prostatic chronic inflammation (PCI). MATERIALS AND METHODS: We prospectively enrolled 168 subjects affected by LUTS due to bladder outlet obstruction submitted to 12 cores prostatic biopsy for suspected prostate cancer + 2 cores collected for PCI valuation. First group consisted of 108 subjects, with histological diagnosis of PCI associated with BPH and high grade PIN and/or ASAP, randomly assigned to 1:1 ratio to daily Profluss® (group I) for 6 months or to control group (group Ic). Second group consisted of 60 subjects, with histological diagnosis of BPH, randomly assigned to 1:1 ratio to daily Profluss® + a-blockers treatment (group II) for 3 months or to control group (group IIc). After 6 months first group underwent 24 cores prostatic re-biopsy + 2 cores for PCI while after 3 months second group underwent two-cores prostatic for PCI. Specimens were evaluated for changes in inflammation parameters and for density of T-cells (CD3, CD8), B-cells (CD20) and macrophages (CD68). RESULTS: At follow-up there were statistical significant reductions of extension and grading of flogosis, mean values of CD20, CD3, CD68 and mean PSA value in group I compared to Ic, while extension and grading of flogosis in group II were inferior to IIc but not statistical significant. A statistically significant reduction in the density of CD20, CD3, CD68, CD8 was demonstrated in group II in respect to control IIc. CONCLUSIONS: Serenoa repens+Selenium+Lycopene may have an anti-inflammatory activity that could be of interest in the treatment of PCI in BPH and/or PIN/ASAP patients.
Assuntos
Carotenoides/uso terapêutico , Extratos Vegetais/uso terapêutico , Hiperplasia Prostática/tratamento farmacológico , Prostatite/tratamento farmacológico , Selênio/uso terapêutico , Serenoa , Idoso , Anti-Inflamatórios/uso terapêutico , Linfócitos B , Biópsia , Humanos , Itália , Licopeno , Macrófagos , Masculino , Pessoa de Meia-Idade , Gradação de Tumores , Estudos Prospectivos , Antígeno Prostático Específico/sangue , Hiperplasia Prostática/patologia , Prostatite/patologia , Linfócitos T , Resultado do Tratamento , Obstrução do Colo da Bexiga Urinária/tratamento farmacológico , Obstrução do Colo da Bexiga Urinária/etiologiaRESUMO
Objective To evaluate the efficacy of Profluss® on prostatic chronic inflammation (PCI). Materials and Methods We prospectively enrolled 168 subjects affected by LUTS due to bladder outlet obstruction submitted to 12 cores prostatic biopsy for suspected prostate cancer + 2 cores collected for PCI valuation. First group consisted of 108 subjects, with histological diagnosis of PCI associated with BPH and high grade PIN and/or ASAP, randomly assigned to 1:1 ratio to daily Profluss® (group I) for 6 months or to control group (group Ic). Second group consisted of 60 subjects, with histological diagnosis of BPH, randomly assigned to 1:1 ratio to daily Profluss® + α-blockers treatment (group II) for 3 months or to control group (group IIc). After 6 months first group underwent 24 cores prostatic re-biopsy + 2 cores for PCI while after 3 months second group underwent two-cores prostatic for PCI. Specimens were evaluated for changes in inflammation parameters and for density of T-cells (CD3, CD8), B-cells (CD20) and macrophages (CD68). Results At follow-up there were statistical significant reductions of extension and grading of flogosis, mean values of CD20, CD3, CD68 and mean PSA value in group I compared to Ic, while extension and grading of flogosis in group II were inferior to IIc but not statistical significant. A statistically significant reduction in the density of CD20, CD3, CD68, CD8 was demonstrated in group II in respect to control IIc. Conclusions Serenoa repens+Selenium+Lycopene may have an anti-inflammatory activity that could be of interest in the treatment of PCI in BPH and/or PIN/ASAP patients. .
Assuntos
Idoso , Humanos , Masculino , Pessoa de Meia-Idade , Carotenoides/uso terapêutico , Extratos Vegetais/uso terapêutico , Hiperplasia Prostática/tratamento farmacológico , Prostatite/tratamento farmacológico , Serenoa , Selênio/uso terapêutico , Anti-Inflamatórios/uso terapêutico , Linfócitos B , Biópsia , Itália , Macrófagos , Gradação de Tumores , Estudos Prospectivos , Antígeno Prostático Específico/sangue , Hiperplasia Prostática/patologia , Prostatite/patologia , Linfócitos T , Resultado do Tratamento , Obstrução do Colo da Bexiga Urinária/tratamento farmacológico , Obstrução do Colo da Bexiga Urinária/etiologiaRESUMO
Benign prostatic hyperplasia (BPH) is the most common tumor in men over 40 years of age. Acute urinary retention (AUR) is regarded as the most serious hazard of untreated BPH. α-Blockers, such as doxazosin mesylate, and 5-α reductase inhibitors, such as finasteride, are frequently used because they decrease both AUR and the need for BPH-related surgery. An extract of the fruit from American saw palmetto plant has also been used as an alternative treatment for BPH. The paucity of information available concerning the genotoxic action of these compounds led us to assess their activity as inducers of different types of DNA lesions using the somatic mutation and recombination test in Drosophila melanogaster. Finasteride did not induce gene mutation, chromosomal mutation or mitotic recombination, which means it was nongenotoxic in our experimental conditions. On the other hand, doxazosin mesylate and saw palmetto induced significant increases in spot frequencies in trans-heterozygous flies. In order to establish the actual role played by mitotic recombination and by mutation in the genotoxicity observed, the balancer-heterozygous flies were also analyzed, showing no increment in the total spot frequencies in relation to the negative control, for both drugs. Doxazosin mesylate and saw palmetto were classified as specific inducers of homologous recombination in Drosophila proliferative cells, an event linked to the loss of heterozygosity.
Assuntos
Anti-Hipertensivos/toxicidade , Doxazossina/toxicidade , Drosophila/efeitos dos fármacos , Mutagênicos/toxicidade , Extratos Vegetais/toxicidade , Recombinação Genética/efeitos dos fármacos , Animais , DNA/efeitos dos fármacos , Dano ao DNA , Drosophila/genética , Feminino , Perda de Heterozigosidade/efeitos dos fármacos , Testes de Mutagenicidade , Serenoa , Asas de Animais/efeitos dos fármacos , Asas de Animais/crescimento & desenvolvimentoRESUMO
En el presente estudio se evaluaron las propiedades inmunomoduladoras in vitro de dos especies cultivadas nativas de Mesoamérica, (P. alliacea y S. domingensis), conocida popularmente como apacín y zarzaparrilla respectivamente por medio de ensayos de linfoproliferación y ensayos hemolíticos que demostraron la regulación del sistema de complemento en sus dos vías, por medio de extractos etanólicos y acuosos de hoja y raíz de P. alliacea, hojas, fruto y rizoma de S. domingensis. Dichas plantas han sido empleadas como plantas medicinales, a las que se les atribuyen las características de ser antiinflamatorias, analgésicas, antipiréticas, entre otras. En la etapa inicial se realizó la recolección del material cultivado, procediendo a su percolación y rotaevaporación con etanol al 70 % para la obtención de los extractos etanólicos y para la obtención de extractos acuosos de las diferentes partes de las plantas fue a través de la infusión por sonificación y liofilización de los mismos, calculando su porcentaje de rendimiento. Dentro de este estudio, se realizó una metodología colorimétrica para demostrar la actividad moduladora de la linfoproliferación de los extractos de las diferentes partes de las plantas, así como el determinar la concentración efectiva mínima (CEM). La metodología colorimétrica empleada, se realizó mediante una separación inicial de los linfocitos, los cuales se agregaron a una microplaca, la cual contenía una concentración conocida de los diferentes extractos, que posteriormente se incubaron por cuatro días, para luego obtener las actividades por medio de absorbancia tomadas con la ayuda de un lector de ELISA. Se empleo el mitógeno Phaseolus vulgaris (PHA), como control positivo y se determino, junto con la CEM si la actividad que presenten los extractos es inhibitoria o estimulatoria. Los extractos que presentaron actividad lo hicieron de manera inhibitoria sobre la actividad linfocítica y se les determinó su CEM siendo: extracto etanólico de rizoma de S. domingensis (CEM de 250 µg/ml) y extractos acuosos de hoja y raíz de P. alliacea (CEM de 500 y 250 µg/ml, respectivamente) y hoja y rizoma de S. domingensis (CEM de 250 y 500 µg/ml, respectivamente). Mientras que en los extractos etanólicos de hoja de P. alliacea, fruto y hoja de S. domingensis mostraron actividad únicamente en la concentración inicial de 1,000 µg/ml y los extractos sin actividad fueron extracto etanólico de raíz de P. alliacea y extracto acuosos del fruto de S. domingensis La evaluación sobre la actividad del sistema de complemento se efectuó mediante ensayos basados en la hemólisis de eritrocitos por el Complejo de Ataque a Membrana (CAM), el cual es generado al activarse el sistema de complemento; en este ensayo los eritrocitos actúan como células blanco y al ser activados se produce la lisis de eritrocitos, liberándose hemoglobina la cual es utilizada como parámetro para medir la actividad. Los resultados obtenidos en el ensayo del sistema de complemento mostraron que tanto para la vía clásica como para la vía alterna, la mayoría de los extractos tanto etanólicos como acuosos de hoja y raíz de P. alliacea, hoja y rizoma de S. domingensis presentaron un efecto inhibitorio de ambas vías, determinado por su CI50, por el contrario los extractos que no mostraron ninguna actividad fueron: extractos etanólicos y acuosos de fruto en la vía clásica y alterna y extracto acuoso de hoja de S. domingensis en vía clásica. Esto se estableció con la determinación del CI50 considerando un límite de 15 µg/ml como punto significativo de corte para establecer la presencia o ausencia de la actividad sobre las vías clásicas y alternas del complemento. Puede decirse que los extractos evaluados son de gran interés por el efecto inhibidor sobre la linfoproliferación y sobre el sistema de complemento, además de representar material vegetal cultivado que se puede aprovechar de mejor manera generando mayor volumen para su utilización en la disminución de la estimulación del sistema inmune y aprovechamiento de manera sostenible.
Assuntos
Humanos , Allium , Fatores Imunológicos , Medicina Tradicional , Serenoa , Guatemala , Técnicas In VitroRESUMO
Se presenta el caso de un hombre de 52 años con cuadro clínico de hiperazoemia de origen no claro, quien tenía como antecedentes de importancia hipertrofia prostática benigna (HPB) y prostatitis crónica, tratadas durante varios meses con palmito salvaje o palma enana americana (Serenoa repens o Saw palmetto); medicamento a base de extractos de los frutos de esta planta y a quien en la última semana se le había prescrito dosis elevadas (960 mg/d). Sus estudios de laboratorio demostraron una tasa de filtración glomerular (TFG) de 60 mililitros por minuto y la suspensión del medicamento fitoterápico logró restauración de su función renal a niveles normales. Se discute los mecanismos a través de los cuales el palmito salvaje podría ocasionar hiperazoemia.
Assuntos
Humanos , Azotemia , Taxa de Filtração Glomerular , Fitoterapia , Insuficiência Renal , Serenoa , ToxicidadeRESUMO
Saw palmetto is the most popular herbal supplement used to treat symptoms of benign prostatic hyperplasia (BPH). The safety and efficacy of saw palmetto has been established in the literature. While the majority of studies document the efficacy and safety of saw palmetto, some studies document the adverse side effects, including increased risk of bleeding. There are no reports in the literature about increased prothombin time (PT), partial thromboplastin time (PTT) or international normalized ratio (INR) while using saw palmetto. We present a case of hematuria and coagulopathy in a patient who was using saw palmetto.
Assuntos
Hematúria/induzido quimicamente , Transtornos Hemorrágicos/induzido quimicamente , Fitoterapia/efeitos adversos , Extratos Vegetais/efeitos adversos , Serenoa , Idoso , Aspirina/administração & dosagem , Aspirina/efeitos adversos , Testes de Coagulação Sanguínea , Clopidogrel , Comorbidade , Sinergismo Farmacológico , Humanos , Masculino , Extratos Vegetais/administração & dosagem , Polimedicação , Hiperplasia Prostática/tratamento farmacológico , Ticlopidina/administração & dosagem , Ticlopidina/efeitos adversos , Ticlopidina/análogos & derivadosRESUMO
Benign prostatic hyperplasia (BPH) is the benign uncontrolled growth of the prostate gland, leading to difficulty with urination. Saw palmetto lipid extracts (SPLE), used to treat BPH, have been shown to inhibit prostate 5a-reductase, and some major components, such as lauric, myristic and oleic acids also inhibit this enzyme. Coconut oil (CO) is also rich in fatty acids, mainly lauric and myristic acids. We investigated whether CO prevents testosterone-induced prostate hyperplasia (PH) in Sprague-Dawley rats. Animals were distributed into seven groups (10 rats each). A negative control group were injected with soya oil; six groups were injected with testosterone (3 mg kg(-1)) to induce PH: a positive control group, and five groups treated orally with SPLE (400 mg kg(-1)), CO or sunflower oil (SO) (400 and 800 mg kg(-1)). Treatments were given for 14 days. Rats were weighed before treatment and weekly thereafter. Rats were then killed and the prostates were removed and weighed. CO (400 and 800 mg kg(-1)), SPLE (400 mg kg(-1)) and SO at 800 mg kg(-1), but not at 400 mg kg(-1), significantly reduced the increase in prostate weight (PW) and PW:body weight (BW) ratio induced by testosterone (% inhibition 61.5%, 82.0%, 43.8% and 28.2%, respectively). Since CO and SPLE, but not SO, contain appreciable concentrations of lauric and myristic acids, these results could be attributed to this fact. In conclusion, this study shows that CO reduced the increase of both PW and PW:BW ratio, markers of testosterone-induced PH in rats.
Assuntos
Óleos de Plantas/uso terapêutico , Próstata/efeitos dos fármacos , Hiperplasia Prostática/tratamento farmacológico , Administração Oral , Animais , Peso Corporal/efeitos dos fármacos , Óleo de Coco , Masculino , Fitoterapia , Extratos Vegetais/administração & dosagem , Extratos Vegetais/farmacologia , Extratos Vegetais/uso terapêutico , Óleos de Plantas/administração & dosagem , Óleos de Plantas/farmacologia , Próstata/patologia , Hiperplasia Prostática/induzido quimicamente , Ratos , Ratos Sprague-Dawley , Serenoa , Óleo de Girassol , TestosteronaRESUMO
Benign prostatic hyperplasia (BPH) is a nonmalignant growth of prostate leading to difficulty in urinating. Drug therapy, phytotherapy included, is frequently used to treat BPH. D-004 is a lipid extract from Roystonea regia fruits, and previous studies have shown that oral treatment with D-004 for 14 days prevented prostate hyperplasia (PH) induced by testosterone in rats. No information is available, however; about the effects of D-004 in reverting already established PH. This study investigated whether D-004 could improve PH after oral dosing with testosterone in rats. Rats were distributed in five groups (10 rats/group). One group was injected with soy oil (negative control) and four groups were injected with testosterone: one was orally treated with the vehicle (positive control), two with D-004 (200 and 400 mg/kg) and the other with Saw palmetto (400 mg/kg). At study completion, the rats were sacrificed and the prostates were removed and weighed. D-004 (200 and 400 mg/kg) significantly and dose-dependently decreased prostate enlargement by 85% and 98%, respectively, versus the positive control. Likewise, Saw palmetto (400 mg/kg) significantly reduced prostate weight by 73% versus the positive control. D-004 (400 mg/kg) was more effective (p < 0.05) than Saw palmetto (400 mg/kg) in lowering prostate enlargement. D-004 and Saw palmetto also decreased the prostate weight to body weight ratio, but did not affect body weight. In conclusion, D-004 (200 and 400 mg/kg) orally administered was effective for reducing PH after testosterone dosing. D-004 (400 mg/kg) was more effective than Saw palmetto (400 mg/kg). Further studies, however, are needed to corroborate the present results.