BERKELEY, CA (UroToday.com) - Serenoa repens has been the object of intense research into the treatment of symptoms of benign hypertrophy, and recently of infections of the urinary tract. Its mechanism of action, while it has not been fully elucidated, is attributed to hormonally and non-hormonally mediated anti-inflammatory activity. The former is related to the inhibition of conversion of testosterone to the more potent anti-androgen, dihydrotestosterone, at the level of androgen receptors. This results in a reduction of the hormonal response of macrophages and leukocytes and the inhibition of their migration to the site of inflammation. As a consequence, there is a reduction in the release of myeloperoxidase, which causes destruction of the inflamed tissue and of platelet-derived growth factor and growth factor-beta which induce inflammation. Existing evidence regarding serenoa repens’ anti-androgenically anti-proliferative and/or anti-apoptotic action through inhibition of 5-alpha reductase is probably conflicting.[2, 3] There is experimental proof of inhibition of signaling of growth factors such as IGF-1 (Insulin-like Growth Factor), as well as cytokines such as MCP-1/CCL2 (monocyte chemotactic protein-1/chemokine CL2), which interfere with inflammatory activity in human prostate epithelial cells.[4, 5]
Serenoa repens has been used as a sole agent, in combination with or in comparison to other phytotherapeutics, combined with antibiotics, with alpha-blockers, anti-inflammatory agents, and 5-alpha reductase inhibitors for the treatment of both BPH and prostatitis. Evidence from the existing literature is conflicting given that in the above studies the outcomes measured, as well as the materials and methods used, differ. On the other hand, conditions such as chronic bacterial and chronic non-bacterial prostatitis and prostatic hypertrophy overlap. Many of the symptoms are common, while conditions and diseases of organs other than the prostate can contribute towards the presentation or deterioration of these symptoms.
In the present study, the authors investigated whether serenoa repens extract enhances the effect of quinolones in the treatment of patients with proved chronic bacterial prostatitis. Patients were randomized into two groups depending on the date of attendance (odd/even day of the month). Patients in the first group received only antibiotic for 15 days and patients in the second group (Group B) received the same antibiotic for 15 days and an extract of serenoa repens for 8 weeks. Comparison of culture results before and after treatment revealed no statistically significant differences between the two groups with regard to bacterial eradication. In contrast, symptoms questionnaire analysis revealed statistically significant differences between the two groups with regard to symptoms regression. According to our findings, an administration period of 8 weeks appears to improve the effect of antibacterial therapy on pain while a longer duration of administration possibly alleviates the remaining symptoms.
- Levin RM, Das AK. A scientific basis for the therapeutic effects of Pygeum africanum and Serenoa repens.Urol Res. 2000;28(3):201-9.
- Hill B, Kyprianou N. Effect of permixon on human prostate cell growth: lack of apoptotic action. Prostate. 2004;61(1):73-80.
- Marks LS, Hess DL, Dorey FJ. et al. Tissue effects of saw palmetto and finasteride: use of biopsy cores for in situ quantification of prostatic androgens. Urology. 2001;57(5):999-1005.
- Wadsworth Τ, Carroll J, Mallinson R. et al. Saw Palmetto extract suppresses Insulin-Like Growth Factor-I signaling and induces stress-activated protein kinase/c-Jun N-terminal kinase phosphorylation in human prostate epithelial cells. Endocrinology 2004;145(7):3205–3214.
- Latil A, Libon C, Templier M. et al. Hexanic lipidosterolic extract of Serenoa repens inhibits the expression of two key inflammatory mediators, MCP-1/CCL2 and VCAM-1, in vitro. BJU Int. 2012;110(6 Pt B):E301-7.
Konstantinos Stamatiou as part of Beyond the Abstract on UroToday.com. This initiative offers a method of publishing for the professional urology community. Authors are given an opportunity to expand on the circumstances, limitations etc... of their research by referencing the published abstract.
Department of Urology, Tzaneio General Hospital of Piraeus, Piraeus, Greece