What is the role of phytotherapeutic agents and dietary supplements in the treatment of benign prostatic hyperplasia (BPH)?

Updated: Feb 19, 2021
  • Author: Levi A Deters, MD; Chief Editor: Edward David Kim, MD, FACS  more...
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Answer

A number of  herbal formulations and plant-derived compounds have gained popularity worldwide for the management of BPH. [35] Phytotherapeutic agents and dietary supplements are considered emerging therapy by the AUA Guidelines panel and are not recommended for the treatment of BPH because of the lack of evidence at this time.

Pharmaceuticals derived from plant extracts are widely used throughout the world for the treatment of various medical ailments. In 1998, Americans spent a total of $3.65 billion on all herbal remedies. In France and Germany, plant extracts have a market share of up to 50% of all drugs prescribed for symptomatic BPH. In the United States, these agents are also popular and readily available.

The attraction to phytotherapeutic agents appears to be related to the perception of therapeutic healing powers of natural herbs, the ready availability, and the lack of adverse effects.

Most of the phytotherapeutic agents used in the treatment of LUTS secondary to BPH are extracted from the roots, seeds, bark, or fruits of plants listed below. Some suggested active components include phytosterols, fatty acids, lectins, flavonoids, plant oils, and polysaccharides. Some preparations derive from a single plant; others contain extracts from 2 or more sources.

Each agent has one or more proposed modes of action. The following modes of action are suggested:

  • Antiandrogenic effect
  • Antiestrogenic effect
  • Inhibition of 5-alpha-reductase
  • Blockage of alpha receptors
  • Antiedematous effect
  • Anti-inflammatory effect
  • Inhibition of prostatic cell proliferation
  • Interference with prostaglandin metabolism
  • Protection and strengthening of detrusor

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