Saw Palmetto Extract Effective in Treating Chronic Prostatitis

Emma Hitt, PhD

April 28, 2003

April 28, 2003 (Chicago) — Permixon, a compound extracted from the fruit of the American dwarf palm tree Serona repens, also known as saw palmetto, appears to improve symptoms of chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS).

Mesut Remzi, MD, from the Department of Urology at the University of Vienna in Austria, and colleagues presented their findings here at the annual meeting of the American Urological Association.

"Although antimicrobial treatment is usually successful in men with bacterial prostatitis, currently no standardized treatment is available for Category III CP/CPPS," Dr. Remzi and colleagues point out.

The researchers evaluated the efficacy and safety of Permixon in 61 patients with Category IIIB CP/CPPS.

Men were enrolled in two institutions and randomized to six weeks of active treatment with 160 mg Permixon twice daily (n = 32) or a control group, which did not receive a placebo (n = 24). Age, prostate volume, and prostate-specific antigen (PSA) levels were comparable between groups.

The researchers evaluated the response to therapy at six and 12 weeks after treatment based on several efficacy parameters. These included Patients Subjective Global Assessment (SGA); the total NIH Chronic Prostatitis Symptom Index (CPSI); the pain, voiding, and quality of life/impact domains of the CPSI; safety data; PSA level; and prostate volume.

Seventy-five percent of the patients who received Permixon had at least mild improvement in symptoms compared with 20% of the control group. Similarly, 55% of patients who received Permixon reported moderate or marked improvement compared with 16% of the control group. After six weeks, 38% of patients treated with Permixon showed a 30% reduction in total NIH-CPSI compared with 12.5% of the control group, although no difference in this score was observed after 12 weeks.

Despite the improvement in symptoms, prostate volume did not change significantly in either group. In the control group, PSA did not differ from baseline. However, the group taking Permixon experienced median decreases from baseline PSA of 22% after 6 weeks.

According to Dr. Remzi, previous studies have indicated that Permixon has an effect on benign prostatic hyperplasia (BPH) and that it might have an impact on prostatitis.

"Currently, it is the number one treatment for BPH in France and it is also very popular in Germany and Austria for BPH," he told Medscape.

Dr. Remzi suggested that Permixon might treat CP/CPPS by exerting an influence on levels of dihydrotestosterone, or it might exert an anti-inflammatory effect or act as an alpha-blocker.

"Because of these findings, we are now going to do a placebo-controlled trial," he added.

"This study is provocative and interesting," said J. Curtis Nickel, MD, from the Department of Urology at Queen's University in Kingston, Ontario, Canada. "This type of study is what has to be done — we have to look at everything and compare it to placebo, since herbal therapies may have a role to play in many of these patients." Dr. Nickel estimated that 20% to 30% of his prostatitis patients have tried saw palmetto.

"This is the first study that I know of that has showed a benefit in CP/CPPS for saw palmetto. The study should be repeated with larger numbers and we may be able to show that this type of phytotherapeutic agent may be of benefit," he told Medscape.

The study was self-funded.

AUA 98th Annual Meeting: Abstract 103937. Presented April 26, 2003.

Reviewed by Gary D. Vogin, MD

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