title: Benign prostatic hyperplasia treated with saw palmetto: a literature search and an experimental case study.
abstract: European physicians treat benign prostatic hyperplasia (BPH) with saw palmetto extract (SPE), while American physicians generally disregard SPE because "research is lacking." The authors investigated this discrepancy with a literature search and a clinical trial. The literature search began with MEDLINE, then expanded to "alternative" databases, including AGRICOLA, EMBASE, IBIS, and Cochrane, plus a manual search of unindexed herbal journals. The clinical trial was an experimental case study in which a 67-year-old man with symptomatic BPH was randomly administered SPE (160 mg standardized extract twice daily) or placebo. Outcome measures included the American Urological Association Symptom Index (AUASI), serum prostate-specific antigen, and prostate volume. Our expanded literature search revealed 58 clinical trials, whereas MEDLINE yielded only 19 clinical trials, or 33% of the total. Our clinical trial measured a baseline AUASI score of 20, which improved to 7 after unblinded administration of SPE. Subsequent double-blinded placebo produced a score of 14, and final single-blinded allotment of SPE produced a score of 11. Prostate-specific antigen was 10.3 ng/mL at baseline and 10.7 ng/mL at trial's conclusion. Baseline prostatic volume was 92 mL, and end volume was 75 mL. In conclusion, MEDLINE proved inadequate as a stand-alone search engine for locating information about an herbal medicine. Our experimental case study, similar to N = 1 research methodology, proved suitable for clinical evaluation of an herbal medicine in a rural private practice. SPE improved the patient's BPH. Unstandardized look-alike herbs may act as nontherapeutic placebos and may undermine consumer confidence in herbal medicine.
authors.affiliation: Department of Family Practice, University of Vermont, USA. john.mcpartland@vtmednet.org
authors.forename: J M
authors.initials: JM
authors.lastname: McPartland
authors.forename: P L
authors.initials: PL
authors.lastname: Pruitt
mesh_terms: D000368:Aged; D000726:Androgen Antagonists / Q000627:therapeutic use*; D016206:Databases, Bibliographic; D004311:Double-Blind Method; D005060:Europe; D006801:Humans; D016239:MEDLINE; D008297:Male; D010936:Plant Extracts / Q000627:therapeutic use*; D011470:Prostatic Hyperplasia / Q000188:drug therapy*; D028024:Serenoa; D016896:Treatment Outcome; D014481:United States
chemical_list: D000726:Androgen Antagonists; D010936:Plant Extracts; C040972:saw palmetto extract