Is Serenoa repens Effective in the Treatment of Benign Prostatic Hyperplasia?

Dear editor,

I read with great interest in the previous issue of the American Journal of Men’s Health the article “Comparison of Serenoa repens With Tamsulosin in the Treatment of Benign Prostatic Hyperplasia: A Systematic Review and Meta-Analysis” (Cai et al., 2020).

First of all, I have benefited from the article that informs urologists about phytotherapy in the treatment of men with lower urinary tract symptoms (LUTS)/benign prostatic hyperplasia (BPH). In vitro studies have demonstrated that S. repens has antiandrogenic, antiproliferative, and anti-inflammatory effects (Buck, 2004). Nevertheless I have some concerns about treatment of LUTS with S. repens. One-year follow-up Saw Palmetto for Treatment of Enlarged Prostates (STEP) study (Avins et al., 2008) and 18-months follow-up Complementary and Alternative Medicine for Urological Symptoms (CAMUS) study (Avins et al., 2013) have showed that saw palmetto did not demonstrate superiority over placebo in men with BPH who had LUTS. Moreover, a prospective, 1-year trial using saw palmetto versus finasteride in the treatment of category III prostatitis showed that patients treated with saw palmetto had no appreciable long-term improvement (Kaplan et al., 2004). It should be noted that although S. repens is used in many countries for the treatment of BPH, it is not currently recommended as equivalent to alpha-blockers in any guideline.