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      Estudo exploratório da utilização de saw palmetto no tratamento da hiperplasia benigna da próstata por urologistas de Porto Alegre Translated title: Investigation study concerning the saw palmetto use for the benign prostatic hyperplasia treatment by urologists in Porto Alegre

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          Abstract

          O objetivo deste trabalho foi avaliar a utilização de fitoterápicos a base de saw palmetto na terapia sintomática da hiperplasia benigna da próstata (HBP) por médicos urologistas da cidade de Porto Alegre. Consistiu em um estudo transversal, exploratório, por meio de entrevista semi-estruturada aplicada a urologistas de Porto Alegre. A amostra foi obtida utilizando catálogo do plano de saúde UNIMED- Porto Alegre. A randomização foi realizada através de sistemática aleatória, sendo sorteados trinta e cinco médicos, dos quais 21 foram selecionados para realização da pesquisa através de questionário. Todos os urologistas entrevistados avaliam e tratam pacientes com hiperplasia benigna da próstata. O saw palmetto não foi citado como terapia medicamentosa de 1ª ou 2ª escolhas no tratamento da HBP. O grupo farmacológico mais freqüentemente utilizado para o tratamento da HBP foi ∝-bloqueadores. Mais da metade dos médicos entrevistados relata ter conhecimento sobre a utilização do saw palmetto, principalmente através de artigos científicos. Os resultados indicam que o saw palmetto não é prescrito pelos urologistas em Porto Alegre, todavia a maior parte destes profissionais tem conhecimento sobre sua utilização.

          Translated abstract

          The aim of this work was to assess the prescription of saw palmetto phytomedicines for improving symptoms of benign prostatic hyperplasia (BPH) by urologists in Porto Alegre (Brazil). The study was transversal and exploratory consisting of a semi-structured interview with urologists. The sample was obtained from the UNIMED Catalog - Porto Alegre (Brazil). The randomization was made by chance, being selected thirty-five physicians. The first twenty-one who accepted to participate were interviewed. All the interviewed urologists treat patients with benign prostatic hyperplasia. The saw palmetto was not mentioned as the first or second choice for treating BPH. The α-blockers were the most mentioned pharmacological group. However, more than half of urologists have heard about the use of saw palmetto and most of them gathered the information in scientific papers. The results indicate that saw palmetto is not prescribed for urologists in Porto Alegre, although most of them have knowledge about this phytomedicine.

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          Saw palmetto for benign prostatic hyperplasia.

          Saw palmetto is used by over 2 million men in the United States for the treatment of benign prostatic hyperplasia and is commonly recommended as an alternative to drugs approved by the Food and Drug Administration. In this double-blind trial, we randomly assigned 225 men over the age of 49 years who had moderate-to-severe symptoms of benign prostatic hyperplasia to one year of treatment with saw palmetto extract (160 mg twice a day) or placebo. The primary outcome measures were changes in the scores on the American Urological Association Symptom Index (AUASI) and the maximal urinary flow rate. Secondary outcome measures included changes in prostate size, residual urinary volume after voiding, quality of life, laboratory values, and the rate of reported adverse effects. There was no significant difference between the saw palmetto and placebo groups in the change in AUASI scores (mean difference, 0.04 point; 95 percent confidence interval, -0.93 to 1.01), maximal urinary flow rate (mean difference, 0.43 ml per minute; 95 percent confidence interval, -0.52 to 1.38), prostate size, residual volume after voiding, quality of life, or serum prostate-specific antigen levels during the one-year study. The incidence of side effects was similar in the two groups. In this study, saw palmetto did not improve symptoms or objective measures of benign prostatic hyperplasia. (ClinicalTrials.gov number, NCT00037154.). Copyright 2006 Massachusetts Medical Society.
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            Comparison of a phytotherapeutic agent (Permixon) with an alpha-blocker (Tamsulosin) in the treatment of benign prostatic hyperplasia: a 1-year randomized international study.

            While the lipido-sterolic extract of Serenoa repens (LSESr)-Permixon((R))-has been shown to have an equivalent efficacy to finasteride in patients with benign prostatic hyperplasia (BPH), to date, there has been no valid comparison of phytotherapy with alpha-blockers. The aim of this study was to assess the equivalent efficacy of Permixon and tamsulosin. Eight hundred and eleven men with symptomatic BPH (I-PSS> or =10) were recruited in 11 European countries for a 12-month, double-blind randomized trial. After a 4-week run-in period, 704 patients were randomly assigned to either tamsulosin 0.4mg/day (N=354) or Permixon 320mg/day (N=350). I-PSS, QoL and Q(max) were evaluated at baseline and periodically for 1 year. Prostate volume and serum prostate-specific antigen (PSA) were measured at selection and at endpoint. The endpoint analysis was performed on the per-protocol population of 542 patients (tamsulosin: N=273; Permixon: N=269). At 12 months, I-PSS decreased by 4.4in each group and no differences were observed in either irritative or obstructive symptom improvements. The increase in Q(max) was similar in both treatment groups (1.8ml/s Permixon, 1.9ml/s tamsulosin). PSA remained stable while prostate volume decreased slightly in the Permixon-treated patients. The two compounds were well tolerated, however, ejaculation disorders occurred more frequently in the tamsulosin group. This study demonstrates that Permixon and tamsulosin are equivalent in the medical treatment of lower urinary tract symptoms in men with BPH, during and up to 12 months of therapy.
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              Effects of a saw palmetto herbal blend in men with symptomatic benign prostatic hyperplasia.

              We tested the effects of a saw palmetto herbal blend in men with symptomatic benign prostatic hyperplasia (BPH) via a randomized, placebo controlled trial. We randomized 44 men 45 to 80 years old with symptomatic BPH into a trial of a saw palmetto herbal blend versus placebo. End points included routine clinical measures (symptom score, uroflowmetry and post-void residual urine volume), blood chemistry studies (prostate specific antigen, sex hormones and multiphasic analysis), prostate volumetrics by magnetic resonance imaging, and prostate biopsy for zonal tissue morphometry and semiquantitative histology studies. Saw palmetto herbal blend and placebo groups had improved clinical parameters with a slight advantage in the saw palmetto group (not statistically significant). Neither prostate specific antigen nor prostate volume changed from baseline. Prostate epithelial contraction was noted, especially in the transition zone, where percent epithelium decreased from 17.8% at baseline to 10.7% after 6 months of saw palmetto herbal blend (p <0.01). Histological studies showed that the percent of atrophic glands increased from 25. 2% to 40.9% after treatment with saw palmetto herbal blend (p <0.01). The mechanism of action appeared to be nonhormonal but it was not identified by tissue studies of apoptosis, cellular proliferation, angiogenesis, growth factors or androgen receptor expression. We noted no adverse effects of saw palmetto herbal blend. When the study was no longer blinded, 41 men elected to continue therapy in an open label extension. Saw palmetto herbal blend appears to be a safe, highly desirable option for men with moderately symptomatic BPH. The secondary outcome measures of clinical effect in our study were only slightly better for saw palmetto herbal blend than placebo (not statistically significant). However, saw palmetto herbal blend therapy was associated with epithelial contraction, especially in the transition zone (p <0.01), indicating a possible mechanism of action underlying the clinical significance detected in other studies.
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                Author and article information

                Journal
                rbfar
                Revista Brasileira de Farmacognosia
                Rev. bras. farmacogn.
                Sociedade Brasileira de Farmacognosia (Curitiba, PR, Brazil )
                0102-695X
                1981-528X
                June 2008
                : 18
                : 2
                : 222-225
                Affiliations
                [01] Porto Alegre RS orgnameUniversidade Federal do Rio Grande do Sul orgdiv1Faculdade de Farmácia orgdiv2Departamento de Produção e Controle de Medicamentos Brasil
                [02] Porto Alegre RS orgnameUniversidade Federal do Rio Grande do Sul orgdiv1Faculdade de Farmácia orgdiv2Departamento de Produção de Matéria-prima Brasil
                Article
                S0102-695X2008000200014 S0102-695X(08)01800214
                403ca9d0-f529-479d-b139-c59fb5f352d3

                This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.

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                Figures: 0, Tables: 0, Equations: 0, References: 22, Pages: 4
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                SciELO Brazil

                Self URI: Texto completo somente em PDF (PT)
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                Trabalhos Originais

                Arecaceae,Serenoa repens,Porto Alegre,urologistas,estudo exploratório,saw palmetto,BPH,investigated study,urologists,HBP

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