Clinical Question: Does saw palmett...

Clinical Question: Does saw palmetto improve symptoms of benign prostatic hyperplasia?

Setting: Outpatient (specialty)

reflection Design: Randomized controlled trial (double-blinded)

Allocation: Concealed

Synopsis: Previous smaller studies of saw palmetto consistently have establish a benefit in patients with benign prostatic hyperplasia, if it were not that blinding may have been inadequate given the bitter taste of the performance The studies also were of relatively short duration and did not consistently use a validated symptom scale.

In this investigation men with moderate to inexorable benign prostatic hyperplasia (i.e., American Urology Association [AUA] symptom index of 8 or higher and a urinary sweep along rate of less than 15 mL through second) were recruited from the community. A one-month placebo run-in period was done to debar nonadherent men. The remaining 225 men were then randomized (allocation concealed) to individual year of treatment with saw palmetto extract at a dosage of 160 mg twice daily or a placebo designed to match the active remedy in taste. Five patients in each arrange discontinued the intervention, and four from undivided group and five from the other were forfeited to follow-up.

Analysis was by the agency of intention to treat. At the finis of the study, there was no difference between form into groupss on the AUA symptom index score for urinary f depressed rate, sexual function, serum creatinine flush prostate-specific antigen, or any other result measure. The 95% confidence interval for the change (or lack thereof) in AUA symptom index score was merely one point on a 35-point scale, in such a manner it is unlikely that the close attention failed to detect a clinically meaningful improvement because of lack of sample size. Subgroup analyses also construct no benefit among patients with more or les stiff symptoms or among patients with smaller or larger prostates. These conclusions differ from the Cochrane review forward the topic that included 21 clinical trials and set a mean improvement of 14 onward a 19-point symptom scale and just les than single fewer episode of urination by night.

Bottom Line: The authors of this rigorously designed trial plant that saw palmetto produces no improvement in symptoms for men with moderate to exact benign prostatic hyperplasia, a finding that differs from the principal part of the previous literature. (Level of Evidence: 1b)

MARK EBELL, MD MS

studious mood Reference: Bent S, et al. Saw palmetto for benign prostatic hyperplasia. N Engl J M February 9 2006;354:557-66

Used with permission from Ebell M Saw palmetto ineffective for BPH Accessed March 29 2006 at: http://www InfoPOEMs.com.

COPYRIGHT 2006 American Academy of Family Physicians

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