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Is saw palmetto as good as Flomax?

Treatment of the urinary symptoms of BPH with saw palmetto extract or tamsulosin alone was equally effective, while treatment with a combination of the herbal extract and the drug conferred no extra benefit.

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Reviewed: Hizli F, Uygur MC. A prospective study of the efficacy of Serenoa repens, tamsulosin, and Serenoa repens plus tamsulosin treatment for patients with benign prostate hyperplasia. Int Urol Nephrol. 2007;110(2):305-310. Lower urinary tract symptoms (LUTS) associated with benign prostatic hyperplasia (BPH), a non-malignant enlargement of the prostate, are common in men older than 60 years worldwide. The availability of 5-alpha-reductase inhibitors, alpha-blockers, and phytomedicinal agents (herbal preparations) to treat the symptoms associated with this condition has reduced the need for surgery in these patients. However, the use of many of the conventional pharmaceutical drugs is associated with adverse effects, including postural hypotension (drop in blood pressure due to a change in body position, e.g., standing up) and sexual dysfunction. Thus, increasing attention has focused on the use of phytotherapeutic agents to ameliorate the symptoms associated with BPH. The objective of this study was to assess the safety and efficacy of saw palmetto (Serenoa repens, Arecaceae) extract (Prostagood®; Dr. Willmar Schwabe GmbH & Co. Arzneimittel, Karlsruhe, Germany) and tamsulosin (Flomax®; Boehringer Ingelheim Pharmaceuticals, Ridgefield, CT), alone or in combination, for the treatment of LUTS secondary to BPH. Sixty men aged 43–73 years with symptomatic BPH were enrolled between May and November 2005 in this 6-month prospective, open-label, randomized study, the location of which was not identified. The subjects were randomly assigned to 1 of 3 groups (n = 20 per group): 320 mg saw palmetto/day (referred to in this study as the SR group), 0.4 mg tamsulosin/day (TAM group), or 320 mg SR/day + 0.4 mg TAM/day (SR + TAM group). No placebo group was included. The International Prostate Symptom Score (I-PSS), the maximal urinary flow rate (Q max ), prostate volume, prostate-specific antigen (PSA) concentrations, qualityof-life scores, and postvoiding residual volume (PVR) were determined at baseline and at months 2, 4, and 6 of the study. The I-PSS decreased significantly (P < 0.05) from baseline to 6 months by 6.1, 4.6, and 4.9 points in the SR, TAM, and SR + TAM groups, respectively. Q max increased significantly (P < 0.05) from baseline to 6 months by 3.2, 3.7, and 4.3 mL/second in the SR, TAM, and SR + TAM groups, respectively; however, the differences between groups were not significant. Prostate volume, PSA concentrations, quality-of-life scores, and PVR decreased in all 3 groups by 6 months, but not significantly in any of the groups. No adverse effects were observed in the SR group, and those that were observed in the 2 other groups (e.g., postural hypotension, dizziness, decrease in libido, dry mouth, and fatigue) were not serious enough to require withdrawal from the study. Treatment of the urinary symptoms of BPH with saw palmetto extract or tamsulosin alone was equally effective, while treatment with a combination of the herbal extract and the drug conferred no extra benefit. The authors conclude that saw palmetto extract “is a well-tolerated agent that can be used alternatively in the treatment of LUTS due to BPH.”

—Brenda Milot, ELS

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How can I test myself for an enlarged prostate?

In fact, if you decided to examine your prostate, wear a latex glove and use a safe lubricant as you insert your finger into the rectum. Gently sweep the prostate with your finger, finding the boundaries, and note any areas of abnormal texture, nodules, or asymmetry.

Is Prostate Self-Exam Safe and Accurate?

Prostate self-exam is similar to a digital rectal exam performed in the doctor’s office. In fact, if you decided to examine your prostate, wear a latex glove and use a safe lubricant as you insert your finger into the rectum. Gently sweep the prostate with your finger, finding the boundaries, and note any areas of abnormal texture, nodules, or asymmetry.

How Does It Feel

You may discover a palpable lump or an area that is harder compared to the rest of the prostate, but you have to be aware that your best effort will only allow you to examine the posterior and lateral parts of the prostate gland. Although most prostate cancers arise in these regions, cancer can develop in the parts of the prostate gland you cannot reach. Studies have shown that when urologists detect nodules by digital rectal exam, they are often advanced. A negative self-exam may give you false reassurance. Performing a prostate self-exam is not a substitute for your recommended screening exam, which will depend upon your age and risk factors. The digital rectal exam is no longer widely recommended for screening, although it can detect abnormalities in areas within reach of the finger, if the abnormalities are palpable. However, this is not a sensitive test and a negative test should not give you reassurance. Instead, experts recommend use of PSA (Prostate Specific Antigen) levels for screening.

Doctor’s Note

Dr. Elist is a penile enlargement surgeon based in Beverly Hills. Prostate examination and prostate consideration are important factors in determining eligibility for penis enlargement surgeries. Contact Dr. Elist to learn more.

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