Plant and herb extracts are widely used in many countries for the treatment of BPH. The extracts of greatest interest are saw palmetto (Serenoa repens; Permixon) and b-sitosterol. A systematic review of randomised studies in which men were treated with saw palmetto indicated a similar improvement in LUTS and urinary flow, and a lower rate of erectile dysfunction, compared with finasteride.79 Another systematic review was conducted for b-sitosterol, and produced similar findings.80
These studies included a small patient population, short treatment duration, variability in study design, and a number of omissions in reported outcomes that may limit their clinical usefulness. Also, because the extraction procedures used to prepare products from natural sources differ among manufacturers, accuracy of the therapeutic effect can differ. Thus, the long-term efficacy of phytotherapy remains to be proven.9
Phytotherapy is not a recommended treatment in guidelines.