Comparison of Serenoa repens With Tamsulosin in the Treatment of Benign Prostatic Hyperplasia: A Systematic Review and Meta-Analysis.

2020-03
American journal of men's health 14(2)
- Tong Cai
- Yuanshan Cui
- Shaoxia Yu
- Qian Li
- Zhongbao Zhou
- Zhenli Gao

PubMed: 32274957
DOI: 10.1177/1557988320905407

Study Design

Type: Meta-Analysis
Sample size: n = 80
Population: 1,080 patients with BPH from four studies
Methods: systematic review and meta-analysis, at least 6-month treatment cycle
Duration: at least 6 months

Studies reported that Serenoa repens was effective in relieving lower urinary tract symptoms (LUTS). This article carried out a systematic review and meta-analysis to compare Serenoa repens with tamsulosin in the treatment of benign prostatic hyperplasia (BPH) after at least 6-month treatment cycle. Four studies involving 1,080 patients (543 in the Serenoa repens group and 537 in the tamsulosin group) were included in the meta-analysis. The results were as follows: compared with tamsulosin, Serenoa repens had a same effect in treating BPH in terms of International Prostate Symptom Score (IPSS) (mean difference [MD] 0.63, 95% confidence interval [CI] [-0.33, 1.59], p = 0.20), quality of life (QoL) (MD 1.51, 95% CI [-1.51, 4.52], p = 0.33), maximum flow rate (Qmax) (MD 0.27, 95% CI [-0.15, 0.68], p = 0.21), postvoid residual volume (PVR) (MD -4.23, 95% CI [-22.97, 14.44], p = 0.65), prostate-specific antigen (PSA) (MD 0.46, 95% CI [-0.06, 0.97], p = 0.08) with the exception of prostate volume (PV) (MD -0.29, 95% CI [-0.41, -0.17], p < 0.00001). For side effects, Serenoa repens was well tolerated compared with tamsulosin especially in ejaculation disorders (odds ratio [OR] = 12.56, 95% CI [3.83, 41.18], p < 0.0001) and decreased libido (OR = 5.40; 95% CI [1.17, 24.87]; p = 0.03). This study indicated that Serenoa repens had the same effect in treating BPH compared with tamsulosin in terms of IPSS, QoL, and PVR after at least 6-month treatment cycle, however, the latter had a greater improvement in PV compared with the former. And Serenoa repens did not increase the risk of adverse events especially with respect to ejaculation disorders and libido decrease.

Research Insights

Saw Palmetto→Improved Maximum Flow Rate
maximum flow rate (Qmax) (MD 0.27, 95% CI [-0.15, 0.68], p = 0.21)
Effect
Neutral
Effect size
Small
Saw Palmetto→Improved Quality of Life
quality of life (QoL) (MD 1.51, 95% CI [-1.51, 4.52], p = 0.33)
Effect
Neutral
Effect size
Small
Saw Palmetto→Reduced International Prostate Symptom Score
compared with tamsulosin, Serenoa repens had a same effect in treating BPH in terms of International Prostate Symptom Score (IPSS) (mean difference [MD] 0.63, 95% confidence interval [CI] [-0.33, 1.59], p = 0.20)
Effect
Neutral
Effect size
Small
Saw Palmetto→Reduced Postvoid Residual Volume
postvoid residual volume (PVR) (MD -4.23, 95% CI [-22.97, 14.44], p = 0.65)
Effect
Neutral
Effect size
Small
Saw Palmetto→Reduced Prostate Volume
prostate volume (PV) (MD -0.29, 95% CI [-0.41, -0.17], p < 0.00001)
Effect
Beneficial
Effect size
Small
Saw Palmetto→Reduced Uric Acid Levels
prostate-specific antigen (PSA) (MD 0.46, 95% CI [-0.06, 0.97], p = 0.08)
Effect
Neutral
Effect size
Small

Adverse Events Reported

Saw Palmetto→decreased libido
Serenoa repens was well tolerated compared with tamsulosin especially in ejaculation disorders and decreased libido (OR = 5.40; 95% CI [1.17, 24.87]; p = 0.03)
Finding
Increased risk
Magnitude
OR = 5.40; 95% CI [1.17, 24.87]
Significant
Yes
Saw Palmetto→ejaculation disorders
Serenoa repens was well tolerated compared with tamsulosin especially in ejaculation disorders (odds ratio [OR] = 12.56, 95% CI [3.83, 41.18], p < 0.0001)
Finding
Increased risk
Magnitude
OR = 12.56, 95% CI [3.83, 41.18]
Significant
Yes
Saw Palmetto→Overall tolerability
Serenoa repens was well tolerated compared with tamsulosin especially in ejaculation disorders and decreased libido.
Finding
Reported