Re: Saw Palmetto Warning
From: Gut-Buster (D-D-D-DONT.stare_at_me.privates)
Date: 03/23/05
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Date: Wed, 23 Mar 2005 23:16:37 +1100
This is rubbish. PSA tests have been known to be about as conclusive as a
digital rectal exam for some time now. Your warning just means people
getting some relief from Saw Palmetto will now be worried, unnecessarily.
"Ed" <ed@online.net> wrote in message news:uRK%d.3077$QZ7.1817@fe09.lga...
> Saw Palmetto Warning : Problems with Detecting Prostate Cancer?
>
>
> ----------------------------------------------------------------------------
> ----
>
> The purpose of this letter is to alert physicians and the general public
> to
> the potential implications regarding the detection and treatment of
> prostate
> cancer involved with the use of an alternative supplement sold in health
> food stores called saw palmetto. Prostate cancer is the most commonly
> diagnosed cancer in American men. In 1996, an estimated 317,100 new cases
> of
> prostate cancer, and 41,400 deaths from prostate cancer will be found,
> among
> men in the United States. It is the second most common cause of death in
> men
> older than 55. Early detection is the most important factor for cure! We
> are
> detecting prostate cancer within the past decade with increasing
> frequency,
> and many patients with this condition are receiving such treatments as
> radical prostatectomy and radiation therapy for cure.
>
> Although refinements in PSA-based testing have contributed substantially
> to
> the increased detection rate of prostate cancer, the incidence of disease
> was increasing dramatically even before the detection of PSA was possible.
> Self medication for prostate disorders has increased throughout the US and
> the rest of the world. Saw palmetto in particular raises concerns for
> urologists regarding their ability to diagnose and treat prostate cancer.
> I
> have seen many patients who have placed themselves on this herb. Its use
> is
> advised in advertisements and other marketing for treatment and prevention
> of benign prostatic hyperplasia (BPH), prostatitis, and "urinary
> difficulty"
> in men.
>
> The extract comes from the berries of the palm tree saw palmetto (Serenoa
> Repens, Serenoa Serrulata), which is indigenous in the Atlantic southeast
> coast of North America from South Carolina to Florida and native to the
> West
> Indies.The plant grows six to 10 feet tall, with a crown of large
> spiny-leaves that form a circular, fan-shaped outline. The berries are
> deep
> red-brown or black and are oblong and about one inch long. The extract
> from
> these berries is cheap and easy to purchase. Word has been spread via
> direct
> marketing, as well as by advertisements in magazines and throughout the
> Internet. Reports, mostly in the European literature, suggest that use of
> saw palmetto can decrease the size of the prostate and improve urinary
> symptoms (dose dependent) after months of use.[1] No "well done"
> long-term,
> double-blind, placebo-controlled studies of saw palmetto have been done to
> date.[2] Although saw palmetto does not affect certain hormonal levels,
> there is clinical evidence, however, to suggest that its mechanism of
> action
> is similar to that of the commonly prescribed prostate drug finasteride
> (Proscar). For example, several animal studies[3, 4] suggest that saw
> palmetto has a similar effect on competitively inhibiting the binding of
> dihydrotestosterone (DHT) and blocking the conversion of testosterone to
> DHT, via its inhibition of 5-alpha reductase.
>
> Saw palmetto's primary therapeutic action is to inhibit 5-alpha reductase
> in
> forming DHT and to a lesser extent, 3-alpha reductase, and to block the
> action of DHT to receptors on prostate cells via 3-ketosteroid reductase.
> Research has also shown an anti-inflammatory[5] and antiestrogenic[3, 6,7]
> effect of Serenoa Repens. Use of saw palmetto in >patients with BPH
> results
> in reduction in the size of the prostate.[5 ] With finasteride, however,
> studies have shown that 6 to 12 months of >treatment with 5 mg of
> finasteride daily can reduce prostate volume, DHT, and prostate-specific
> antigen (PSA) levels by 50 percent.[8] Therefore, any patient placed on
> finasteride must have a baseline PSA and digital rectal examination.The
> mechanism of action mimics the pharmacologic action of finasteride, which
> has recently been documented to be of little physiologic value compared
> with
> a placebo or alpha blockers.[9] The purified extract of saw palmetto
> contains 85% to 95% fatty acids and sterols. Unfortunately, there are many
> forms of this extract on the market, containing additives and many
> combinations of other herbs, vitamins, and minerals. Consequently the
> consumer does not know exactly what he is purchasing. Saw palmetto has
> been
> used in Europe for more than 20 years. Research there, however, has
> included
> clinical studies showing its clinical urologic effects versus a placebo.
> [10] Only one study measured the PSA levels prematurely after 3months "the
> treatment did not significantly alter PSA concentrations in these
> patients."[13] However 5-alpha reductase inhibitors will reduce the PSA
> levels by average of 50% after 6-12 months of use, invalidating this study
> on PSA. Consequently of most significance is the lack of well planned
> "long
> term clinical studies" concerning the effects of saw palmetto on "lowering
> the PSA" levels after 6-12 months! Any interference with PSA makes this
> test
> useless as a diagnostic tool for prostate cancer.
>
> The use of saw palmetto is not regulated by the FDA (its use falls under
> the
> guidelines for food supplements). In my own clinical practice, I have seen
> many patients on saw palmetto who were embarrassed to bring this to my
> attention. I have also noticed a dramatic drop in PSA levels when patients
> have been on this herb for many months, making my clinical diagnostic
> determination of prostate cancer more complex. Any 5-alpha reductase
> inhibitor--whether saw palmetto or finasteride--will reduce PSA
> significantly. I quote Dr. Julian Whitaker in his book, Prostate
> Report-Prevention and Healing[11]: "When one of my patients has an
> elevated
> PSA, I don't rush him off for a biopsy. Instead, I encourage him to go on
> a
> low-fat diet, and I prescribe a daily course of serenoa repens extract,
> 360
> mg a day, along with zinc and a regimen of antioxidant vitamins and
> minerals. We then recheck his PSA level periodically, and it has been my
> clinical experience that, in many cases, the PSA gradually falls." This is
> an example of how an underlying condition, possibly prostate cancer, can
> potentially be concealed by losing the sensitivity of the PSA diagnostic
> test. Although refinements in PSA-based testing have contributed
> substantially to the increased detection of early prostate cancer, the
> incidence of the disease is increasing dramatically although the detection
> by PSA-incidence is alling since 1992. [12] Possibly the confusion in the
> literature about when to and who to treat prostate cancer has contributed
> to
> this decline. So has the introduction of medical therapy with 5-alpha
> reductase inhibitors and herbs introduced during the same time period. The
> most disturbing aspects of self-treatment with such herbal remedies are
> their potential effects in masking PSA, which has revolutionized our
> ability
> to pick up prostate cancer. If one curtails the ability to detect prostate
> cancer by PSA, many cancers will progress undetected until it is too late,
> resulting in Stage D Disease.
>
> As a clinical urologist, I feel that the public deserves and has the right
> to know these possible consequences--further research is needed. I am not
> saying that saw palmetto or finasteride should never be used, but only
> that
> they should be used with careful medical supervision and after obtaining a
> baseline PSA and digital rectal exam. Although saw palmetto is an herb, we
> must treat it as a medicine. Since saw Palmetto can act as a 5-alpha
> reductase inhibitor, thereby potentially interfering with PSA levels in
> men
> and decrease prostate cancer detection, it is imperative that men get a
> baseline PSA level (as is recommended by the FDA for Finasteride, but not
> for the unregulated use of Saw Palmetto). Men self -medicating themselves
> with this herb are not aware of this detrimental effect. We are in a new
> world where patients are more inclined to self-treat their medical
> conditions with alternative means. I believe that there is some merit to
> this, with proper guidance by qualified individuals. The escalating cost
> of
> medicines in the US has provoked Americans to seek more cost-effective
> approaches, which is one of the many dilemmas that our present health care
> system has to address promptly. Doctors need to be better educated about
> nutrition and alternative medicine. Physicians in the US are not informed
> about alternative botanical medicine; we are far behind the European
> community in this regard. I believe that there are many benefits to
> botanical treatments for many ailments when combined with nutritional
> approaches. We must discover the alternative approaches that are
> accessible
> to us, while simultaneously using these remedies when appropriate and
> combining them with conventional medical treatment. We must start to
> incorporate this into our medical schools and residency programs so that
> we
> maintain the doctor-patient relationship. To render a proper diagnostic
> evaluation, doctors and patients must communicate with each other, which
> means that patients should inform their doctors about their use of any
> over-the-counter vitamins, minerals, or herbs. A man who treats himself
> may
> have a fool for a patient!
>
> Arnaldo F. Trabucco, M.D
>
> Department of Surgery, Division of Urology
> Catholic Medical Center of Brooklyn & Queens
> St. Johns Hospital
> Elmhurst, NY
>
> References:
> 1. Weisser H., Tunn S., Behnke B., Krieg M.: Effects of the sabal serulata
> extract IDS 89 and its subfractions on 5 alpha-reductase activity in human
> benign prostatic hyperplasia. Prostate 1996; 28:300-306.
>
> 2. Lowe F., Ku J.: Phytotherapy in treatment of benign prostatic
> hyperplasia: A critical review. Urology 1996; 48:12-20.
>
> 3. Carilla E., et al: Binding of Permixon, a new treatment for prostatic
> benign hyperplasia, to the cytosolic androgen receptor in the rat
> prostate.
> J. Steroid Biochem 1984; 20:521-523.
>
> 4. Sultan C., et al: inhibition of androgen metabolism and binding by a
> liposterolic extract of serenoa repens B in human foreskin fibroblasts. J.
> Steroid Biochem 1984; 20:515-519.
>
> 5. Di Silverio F., et al: Plant extracts in BPH. Minerva Urol Nefrol 1993;
> 45:143-149.
>
> 6. Di Silverio F., et a.: Evidence that Serenoa Repens extract displays
> antiestrogenic activity in prostatic tissue of benign prostatic
> hypertrophy.
> Eur. Urol 1992; 21:309-314.
>
> 7. Briley M., et al: Permixon, a new treatment for benign prostatic
> hyperplasia, acts directly at the cytosolic androgen receptor in rat
>>prostate. Br. J. Pharmacol 1983; 79:327.
>
> 8. Stoner E.: 5 Alpha-reductase inhibitors/finasteride. Prostate suppl.
> 1996; (6): 82-87.
>
> 9. Lepor H., Willford W.D., et al: The efficacy of terazosin, finasteride,
> or both in benign prostatic hyperplasia. Veterans Administration
> Cooperative
> Studies Benign Prostatic Hyperplasia Study Group. N. Engl. J. Med. 1996;
> 335:533-539.
>
> 10. Dreikorn K., Schonhofer PS: Status of phytotherapeutic drugs in
> treatment of benign prostatic hyperplasia. Urologe A 1995 Mar; 34(2):
> 119-129.
>
> 11. Whitaker J.: The Prostate Report--Prevention and Healing, chapter 7, p
> 44. 1994, Phillips Publishing, Inc.
>
> 12. Stephenson R., et a.: "The fall in incidence of prostate carcinoma: On
> the down side of a prostate specific antigen induced peak in
> incidence"--Data from the Utah Cancer Registry. Cancer 1996; 77:
> 1342-1348.
>
> 13.Braeckman J.: The extract of sereona repens in the treatment of benign
> prostatic hyperplasia: a multicenter open study.Current Therapeutic
> Research
> (Vol. 55, No. 7,July, pp 776-785) 1994.
>
>
- Next message: jrh: "Clinical Diagnostic Procedure (do you really have prostatitis?)"
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- In reply to: Ed: "Saw Palmetto Warning"
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