Re: Saw Palmetto Warning
From: Rich256 (nospam_at_xxx.com)
Date: 03/26/05
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Date: Sat, 26 Mar 2005 17:15:29 GMT
That really is not a very good arguement. DRE is only a limited test for
prostate abnormalities. Medical groups I have seen indicate that it is
helpful only if accompanied with a valid PSA test. They warn you to let
your doctor know if you are taking Saw Palmetto so that he can take that
into account.
"Gut-Buster" <D-D-D-DONT.stare@me.privates> wrote in message
news:G6d0e.441$ZV4.5040@nnrp1.ozemail.com.au...
>
> This is rubbish. PSA tests have been known to be about as conclusive as a
> digital rectal exam for some time now. Your warning just means people
> getting some relief from Saw Palmetto will now be worried, unnecessarily.
>
>
> "Ed" <ed@online.net> wrote in message news:uRK%d.3077$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. > > > > > >
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