Therapeutic Approach: The Importance of Controlling Prostatic Inflammation

Context: Benign prostatic hyperplasia (BPH) is the result of a number of different factors, of which one is inflammation. Objective: To examine evidence for the role of inflammation in BPH and the use of various drug classes to reduce and prevent prostatic inflammation, with a particular focus on hexanic lipidosterolic extract of Serenoa repens (Permixon). Evidence acquisition: A review of clinical literature and experimental evidence relating specifically to the treatment of prostatic inflammation. Evidence synthesis: Drug classes investigated for the treatment of prostatic inflammation include nonsteroidal anti-inflammatory drugs (especially cyclooxygenase-2 inhibitors), vitamin D receptor agonists and extracts of Serenoa repens. In daily practice, however, the only practicable option is extracts of Serenoa repens. In studies of cell lines from normal prostate and from tissues of patients with BPH, hexanic extract of Serenoa repens was shown to decrease cell proliferation induced by the proinflammatory mediators interleukin (IL)-6, IL-17, and fibroblast growth factor (FGF) 2. Hexanic extract of Serenoa repens also demonstrated differential regulation of genes involved in the proliferation, apoptosis, and inflammation pathways of BPH, increasing the expression of anti-inflammatory genes and decreasing the expression of proinflammatory genes. An ongoing exploratory study is comparing the activity of hexanic extract of Serenoa repens and tamsulosin LP on serum and urine markers of inflammation in patients with BPH. Conclusions: Inflammation has a key role in the pathogenesis and progression of BPH and therefore represents a rational target for BPH therapy. Scientific evidence supports the conclusion that hexanic extract of Serenoa repens treats BPH through several mechanisms, one of which is reduction of inflammation. (C) 2013 Published by Elsevier B.V. on behalf of European Association of Urology.