Submit Manuscript | http://medcraveonline.com Abbreviations: Akt, protein kinase B; BPH, benign prostatic hyperplasia; EFK ½, elongation factor kinase; HBEGF, heparin bin- ding epidermal growth factor like growth factor; HDL, high density lipoprotein; IL-6, interleukin-6; Inos, inducible nitric oxide synthase; LDL, low density lipoprotein; PDGF, platelet derived growth factor: TNFα, tumor necrosis factor α; VEGF, vascular endothelial growth factor Introduction Saw palmetto, Serenoa repens (Arecaceae), is a traditional medicine of American Indians of the southeast. The berries are used as medicine and as food. The leaves are used to make thatching, baskets, fans, brushes, brooms, rope, fre kindling, fsh traps and dolls. 1 European immigrants to the Florida area learned from American Indians to use the berries as medicine. S. Repens is the third most popular plant medicine in the USA and is very popular in Europe. In 2006, it was reported that over 2 million men in the USA used S. Repens daily. 2 Global sales are more than $700 million per year, as reported in 2014 by the Valens Company, a manufacturer of the plant medicine. Men are most likely to use S. Repens to help with nocturnal urination that prevents them from sleeping through the night. Men use this plant medicine because it helps them with their symptoms. Discussion What is benign prostatic hyperplasia Benign prostatic hyperplasia (BPH) is a condition that increases with aging in men over the age of about 40. 3 By age 60, about 50% of men have BPH. The incidence increases to 90% by age 85. It involves swelling of the prostate that restricts urine fow. As a result urination becomes diffcult, incomplete and sometimes painful. Chronic inability to empty the bladder leads to bladder distention and instability. Enlargement of the prostate involves hyperplasia of stromal and glandular cells. This hyperplasia appears to be the consequence of infammation. Diagnosis depends on the answers to seven questions from the American Urological Association Symptom Index. 3 These questions concern: how often in the past month has the patient felt that urination was incomplete, how often in the past month the patient had to urinate within 2hours of the previous urination, how often in the past month the patient’s urine fow stopped and restarted multiple times during one urination, how often in the past month the patient found it diffcult to postpone urination, how often in the past month urine fow was weak, how often in the past month the patient had to strain to begin urination, how many times in the last month did the patient typically get up at night to urinate. A score of 7 or more with a urinary fow rate of 15mL per second or less is diagnostic of BPH. Palpation of the prostate through the rectum usually demonstrates an enlarged prostate. What causes benign prostatic hyperplasia The answer to this question is that no one knows. There are many theories. Alpha 1 blockers are considered the drugs of choice for BPH, doxazosin, terazosin, alfuzosin, tamsulosin and silodosin. 4 This suggests that sympathetic dysfunction is involved in BPH. Finasteride and dutasteride have been shown in clinical trials to improve the symptoms of BPH. 5 These drugs inhibit 5-alpha-reductase also called 3-oxo-5α-steroid 4-dehydrogenase, which converts testosterone into dihydrotestosterone. This suggests that dihydrotestosterone may cause or contribute to prostatic enlargement. The antimuscarinic agent, tolterodine, can be used in combination with a α 1 blocker to improve BPH symptoms. 6 Therefore, autonomic dysfunction may be involved in BPH. Tadalafl improves the symptoms of BPH in patients that suffer from erectile dysfunction and BPH, as approved by the FDA in October, 2011. Tadalafl is a phosphodiesterase type 5 inhibitor, which increases cGMP levels. Smooth muscle cells relax when cGMP levels increase. This suggests that unstable smooth muscles in the prostate or bladder are important in BPH. Lifestyle is important in BPH. 7 Obesity, diabetes; meat and fat consumption are risk factors for BPH. Factors that decrease BPH risk include exercise, moderation in alcohol consumption and eating Pharm Pharmacol Int J. 2015;2(1):1‒4. 1 © 2015 Adams et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and build upon your work non-commercially. Saw palmetto, Serenoa repens, in the treatment of benign prostatic hyperplasia, mechanisms of action and reasons for its use Volume 2 Issue 1 - 2015 James D Adams, Eric J Lien, Xiaogang Wang Department of Pharmacology and Pharmaceutical Sciences, University of Southern, USA Correspondence: James D Adams, Department of Pharmacology and Pharmaceutical Sciences, School of Pharmacy, University of Southern California, 1985 Zonal Avenue, Los Angeles, CA, USA, 90089, Tel 3234421362, Email jadams@usc.edu Received: October 31, 2014 | Published: December 30, 2014 Abstract Saw palmetto, Serenoa repens, produces berries that are the source of a popular medicine used in the treatment of benign prostatic hyperplasia, prostate infections, prostatitis, chronic pelvic pain syndrome, prostate cancer, hypotonic neurogenic bladder, sexual dysfunction and other conditions. Several clinical trials have been conducted with various extracts of the plant. The results have been mixed. Meta- analyses and systematic reviews of the trials have concluded that S. Repens appears to be effective in the treatment of benign prostatic hyperplasia. The mechanism of action of the medicine is not clear. This review discusses the possibility that medium length fatty acids from S. Repens decrease the inflammation of the prostate by altering adipokine secretion from visceral fat. This leads to less hyperplasia and perhaps less risk of promoting prostate cancer. Keywords: saw palmetto, Serenoa repens, benign prostatic hyperplasia, prostate cancer Pharmacy & Pharmacology International Journal Research Article Open Access