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Effects of Saw Palmetto Herbal Blend (SPHB) on Prostate Epithelial Nuclei in Men with Symptomatic BPH

Leonard S Marks, Los Angeles, CA, Robert W Veltri, Oklahoma City, OK, Alan W Partin, Jonathan I Epstein, Baltimore, MD, Wes D Bales, M Craig Miller, Oklahoma City, OK. (Presentation by Dr. Marks)

Abstract to be presented at the 2001 AUA Meeting in Anaheim, CA on Wednesday, June 5, 2001.

INTRODUCTION AND OBJECTIVES: Saw palmetto (SP) treatment appears to cause contraction of prostate epithelial cells (PECs) and suppression of tissue DHT levels, but a molecular mechanism remains unknown. We examined nuclear characteristics of PECs, looking for a SP-mediated effect on DNA.

MATERIALS AND METHODS: A 6-month randomized trial, comparing prostate tissue of men treated with SPHB (n = 20) or placebo (PBO) (n = 20), was performed. At baseline, the two groups were similar in age (63-65 yo), symptoms (IPSS = 16-18), uroflow (Qmax = 10-12 cc/sec), prostate volume (54-58 cc), PSA (2.5 - 4.1 ng/ml), and %epithelium (15-17%). Prostate tissue was obtained by sextant biopsy before and after treatment. 5 m sections were stained with Feulgen and subjected to quantitative image analysis using the TriPath QUIC-DNA system. Nuclear images were captured from 200 randomly selected PECs, and 60 different nuclear morphometric descriptors (NMDs)-e.g., size, shape, DNA content, textural features-- were determined for each. Logistic regression analysis was used to assess the NMDs.

RESULTS: At baseline, the SPHB and PBO groups were similar in their NMDs (p=NS using a multivariate cutoff of p < 0.05). After 6 months of PBO, no significant change from baseline was found, using the same criteria. However, after 6 months of SPHB, 25 of the 60 NMDs were significantly different from baseline, and a multivariate model for predicting treatment effect using 4 of the 25 was created (p < 0.001). The ROC curve for the multivariate model showed an area under the curve of 94%. The sensitivity, specificity, and accuracy of the model (at a cutoff of > 0.5) was 85%. The change in nuclear morphometry was not correlated with epithelial contraction or DHT suppression, two objective effects reported previously.

CONCLUSION: 6 months of SPHB treatment alters the DNA in prostate epithelial cells, suggesting a possible molecular mechanism for the tissue changes reported previously. However, in this small sample (n = 40), the 3 significant changes (p < 0.01) (DNA, epithelial volume, tissue DHT levels) were not correlated with each other.


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