LOWER urinary tract symptoms (LUTSs) encompass a range of bothersome urinary issues such as frequency, urgency, hesitancy, and nocturia. These symptoms significantly affect quality of life and may arise from diverse causes, including neurological conditions and lifestyle factors, not solely prostate disorders. Traditional pharmacological treatments for LUTSs often alleviate symptoms but can cause side effects and fail to address underlying causes, prompting interest in alternative therapies like phytotherapy.
Phytotherapy, the use of plant-derived remedies, offers a holistic approach with fewer side effects. Herbs such as saw palmetto, red ginseng, and pygeum africanum have shown potential for improving urinary function and reducing inflammation. Among these, Salvia miltiorrhiza (Danshen or red sage) has emerged as a promising option. Known for its use in traditional Chinese medicine, Danshen has demonstrated antioxidant and anti-inflammatory properties. Recent studies highlight its efficacy in alleviating LUTSs and managing benign prostatic hyperplasia (BPH).
Clinical trials reveal that S. miltiorrhiza extract (SAGX) can reduce prostate size and improve symptoms in animal models. It achieves this by modulating oxidative stress and inflammation through pathways like Nrf-2/HO-1 and NF-κB, while also inhibiting androgen receptor activity. These mechanisms suggest a potential for broader benefits without the side effects often seen with alpha-blockers and 5-alpha-reductase inhibitors (5-ARi), such as hypotension, retrograde ejaculation, or altered sexual function.
In a recent double-blind clinical trial, SAGX improved LUTS-related quality of life scores comparably to existing drugs, with notable safety advantages. Unlike 5-ARi, SAGX does not affect prostate-specific antigen levels, avoiding concerns about masking prostate cancer. Additionally, SAGX demonstrated improvements in sexual function, making it a promising alternative for sexually active men.
While further research is needed to assess long-term benefits and effects on prostate size, SAGX presents a compelling case for phytotherapy as a safer, holistic approach to LUTS management. This study underscores the potential for herbal treatments to transform care for individuals struggling with LUTSs.
Katie Wright, EMJ
Reference
Shin D et al. Salvia miltiorrhiza Root Extract for Men with Lower Urinary Tract Symptoms: A Multicenter, Randomized, Double-Blind, Placebo-Controlled Trial. Nutrients. 2024;17(1):24.
