Peer Review Report For: Exploring the use of phytotherapy in benign prostatic hyperplasia [BPH]: a systematic review [version 1; peer review: 2 approved with reservations]

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Background Benign prostatic hyperplasia [BPH] is a prevalent condition among aging men, characterized by prostate gland enlargement leading to lower urinary tract symptoms [LUTS]. Conventional treatments like alpha-blockers and 5-alpha-reductase inhibitors, though effective, often result in adverse effects. This has spurred interest in phytotherapy, leveraging plant-derived compounds to mitigate BPH symptoms due to their safety, cost-effectiveness, and patient preference. Method The review highlighted 84 studies involving diverse plants and bioactive compounds. Prominent examples include Serenoa repens [saw palmetto], Urtica dioica [nettle root], Cucurbita pepo [pumpkin seed], and Pygeum africanum [African cherry]. These plants exhibit mechanisms such as 5α-reductase inhibition, anti-inflammatory effects, and modulation of oxidative stress. Clinical and preclinical findings demonstrate improved urinary flow, reduced prostate volume, and alleviated LUTS. However, variability in methodologies, extract preparations, and dosages poses challenges to standardization. Results The review highlighted 84 studies involving diverse plants and bioactive compounds. Prominent examples include Serenoa repens [saw palmetto], Urtica dioica [nettle root], Cucurbita pepo [pumpkin seed], and Pygeum africanum [African cherry]. These plants exhibit mechanisms such as 5α-reductase inhibition, anti-inflammatory effects, and modulation of oxidative stress. Clinical and preclinical findings demonstrate improved urinary flow, reduced prostate volume, and alleviated LUTS. However, variability in methodologies, extract preparations, and dosages poses challenges to standardization. Conclusion Phytotherapy holds significant potential in BPH management, offering symptom relief with minimal side effects. While promising, further robust clinical trials are essential to validate efficacy, establish standardized protocols, and ensure integration into mainstream therapeutic frameworks.