Saw Palmetto for Enlarged Prostate

Gel capsules of saw palmetto may improve the symptoms of enlarged prostate, a new study reports.

Saw palmetto (Serenoa repens) is used popularly in Europe for the management of symptoms associated with benign prostatic hypertrophy (enlarged prostate). Although not considered standard of care in the United States, it is the most popular phytotherapy for this indication.

Numerous controlled trials have reported saw palmetto to be superior to placebo and possibly equivalent to the anti-androgenic agent finasteride/Proscar® (with fewer adverse effects) in the alleviation of nocturia (the need to frequently urinate at night), improvement of urinary flow, reduction of post-void residual bladder volume and improvement of quality of life (but possibly not measurable reduction in prostate size).

Saw palmetto was listed in the United States Pharmacopeia from 1906 to 1917 and in the National Formulary from 1926 to 1950.

Researchers from the People's Republic of China investigated the effect of Prostataplex™ (a saw palmetto gel capsule) in men with lower urinary tract symptoms associated with benign prostatic hyperplasia.

Researchers randomly assigned a total of 92 Chinese men between 49 and 75 years old with lower urinary tract symptoms to the intervention group (46 patients) or the control group (46 patients). The intervention group patients were given two Prostataplex™ soft gels daily for 12 weeks, and the control group patients were given two placebo soft gels for the same time.

The researchers found that after 12 weeks of intervention, the mean urinary flow rate was significantly higher in the treatment group than in the control group, while relative urinary resistance was significantly lower in the treatment group than in the control group. While there was no significant difference in mean prostate volume or International Prostate Symptom Score between the two groups, 18 of 46 patients (39.1 percent) in the treatment group showed an International Prostate Symptom Score improvement (decrease of three or greater) after intervention, whereas only one of 46 (2.2 percent) in the control group showed an International Prostate Symptom Score improvement.

The study authors concluded that Prostataplex™ may have short-term effects in improving symptoms and objective measures in Chinese men with lower urinary tract symptoms associated with benign prostatic hyperplasia.

For more information about saw palmetto, please visit Natural Standard’s Foods, Herbs & Supplements database.

 

Comments

[Jess]

This is a promising study because a lot of men suffer from benign prostatic hypertrophy (BPH). Tamsulosin (Flomax®) is the drug commonly used for BPH, but it comes with many common side effects. A few of these include headache, rhinitis, abnormal ejaculation, arthralgia, backache and rash. The only problem with this study is that the subjects were Chinese men. Different ethnicities can have different problems and react to certain medications differently. Therefore, more studies with a more diverse subject group would need to be conducted.

[Kelsy]

A six-month controlled trial of saw palmetto in 41 men from whom prostate biopsy specimens were obtained revealed significant contraction of transition zone epithelium and epithelial atrophy. The authors suggest that since no evidence of alteration in prostatic androgen metabolism was demonstrated, saw palmetto may suppress prostatic epithelium via a non-hormonal mechanism. Clinical observations have suggested a lack of systemic hormonal effects, including unchanged levels of testosterone, follicle-stimulating hormone, and luteinizing hormone. Possible estrogenic effects of saw palmetto have been suggested to derive from β-sitosterol, although subsequent evaluation reports possible inhibitory effects on estrogen receptor binding.

[mark]

Beta-sitosterol and beta-sitosterol glucoside have also been used to treat symptoms of BPH. Several studies have analyzed the effects of phytosterols on BPH. Beta-sitosterol is the most extensively studied of the phytotherapeutic agents used for BPH, although no well-defined mechanism of action has been proposed. Both subjective and objective symptom improvements have been inconsistently demonstrated.

[Alison]

Pygeum (P. africanum bark extract) has been observed to moderately improve urinary symptoms associated with prostate gland enlargement or prostate inflammation. Numerous human studies report pygeum to significantly reduce the number of nighttime urinary episodes, urinary hesitancy, urinary frequency and pain with urination in men who experience mild-to-moderate symptoms. However, pygeum does not appear to reduce the size of the prostate gland or reverse the process of BPH. It is unclear how pygeum compares to the effectiveness or safety of other medical therapies, such as prescription drugs (eg. alpha-adrenergic blockers or 5-alpha reductase inhibitors), surgical approaches or other herbs/supplements, such as saw palmetto.

There is ongoing study in this area. Patients with urinary symptoms or BPH should speak with their healthcare professionals about the various available treatment options.

[Mark]

Interesting info about saw palmetto...researchers found that a side effect of taking saw palmetto is slowed hair loss, and some studies have shown that saw palmetto can actually prevent hair loss by blocking the effects of testosterone. Profinast is a popular hair-loss treatment product that contains saw palmetto.

[Tyler]

Saw palmetto is used much more frequently for medicinal purposes in Europe than in the United States. In the United States, Florida is the biggest producer of saw palmetto. It is also cultivated from southeastern George to southern Mississippi.

[Liz]

I've also read that zinc is beneficial for men with enlarged or swollen prostates. Research suggests that zinc deficiency can cause prostate enlargement. Infections and other stress causes zinc levels in the body to decrease. Men with prostatitis, or inflammation of the prostate caused by an infection, have 1/10 of the amount of zinc that healthy men have.

[Harold]

In theory, saw palmetto may lower prostate specific antigen (PSA) because it has been suggested that the herb inhibits 5-alpha reductase. Therefore, there may be a delay in diagnosis of prostate cancer or interference with following PSA levels during treatment or monitoring in men with known prostate cancer. In contrast, a small, but statistically significant, increase in PSA levels has been reported in association with saw palmetto use in one study. However, this has not been observed in other studies.

[Jen]

The New England Journal of Medicine published a study in February 2006 on Saw Palmetto in treating the symptoms of enlarged prostate versus placebo. This study found that there was no statistically significant difference in symptom improvement versus placebo. It was a yearlong, double-blinded study of 225 men with enlarged prostates. Men older than 49 and were given 160mg of saw palmetto twice daily for one year, which is the same dose used in previous studies. You can find the full article in the New England Journal of Medicine Volume 354(6):557-566 by Bent, Stephen, et al.

[Greg]

Before trying saw palmetto, be aware that it may cause side effects or interact with other herbs, supplements, or medications you are taking. Based on current research, saw palmetto may be unsafe if you have a bleeding disorder or if you're taking agents that increase the risk of bleeding. Saw palmetto should not be taken before surgery or some dental procedures. If you're taking finasteride (Proscar®) or other anti-androgenic drugs, you should talk to your doctor before taking saw palmetto to find out if it is safe.

[Ernie]

I've also heard of people taking saw palmetto rectally for BPH. Rectal administration of saw palmetto (640mg once daily) extract was reported as being clinically equivalent to oral administration (160mg four times daily) in a 30-day controlled trial in 40 men.

[Holly]

In Europe, the German expert panel, the Commission E, has approved saw palmetto for the treatment of mild-to-moderate BPH (stage I-II). In Italy, herbal therapy represents about half of treatment for BPH, whereas it is a first line of treatment in Germany and Austria. Why is the United States slow to except this as a legitimate treatment option?

[Ted]

Coconut oil, like saw palmetto, is rich in fatty acids, mainly lauric and myristic acids. A recent animal study showed that coconut oil reduced the increase of both prostate weight and prostate weight:body weight ratio, markers of testosterone-induced prostatic hyperplasia in rats. The PMID of this article is: 17637195.

[Shannon]

Avoiding decongestants and antihistamines may help reduce symptoms of BPH. These drugs cause the muscles around the urethra that control urine flow to constrict, making it difficult to urinate. Also, being inactive may cause you to retain urine. So, even a little bit of exercise can help reduce urinary problems associated with BPH.

[Julio]

As many as 14 million men in the United States have symptoms related to benign prostatic hyperplasia. With so many people being affected by BPH, it's great to know that there are herbal remedies available that are equally effective to medications, minus many of the side effects.

[Stacey]

It has been found that saw palmetto takes about one to two months for any benefit to be seen. Also, it is suggested that saw palmetto only be used as a short-term treatment of BPH symptoms because the long-term effectiveness and safety information is not available.

[Jake]

I’ve heard that if you use saw palmetto it should be standardized with at least 85% fatty acids and sterols. It is thought that the fatty acids have testosterone inhibitory effects on the prostate. Does anyone else know anything more about this?

[Mike]

It seems that there is still very limited research on using saw palmetto to treat symptoms of BPH. While this article mentions that some research shows it to be comparable in efficacy to finasteride, it appears that this was the only study that reached that conclusion. Finasteride is a 5-alpha-reductase inhibitor, one of two classes of drugs used to treat BPH, and the advantage to taking saw palmetto over finasteride is less side effects. For example, saw palmetto does not cause impotence, which can be experienced by those people who take finasteride, but it has caused gastrointestinal problems, including irritation of peptic ulcers and ulcerative colitis.

However, superior treatment results have consistently been observed with the use of alpha blockers, including the FDA-approved drugs terazosin (Hytrin®), doxazosin (Cardura®), and tamsulosin (Flomax®), in the treatment of BPH. All three of these drugs act by relaxing the smooth muscle of the prostate and bladder neck, improving urine flow and reducing bladder outlet obstruction. Tamsulosin was the first alpha blocker developed specifically to treat BPH.

[Carey]

Some other herbs that have been used for years, either alone or in various combinations in traditional Chinese medicine for prostate health problems are: baikal skullcap, chrysanthemum, ganoderma, isatis, licorice, ginseng and Isodon rubescens. Each of these has been reported to have anti-inflammatory, antioxidant, and/or anticarcinogenic properties.

[mo]

It might be worth noting that while saw palmetto has fairly good evidence in the treatment of BPH, it has a fair amount of negative evidence (that is, it doesn’t work) for prostatitis. This is important because prostatitis (literally inflammation of the prostate) might be mistaken for benign prostatic hypertrophy. I would therefore think a visit to the doctor would be in order any time there is concern over prostate issues.

[Lynne]

Saw palmetto has also been used by some people with prostate cancer. But there is not enough evidence to support this use. Saw palmetto was also thought to decrease prostate-specific antigen (PSA), which is an indicator of prostate cancer. However, a large, randomized study did not find this effect. This study did find that finasteride can decrease PSA by more than 40%.

[Jill]

It is known that saw palmetto has anti-androgen and anti-estrogenic effects. This means that saw palmetto should be used carefully if taken with any kind of hormone therapy. It should also be avoided in pregnant women or in those taking oral contraceptives if using saw palmetto for other purposes.

[Kenneth]

Does anyone know whether Prostataplex™ is commercially available and/or available in the United States? I couldn't find any information about the ingredients (if any other than saw palmetto) in Prostataplex™ or a manufacturer Web page. I'm interested in this product, especially because it is a gel capsule. Does anyone know where I can find information about this product for use in clinical trials?

[prostate enlarged]

According to the statistics of the male case data in the recent years, because the seminal vesicle are close to the prostate, the pathogenesis of prostatitis may also affect the seminal vesicle, thus it is also called prostate seminal vesicle phlogistic. Because there are increased difficulties in the prostatitis treatment, many patients will develop this prostatitis infection, which takes a long time to heal. This is the most common prostate problem encountered by men under the age of fifty, with most infections occurring in men between the ages of thirty and fifty.

Unfortunately, some men will delay seeing their doctors for these symptoms for fear of having prostate cancer or for fear of an uncomfortable exam and treatment, but this type of thinking is exactly the opposite of good health advice.

[flomax treatment]

Interesting to read about natural, alternatives to BPH. Are you aware of any studies that compared the effectiveness of Prostataplex with the drug Flomax (which is currently on the market and very commonly prescribed for BPH)? Also, is it known if there any long-term or major side effects to using Prostataplex?