Saw palmetto (Serenoa repens/Sabal serrulata, also known as the American dwarf palm tree) has been valued for centuries for treatment of prostate and urinary problems. Today, saw palmetto is still widely used for the same purposes throughout Europe and the United States, but most especially for BPH, for which a daily dose of 320 mg has been found to be most effective.
Among the main compounds of saw palmetto are fatty acids and sterols, the latter of which include beta-sitosterol, a substance found to be effective in the treatment of
Saw Palmetto and BPH Symptoms
A recent study (2011) evaluated the long-term efficacy of treatment with a saw palmetto extract (Prostamol Uno) in men who had lower urinary tract symptoms (LUTS) associated with BPH. A total of 120 patients with mild or moderate LUTS were treated daily for 24 months with one capsule of 320 mg ethanolic extract of saw palmetto. At the end of the treatment period, the men showed a statistically significant improvement in their International Prostate Symptom Scores (5.5 points), quality of life, Qmax, International Index of Erectile Function (IIEF; 6.4 points), and reduction in residual urinary volume. Prostate volume had declined from a mean of 39.8 mL at baseline to 36 mL at 24 months. The study’s authors concluded that long-term treatment with 320 mg of ethanolic saw palmetto extract is effective in reducing urinary obstruction, improving LUTS and quality of life, and also has a positive impact on sexual function, illustrated by the statistically significant increase in the IIEF. (Sinescu 2011)
According to Dr. Geo Espinosa, ND, Lac, CNS, RH (AHG), director of the Integrative Urological Center at New York University Langone Medical Center, “The studies with saw palmetto and other herbal supplements strongly suggest a saw palmetto combination can lead to enhanced results when managing symptoms of BPH and prostatitis.”
In fact, failure to use saw palmetto in combination with other selected supplements is likely why some studies of saw palmetto for management of BPH have not yielded good results, according to Dr. Espinosa. A case in point is an updated Cochrane review (May 2012) that evaluated 17 randomized controlled trials (2,008 participants) comparing saw palmetto (usually 320 mg/day) with placebo. The reviewers found that saw palmetto was no better than placebo in improving lower urinary tract symptoms (LUTS).
Saw Palmetto and Tamsulosin
A double-blind trial published in European Urology in 2002 indicated that saw palmetto is effective in reducing BPH symptoms. A total of 704 men who had BPH
Saw Palmetto and Finasteride
In a study recently published in Advances in Therapy, researchers reported that a saw palmetto extract (SPET-085) effectively inhibited 5-alpha-reductase and that its effect was similar to that of a prescription drug, finasteride, that is used for this purpose in BPH. The study was conducted in a lab and involved the use of a saw palmetto extract in a cell-free test system, in which scientists measured the inhibitory potency of the extract against 5-alpha-reductase isoenzyme type II and compared it with that of finasteride. Results showed that the saw palmetto extract effectively inhibited the enzyme and that the amount of extract required was very low compared to data associated with other saw palmetto extracts tested in others studies. The researchers also reported that the prostate health-promoting activity of SPET-085 corresponded to that of the standard drug therapy, finasteride. (Pais 2010)
Saw Palmetto and BPH Surgery
Saw palmetto also appears to benefit men who are scheduled to undergo surgery for BPH. A study from the University of Milan showed that men who took saw palmetto for two months prior to transurethral resection of the prostate or prostatectomy experienced significantly reduced intra- and postoperative complications compared with men who did not take the supplement.
The 120 men in the study were randomly assigned to take either 320 mg of saw palmetto (Permixon) daily for two months before their surgery or to undergo surgery without taking the supplement. After the surgeries were performed, the authors noted no intraoperative complications in the treatment group versus 15 percent in the control group. The need for transfusion was also remarkably lower in the treatment group (0%) compared with controls (38.33%). Men in the saw palmetto treatment group also required significantly shorter duration of catheterization (64.95 hours vs 91.7 hours in controls) and a significantly shorter length of hospitalization (5.92 days) compared with controls (7.92 days). The authors conclude that saw palmetto prior to surgery for BPH effectively reduces intraoperative and postoperative complications. (Anceschi 2010)
Saw Palmetto and Pygeum
The University of Milan was the site of a review of two studies that evaluated a total of 70 men who had BPH and who were treated with either saw palmetto or pygeum africanum. In one study, the men were treated with 320 mg per day of saw palmetto for 30 days; in the other study, patients received either 320 mg per day of saw palmetto or four 25-mg capsules of Pygeum africanum (Tadenan) per day for 30 days. The men in both studies experienced about a 50 percent improvement in dysuria (painful urination) and in frequent urination. They also reported about a 50 percent increase in urination rate with positive effects, a reduction in prostate size, and good tolerability of the supplements. (Mantovani 2010)
Saw Palmetto and Prostate Cancer
Two recent Italian studies have reported on the impact of saw palmetto extract on prostate cancer cells. In one, investigators compared the effects of saw palmetto extract in two human prostate cancer lines (PC3 and LNCaP) as well as a breast cancer cell line, with emphasis on the role of the mitochondrial apoptotic (cell death) pathway. The investigators found that the prostate cancer cells treated with saw palmetto extract, but not the breast cancer cells, underwent cell death. Within minutes of adding saw palmetto extract to the prostate cells, the permeability transition pore opened, which led to the cells’ eventual death by 24 hours later. (Baron 2009)
In the second study, scientists evaluated the effects of saw palmetto extract (Permixon) on proliferation and apoptosis of androgen-independent prostate cancer cells. One hour after administering the saw palmetto extract, the investigators observed a marked reduction in the mitochondrial potential, a decline in cholesterol, and modification of the phospholipid composition, including a significant decrease in omega-6 content. They noted that the decrase in omega-6 content could be responsible for the prolonged and consistent increase in the apoptosis rate and the inhibition of proliferation present after 2 to 3 days of treatment with saw palmetto extract. (Petrangeli 2009)
A suggested dose for saw palmetto is 320 mg daily of extract standardized to contain 85 to 95 percent sterols and fatty acids. (University of Maryland) Men who use saw palmetto may experience some back pain and headache.
Anceschi R et al. Serenoa repens (Permixon) reduces intra- and postoperative complications of surgical treatments of benign prostatic hyperplasia. Minerva Urol Nefrol 2010 Sep; 62(3): 219-23
Baron A et al. Sereona repens extract targets mitochondria and activates the intrinsic apoptotic pathway in human prostate cancer cells. BJU Int 2009 May; 103(9): 1275-83
Debruyne Fet al. Comparison of a phytotherapeutic agent (Permixon) with an alpha-blocker (Tamsulosin) in the treatment of benign prostatic hyperplasia: a 1-year randomized international study. Eur Urol 2002; 41(5):497-506.
Mantovani F. Serenoa repens in benign prostatic hypertrophy: analysis of 2 Italian studies. Minerva Urol Nefrol 2010 Dec; 62(4): 335-40
Pais P. Potency of a novel saw palmetto ethanol extract, SPET-05, for inhibition of 5alpha-reductase II. Adv Ther 2010 Aug; 27(8): 555-63
Petrangeli E et al. Lipido-sterolic extract of Serenoa repens (LSESr, Permixon) treatment affects human prostate cancer cell membrane organization. J Cell Physiol 2009 Apr; 219(1): 69-76.
Sinescu I et al. Long-term efficacy of serenoa repens treatment in patients with mild and moderate symptomatic benign prostatic hyperplasia. Urol Int 2011; 86(3): 284-49
Tacklind J et al. Serenoa repens for benign prostatic hyperplasia. Cochrane Database Syst Rev 2009 Apr 15; (2): CD001423.
University of Maryland Medical Center: http://www.umm.edu/altmed/articles/benign-prostatic-000018.htm