Condition
    Strong Evidence
    Effectiveness 1/5

    Saw Palmetto for Frequent Urination

    Saw palmetto failed to beat placebo in the STEP and CAMUS trials, including at triple the standard dose. This question has been answered.

    Overview

    Saw palmetto failed to beat placebo in the STEP and CAMUS trials, including at triple the standard dose. This question has been answered.

    Verdict

    Insufficient evidence

    Not recommended for urinary frequency from prostate enlargement. Alpha-blockers and 5-alpha-reductase inhibitors have real effects; this does not.

    How It Works

    Saw palmetto extract was proposed to inhibit 5-alpha-reductase and reduce dihydrotestosterone-driven prostate growth, and to have anti-inflammatory effects on prostatic tissue.

    Dosing & Protocol

    Typical dose

    Recommended dose
    Not recommended; trials tested 160mg twice daily up to 960mg daily without benefit
    Expected timeframe
    Trials ran 12-72 weeks with no separation from placebo

    Protocol

    form
    Not applicable
    duration
    Not applicable
    co factor
    Evidence is insufficient for urinary frequency as a standalone outcome. The dose studied is 320 mg/day of liposterolic saw palmetto extract, and the large well-conducted trials - STEP and CAMUS, the latter testing up to 960 mg/day - found no improvement over placebo in urinary symptom scores, including frequency and nocturia. Some European hexanic-extract trials disagree, but the highest-quality evidence is null.
    titration
    Not applicable
    starting dose
    Not applicable as an established treatment for this symptom

    Evidence

    What the studies say

    The Saw Palmetto for Treatment of Enlarged Prostate trial randomised 225 men to 160mg twice daily for a year and found no difference from placebo in AUA symptom score, flow rate or residual volume. The larger CAMUS trial then escalated to 320, 640 and 960mg daily over 72 weeks and still found no benefit over placebo, effectively ruling out an inadequate-dose explanation. Cochrane reviews reach the same conclusion. Early positive trials were smaller and lower quality.

    No studies are yet linked to both Saw Palmetto and Frequent Urination.

    Safety

    Caveats

    Generally well tolerated but ineffective. Delaying effective treatment risks urinary retention and bladder decompensation in significant obstruction.

    Less likely to help if

    The trial evidence indicates essentially all men with lower urinary tract symptoms from benign prostatic hyperplasia.

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