Saw Palmetto for Prostate Size Reduction
Saw palmetto does not shrink the prostate in controlled trials.
Overview
Verdict
How It Works
Dosing & Protocol
Typical dose
- Recommended dose
- Studied at 320-960 mg/day; no reduction in prostate volume was demonstrated in the large trials
- Expected timeframe
- Not established
Protocol
- form
- Liposterolic Serenoa repens extract standardised to 85-95% fatty acids and sterols
- duration
- STEP ran 12 months and CAMUS 18 months, both adequate to detect volume change
- co factor
- Evidence indicates no effect. Prostate volume reduction is the specific pharmacological action of 5-alpha-reductase inhibitors, which shrink the gland by around 20-25% over 6-12 months. Saw palmetto does not reproduce this: the STEP and CAMUS trials found no significant reduction in prostate volume or in serum and intraprostatic DHT, and no improvement in urinary symptoms, at doses up to three times the standard. The 2012 Cochrane review of 32 trials in nearly 6,000 men found no benefit over placebo. The in vitro 5-alpha-reductase inhibition does not occur at concentrations achievable in human prostate tissue.
- titration
- Not applicable - dose escalation to 960 mg/day in the CAMUS trial produced no benefit
- starting dose
- Not recommended for this outcome. Trials used 320-960 mg/day of liposterolic extract
Evidence
What the studies say
Efficacy and Safety of Hexanic Lipidosterolic Extract of Serenoa repens (Permixon) in Benign Prostatic Hyperplasia: A Systematic Review and Meta-analysis
Novara G, Giannarini G, Alcaraz A +4 more
Hexanic extract reduced IPSS and nocturia versus placebo with a low rate of sexual adverse events.
Safety
Caveats
If prostate volume reduction is the goal, finasteride and dutasteride achieve it reliably over 6-12 months and reduce the risk of acute urinary retention and the need for surgery - they also halve PSA readings, which the prescriber must account for, and carry sexual and mood side effects that need discussion. Alpha-blockers relieve symptoms faster without changing volume. Urinary symptoms need proper assessment rather than self-treatment, and acute urinary retention is a medical emergency; blood in the urine, weight loss or bone pain need prompt evaluation. Safety of saw palmetto: generally well tolerated, with mild gastrointestinal upset, nausea and headache. It may lower PSA readings, potentially masking prostate cancer detection - always tell your doctor if you are taking it before a PSA test. Weak antiplatelet activity with case reports of bleeding means caution with warfarin, direct oral anticoagulants, aspirin and antiplatelet drugs, and stopping two weeks before surgery. Rare liver injury and pancreatitis have been reported. It is contraindicated in pregnancy and in women who may become pregnant, since antiandrogens can cause genital malformation in a male fetus.
Less likely to help if
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