Clinical Question

Does saw palmetto (Serenoa repens) reduce symptoms associated with benign prostatic hyperplasia (BPH)?

Evidence-Based Answer

Saw palmetto, alone or in combination with other phytotherapeutic agents, does not improve urologic symptoms or quality of life in the short term (3 to 6 months) or long term (12 to 17 months). Also, it does not cause significant adverse events.¹ (Strength of Recommendation: A, consistent, good-quality patient-oriented evidence.)

Practice Pointers

BPH-related symptoms of urologic obstruction and irritation affect about one-fourth of men in their 50s, one-third of men in their 60s, and one-half of men 80 years or older.² Using plants and herbs (phytotherapy) for this condition is common worldwide. Saw palmetto is one of the most commonly used phytotherapeutic agents. The authors of this Cochrane review sought to determine whether saw palmetto, alone or in combination with other phytotherapeutic agents, improves urologic symptoms due to BPH.

This Cochrane review included 27 randomized controlled trials with 4,656 participants.¹ In the review, 19 trials compared saw palmetto to placebo, and eight trials compared the combination of saw palmetto and other phytotherapeutic agents to placebo. Almost all studies used a saw palmetto dosage of 320 mg per day. Other agents used in combination with saw palmetto included pumpkin seed oil, lycopene, and sabal and urtica extract. Most studies included participants who were older than 50 years (mean age = 52 to 68 years) with moderate urologic symptoms (International Prostate Symptom Score [IPSS] = 8 to 19). For urologic symptoms, the authors considered an improvement of 3 points on the IPSS as the minimal clinically important difference to determine effectiveness. The authors used the final question on the IPSS to analyze quality of life and considered an improvement of 0.5 as the minimal clinically important difference to determine effectiveness.