Saw Palmetto – Does it work for BPH?

From all the clinical studies I have reviewed, it became apparent that saw palmetto is not effective for specifically reducing BPH (which means benign prostatic hyperplasia). In the most recent data from double-blind clinical trials, saw palmetto does not achieve results any better than placebo when measuring the enlargement of the prostrate and the PSA in the blood. However Saw palmetto studies do show that it is effective in treating urinary tract infection.

Does that mean saw palmetto should not be used for BPH? No. Let me explain.

Benign prostatic hyperplasia (BPH), also known as benign prostatic hypertrophy, is a histologic diagnosis (diagnosis of biological tissue) characterized by proliferation of the cellular elements of the prostate. Chronic bladder outlet obstruction (BOO) secondary to BPH may lead to urinary retention, renal insufficiency, recurrent urinary tract infections, gross hematuria (presence of blood or red blood cells in the urine), and urinary calculi. Urinary calculi are solid particles in the urinary system. They alone may cause pain, nausea, vomiting, hematuria, and, possibly, chills and fever due to secondary infection.

According to Principles and Practice of Phytotherapy by Simon Mills and Kerry Bone, there is no direct correlation between the histologic and macroscopic (enlarged) BPH and symptoms. Histologic evidence of BPH is found in more than 50% of men aged 60 and this increases to 90% at age 85. Yet with men of histologic changes, only 50% will have clinical enlargement of the prostrate or macroscopic changes and of these individuals, only 50% will develop symptoms. Symptoms can be due to obstruction or irritation or both. Many factors are thought to be involved including sex hormones, stem cells, growth factors, insulin and prolactin. Irritation and associated spasm of smooth muscle tissue, inflammation and edema may also contribute to the development of symptoms.

Prostate-specific antigen, or PSA, is a protein produced by normal, as well as malignant, cells of the prostate gland. The PSA test measures the level of PSA in a man’s blood.

In addition to prostate cancer, a number of benign (not cancerous) conditions can cause a man’s PSA level to rise. The most frequent benign prostrate conditions that cause an elevation in PSA level are prostatitis (inflammation of the prostate) and benign prostatic hyperplasia (BPH) (enlargement of the prostate). There is no evidence that prostatitis or BPH leads to prostate cancer.

Thus Saw palmetto may not specifically reduce the prostrate or lower the PSA, but the use of saw palmetto is certainly valid in treating the numerous symptoms that can arise from BPH.