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Saw Palmetto for Benign Prostatic Hyperplasia

In a randomized trial, no benefit was seen during 1 year of treatment.

Extracts of the berries of saw palmetto, a small palm tree native to the southeastern U.S., are used widely to treat benign prostatic hyperplasia (BPH). In this randomized trial conducted in California, 225 men with moderate-to-severe symptoms of BPH received either saw palmetto extract (160 mg twice daily) or placebo. Patients were not permitted to use -blocking drugs or 5-reductase inhibitors during the trial.

During 1 year of treatment, no significant differences were noted between saw palmetto recipients and placebo recipients in the two primary outcomes — mean American Urologic Association symptom scores and peak urinary flow rate. In addition, no differences were seen in secondary endpoints, such as quality of life scores, sexual function scores, residual urine volume, and prostate volume.

Comment: The finding of this trial — no benefit for saw palmetto — should be taken seriously. The trial was conducted according to rigorous methodologic standards, and the authors discuss methodologic reasons (including the adequacy of blinding) why their results might differ from those of previously published positive trials. When results of an herbal remedy trial are negative, critics often respond that the extract used in the study might not have been representative of biologically active products. However, the chemical content of the extract used in this study met criteria proposed by alternative medicine experts.

— Allan S. Brett, MD

Published in Journal Watch General Medicine February 17, 2006

Citation(s):

Bent S et al. Saw palmetto for benign prostatic hyperplasia. N Engl J Med 2006 Feb 9; 354:557-66.

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