Saw Palmetto Herb Treatment
for Benign Enlargement of the Prostate Gland (Benign Prostate Hypertrophy)
What is saw palmetto?
Saw palmetto is an herbal supplement that has gained increasing
interest in the United States for alleviating urinary symptoms
resulting from benign (not cancerous) enlargement of the prostate
gland, referred to as benign prostatic hypertrophy (BPH). Currently,
such plant-derived treatment (phytotherapy) is more commonly used in
European countries such as Germany and Austria. There, saw palmetto
is the initial treatment of choice for mild-to-moderate urinary tract
symptoms of benign prostatic hyperplasia (a term used synonymously
with hypertrophy). Although still not widely used in the United
States, plant-derived, herbal agents claiming to maintain prostate
health (as the manufacturers say) now are readily available as
nonprescription dietary supplements. On the basis of the favorable
European experience, the accessibility of saw palmetto without a
prescription, the desire for personal control without "medication" or
surgery, and possible dissatisfaction with conventional treatments,
herbal treatment for benign prostatic hyperplasia is likely to gain
greater popularity in the United States.
Where does saw palmetto come from?
The saw palmetto extract is derived from the dried, ripe berry of the
American dwarf palm tree, Serenoa repens (scientific name); Sabal
Serrulata (botanical name). The main source of saw palmetto is the
southeastern United States. With the enlarging reputation of saw
palmetto, this plant now is grown commercially. Harvesting of saw
palmetto berries is becoming a big industry with nearly 2000 tons of
these berries being shipped to Europe for the herbal supplement
market.
What are the conventional medical options for the treatment of
BPH?
Currently, few doctors in the United States at this time recommend
plant extracts for treatment of urinary tract symptoms secondary to
BPH. Instead, conventional drug therapies such as finasteride (Proscar) and several a-adrenergic blockers are favored in the U.S.
Finasteride blocks the conversion of the male hormone testosterone to
its more potent active state. Since the growth of the prostate is
dependent on this potent form of testosterone, finasteride reduces
prostatic growth by preventing this hormone's production. The other
drugs used for BPH symptoms are called a-adrenergic blocking agents.
The action of these drugs is based on the fact that the flow of urine
depends not only on the size of the opening of the urinary passage
(which may be reduced by an enlarged prostate) but also on the muscle
tone of the prostate and the urinary bladder neck. By relaxing the
muscle tone in these areas with a-adrenergic blocker drugs (such as
prazosin, terazosin, and doxazosin), a better urine flow can be
achieved, even without mechanically or surgically enlarging the
urinary passage.
What is the evidence supporting the use of saw palmetto as a
treatment for the prostate?
Of the approximately thirty plant-derived compounds that exist for
alleviating the symptoms of BPH, the saw palmetto extract is the most
widely used and studied. Most of the saw palmetto studies have been
conducted in Europe. Recently, a systematic review of 18 randomized
controlled trials involving a total of 2,939 men was published. The
trials used either saw palmetto by itself or in combination with
other herbal treatments. The effectiveness of these agents was
compared to a placebo (an inactive or inert substance) or one of the
conventional drug therapies for benign prostatic hyperplasia. The
researchers looked at the following: (1) urinary symptoms such as
hesitancy; (2) the number of times a night that a patient arose to
urinate; (3) the average urine rate of flow; and (4) the amount of
urine remaining in the bladder after voiding (urinating).
Changes resulting from the use of this herbal agent in these four
areas were compared to placebo results to determine if an improvement
occurred in the patients' urinary symptoms or urinary flow. These
researchers reported that there was 28% greater reduction in urinary
symptoms in the group treated with saw palmetto than the group taking
the placebo. Secondly, there was a 25% greater reduction in nighttime
urination; for example, a treated patient might urinate three times
nightly instead of four. Thirdly, the average improvement in urine
flow rate was 28% with saw palmetto as compared with the placebo.
Finally, there was 43% less urine remaining in the bladder after
voiding with saw palmetto than with the placebo.
The systematic review of the clinical trials also showed that saw
palmetto provided similar response as finasteride (Proscar) in terms
of urine flow measures and urinary symptoms. A large, double-blind
study (neither the patient nor the doctor knew which drug was used)
involving 1,069 participants with moderate BPH was recently conducted
with subjects treated with either saw palmetto or finasteride for six
months. Similar efficacy was found between the two treatments in
terms of self-rated quality-of-life scores and urinary symptom
scores. The symptom score improved by 37% with saw palmetto and by
39% with finasteride; and the quality-of-life score improved by 69%
with saw palmetto and by 73% with finasteride. Thus, it appears that
the saw palmetto extract is more effective than placebo, and the
extract is similar in effectiveness to finasteride for symptoms of
BPH.
Not many studies have been performed comparing saw palmetto and a-
adrenergic blocking agents, the other conventional drugs used in the
treatment of BPH symptoms. In a small, double-blind study comparing
saw palmetto with prazosin in 41 patients for three months, prazosin
was found to have slightly greater effect on urine flow rate,
nighttime urination, and amount of urine remaining in the bladder
after voiding than saw palmetto. Studies comparing the effect of saw
palmetto to that of surgery for symptoms of BPH have not been
performed.
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From the Doctors at MedicineNet.com  |
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Back to Medications IndexLast Editorial Review: 11/30/1999 8:21:00 PM
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