saw palmetto berry better than drugs for enlarged prostate

As if there was ever any doubt, a massive new systematic review and meta-analysis confirms what we already knew. When it comes to benign prostatic hyperplasia (BPH), or the enlarged prostate that is so annoying and common in older men, the herb saw palmetto berry is better than the best drugs the pharmacy has to offer.



As we recently discussed in Vol. 20, No. 8 of The Natural Path, saw palmetto has beaten finasteride (Proscar) in head-to-head studies (Phytomed 1997;3:309-13) and has been found by a research review to be just as effective (JAMA 1998;280:1604-9).

Saw palmetto berry has fared just as well against the newer alpha-blockers. The herb is at least as good as the drug tamsulosin (Flomax) (Eur Urol 2002;41:497-506; Eur Urol 2004;45:773-80; Prog Urol 2002;12(3):384-92; Int Urol Nephrol 2007;39(3):879-86; Vojnosanif Pregl 2013;70:1091-6), and, in men with severe BPH, it works even better (Eur Urol 2004;45:773-80).

The other really big advantage of saw palmetto is that the studies consistently find it to be safer, leading to fewer side effects, including the common prostate drug side effect of erectile dysfunction.

Now, a new meta-analysis has put all the research together and closed the door tightly on the prostate herb-drug debate.

The meta-analysis included 27 studies published between 1983 and 2016 that included a total of 5,800 men. Twelve of the studies were observational and 15 were controlled. All of the studies used 320mg of saw palmetto berry extract. Saw palmetto was compared to placebo or to drugs that included alpha-blockers, like tamsulosin; 5-alpha-reductase inhibitors, like finasteride; and others.

Compared to placebo, saw palmetto berry significantly reduced the number of times men woke up at night having to urinate: they had to go 64% less often. Urine flow increased significantly on the saw palmetto.

High quality studies compared saw palmetto to alpha-blockers, like tamsulosin, and, though the difference was not significant, International Prostate Symptom Scores (IPSS) improved more on saw palmetto. Saw palmetto was equal to tamsulosin for night time awakening and urine flow.

When saw palmetto was compared to finasteride’s class of drugs, IPSS improved equally.

Saw palmetto berry extract was able to significantly improve IPSS, urine flow, night time awakening to urinate, quality of life and prostate volume: that is, it actually shrunk the enlarged prostate. Importantly, meta-analysis of four studies confirmed that saw palmetto had no effect on sexual functioning, meaning that, unlike the drugs, it does not cause erectile dysfunction and there were significantly less ejaculation disorders. Specifically, saw palmetto improved IPSS by 5.73 points (to put that in perspective, an improvement of only 3.1 points was considered “clinically relevant”), urine flow improved by a significant 2.26 mL/s, men had to get up to urinate 1.56 fewer times per night, quality of life improved by a significant 1.07 points and prostate volume shrunk by 2.36 mL. In studies that lasted a year or longer, results were even better with quality of life improving by 1.31 points and prostate volume shrinking by a full 5.37 mL.

Once again, the major benefit of the safety of the herb was clear. Long term use of saw palmetto was safe and well tolerated, included no adverse effects on sexual function. The researchers highlighted that, in an older population that is often on several medications, an effective treatment for BPH that is very safe and has “very limited” drug interactions” is “of relevance.”

Interestingly, the researchers recommend that, based on this meta-analysis, the next update for the treatment of BPH should recommend considering saw palmetto berry extract as a treatment option.

This very exciting systematic review and meta-analysis firmly establishes the benefit of a herbal treatment over pharmaceutical treatment.


BJU Int 2018;122(6):1049-1065


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For much more on preventing and treating enlarged prostate naturally, see our books The Family Naturopathic Encyclopedia and Sex & Fertility: Natural Solutions .

For comprehensive help with benign prostatic hyperplasia, make an appointment to see Linda Woolven now.


The Natural Path
 is intended for educational purposes only and is in no way intended for self-diagnosis or self-treatment. For health problems, consult a qualified health practitioner for a comprehensive program.

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