Summary: In a three month, open trial, 505 patients with mild to moderate symptoms of benign prostatic hyperplasia (BPH) were treated with Prostaserene®, an oral preparation of Serenoa repens (saw palmetto) at a daily dosage of 160 mg twice daily. Three hundred five patients were available for evaluation at the end of the three month period. Using the International Prostate Symptom Score, the quality of life score, urinary flow rates, residual urinary volume, and prostate size, patients taking saw palmetto showed significant improvement after only 45 days of treatment. After 90 days, 88 percent of the patients and 88 percent of physicians considered the therapy successful. Serum prostate-specific antigen (PSA) concentration was not modified by taking saw palmetto, thus reducing the chance of masking potential prostate cancer. Side effects were reported in only 5 percent of the patients completing the three month study. (Braeckman)

 
Commentary: Saw palmetto extract continues to be used as a primary treatment for both short-term and long-term treatment of BPH. This study is another indication that the daily dose of 320 mg is not only effective in the reduction of BPH symptoms but is also devoid of side effects - particularly when compared to its drug counterpart, finasteride. The therapeutic efficacy of saw palmetto extract is equal to that of finasteride and far more cost-effective.

The author of this study has recently completed a placebo-controlled, double-blind, randomized study BPH patients taking saw palmetto extracts. He reports that the results corroborate with those demonstrated in this open-label trial. I was recently supplied with the results of another unpublished study which used a combination of saw palmetto extract and urtica (nettle) root with 2,080 patients with BPH. At a daily dosage of 320 mg saw palmetto extract and 240 mg urtica root for 12 weeks, there was a 25.8 percent increase in maximum urinary flow, 29 percent increase in mean urinary flow, 44.7 percent reduction in residual urine, and 50.4 percent reduction in nocturia. There was also noted a reduction in dysuria (62.5 percent) and post-voiding dribbling (53.6 percent).

Two excellent review articles have recently been published on the mechanism of action of saw palmetto extract. The first, published in the new journal Phytomedicine (Nieferprum, et al:.), explores the 5-a-reductase inhibiting properties of the free fatty acids in the saw palmetto berry. This activity is not only critical to saw palmetto's efficacy with BPH but may also open the door for saw palmetto as a potential deterrent to prostate cancer.

The second study (Koch & Biber) examines the role of dihydrotestosterone, 5-a-reductase, estrogen, and sexual-hormone-binding globulin (SHBG) play in the pathogenesis of BPH. This paper not only explores saw palmetto extract's 5-a-reductase inhibiting and antiedematous actions but also explores the efficacy of urtica (nettle) root in the BPH treatment. A translation of this article appears in the Summer 1995 issue of the Quarterly Review of Natural Medicine.

It is clear that the next step in clinical research with saw palmetto extract is a comparative study with finasteride (Proscar®). In the meantime, healthcare practitioners utilizing saw palmetto extract in their practices have excellent research documentation to support their choice. --Donald Brown, N.D.

[Braeckman, J. 1994. The extract of Serenoa repens in the treatment of benign prostatic hyperplasia: A multicenter open study. Current Ther Res 55: 776-85, 1994.

Koch, E. & Biber, A. 1994Urologe 34: 3-8

Nieferprum, H. J., Schweikert, H. U., Zänker, K. S. 1994. Phytomedicine1: 127-33]