Saw Palmetto (Serenoa repens) for the Treatment of Lower Urinary Tract Symptoms in Men with Benign Prostatic Hyperplasia: A Systematic Review

Abstract

Introduction: Benign Prostatic Hyperplasia (BPH) is highly prevalent in aging men, causing bothersome lower urinary tract symptoms (LUTS). Saw palmetto is one of the most common herbal remedies used for BPH. This review assesses its efficacy compared to placebo.

Methods: The Cochrane Library, MEDLINE, and Embase were searched for RCTs up to September 2019. We included trials of at least 4 weeks duration that compared saw palmetto (monotherapy) to placebo for men with BPH. The primary outcome was the change in urologic symptom scores (e.g., IPSS).

Results: We included 32 RCTs involving 5,666 men. The overall evidence quality was moderate. When compared to placebo, saw palmetto did not demonstrate a significant improvement in IPSS scores (MD = -0.70 points, 95% CI: -1.45 to 0.05) or maximum urinary flow rate (Qmax). Results were consistent even at double and triple doses.

Discussion: High-quality evidence from numerous trials indicates that Saw Palmetto is not more effective than placebo for treating LUTS associated with BPH. The perception of benefit may be largely due to a placebo effect or the natural waxing and waning of symptoms.

Conclusion: Based on robust evidence available up to 2019, Saw palmetto does not provide clinically meaningful improvement in urinary symptoms for men with BPH and is not recommended.