reviewed by X. Li, Ph. D.
(credential)
In USA finasteride (Proscar) is a prescription drug approved by FDA and is often prescribed
as the first line treatment for BPH (benign prostatic hyperplasia). Saw palmetto belongs to alternative
medicine in USA and is not endorsed by FDA. This is in contrast to European countries like Germany where
saw palmetto is a prescription medicine and often used as the first line treatment for BPH.
At least two clinical trials have been done to make side by side comparisons of saw palmetto and finasteride
in terms of their benefits on BPH and side effects1, 2. The studies were multi-center, randomized,
double-blinded, controlled trials conducted in France and
Germany separately and arrived with similar conclusions. Basically both trials concluded that saw palmetto
is as effective as finasteride in relieving BPH symptoms but saw palmetto has less side effects than finasteride.
Let us discuss in more detail the first study1, which was regarded as well-designed and well-executed.
In this study, 1098 patients with moderate BPH
were randomized to receive either standardized saw palmetto extract or finasteride at the standard dose for 6 months.
The International Prostate Symptom Score (I-PSS) of the patients was taken as the primary measure.
After 6 month treatment, both saw palmetto and finasteride decreased the I-PSS
(the smaller the score the better) equally well (-37% and -39%, respectively). Moreover, both
saw palmetto and finasteride improved quality of life (by 38% and 41%) and increased peak urinary flow rate
(+25% and +30%).
However, important differences exist between saw palmetto and finasteride1. First, finasteride markedly
decreased prostate volume (-18%) whereas saw palmetto only slight reduced prostate volume (-6%).
Second, significantly more patients treated with finasteride had complaints of reduced sex desire and
impotence than patients treated with saw palmetto. Third, saw palmetto does not change the level of
PSA (prostate specific antigen) whereas finasteride lowers the level of PSA by as much as 41%.
PSA is a prostate specific marker whose
level goes higher when prostate cancer occurs and is thus useful in diagnosing prostate cancer. As proscar
reduces the PSA level, it may make PSA screen less useful in the prostate cancer diagnosis and mask the
early detection of prostate cancer.
In summary of these results, saw palmetto seems to be as effective as finasteride in treating mild
BPH but to have less side effect. Another consideration is the cost. While finasteride costs $70 per
month standardized saw palmetto extract may cost less than $10 per month.
Saw Palmetto for benign prostatic hyperplasia (BPH) (1)
Saw Palmetto for benign prostatic hyperplasia (BPH) (2)
Reference
1. Carraro
JC, Raynaud JP, Koch G, Chisholm GD, Di Silverio F, Teillac P, Da Silva FC,
Cauquil J, Chopin DK, Hamdy FC, Hanus M, Hauri D, Kalinteris A, Marencak J,
Perier A, Perrin P. Comparison of phytotherapy (Permixon) with finasteride in the treatment of
benign prostate hyperplasia: a randomized international study of 1,098
patients. Prostate. 1996 Oct;29(4):231-40.
2. Sokeland J. Combined sabal and urtica extract compared with finasteride in men with benign
prostatic hyperplasia: analysis of prostate volume and therapeutic
outcome. BJU Int. 2000 Sep;86(4):439-42.
