A large prostate does NOT always cause urinary problems. Can Saw Palmetto also shrink the Prostate?



DR Nyankotey

A large prostate does NOT always cause urinary problems. I think one of the areas urological medicine is behind is assuming that a 60-year-old plus man with urinary problems has a big prostate. A big prostate is not always the problem. I often see 100 to 150-gram prostates (normal is roughly 20 to 40grams) with little to no urinary symptoms and smaller prostates with lots of frequency, urgency and nighttime urination.

Benign Prostatic Hyperplasia (also known as BPH or enlarged prostate) is treated with 5-alpha-reductase inhibiting drugs like Finasteride (Proscar, the trade name) or Dutasteride (Avodart). These drugs can marginally make the prostate smaller but do NOT help with urination.   5-alpha reductase drugs can cause feminization, sexual dysfunction and may lead to advanced prostate cancer.Traish et al 2014, published in the Korean Journal of Urology, titled “The Dark Side of 5α-Reductase Inhibitors’ Therapy: Sexual Dysfunction, High Gleason Grade Prostate Cancer and Depression”


That’s bad news.

Trying to reduce the size of the prostate does not always mean urinary problems go away.  The real problem is the area of the prostate called the transitional zone (TZ) that surrounds the urethra (the tube that brings out your urine in your body).  The TZ squeezes the urethra for many reasons, including due to stress. That’s why some men with small prostate have urinary symptoms. Be aware of this fact: A large prostate does not always cause urinary problems in men, and 5-alpha reductase inhibitors can cause more problems than fix them(Traish et al 2014)

Many claims have been made about the ability of saw palmetto (Serenoarepens) , a natural remedy derived from the American dwarf palm tree, to shrink the prostate and relieve symptoms of an enlarged prostate (BPH) and associated urinary tract problems, as well as showing promise in prostatitis and perhaps even in fighting prostate cancer. But is this hype, or does saw palmetto really work to shrink the prostate?



Can saw palmetto shrink the prostate?

The simple answer to the question is yes, saw palmetto has been shown to be effective in managing BPH symptoms (including urinary tract symptoms) and prostatitis, and it’s too early to tell how effective it may be in the fight against prostate cancer. But here is why saw palmetto works.

One of the main components is beta-sitosterol, a substance that inhibits the activity of an enzyme called 5-alpha-reductase. This enzyme promotes the growth of prostate cells, and thus contributes to an enlarged prostate. Saw palmetto also appears to reduce levels of dihydrotestosterone (DHT), a hormone which, at elevated levels, causes the prostate to become enlarged.

To get a better idea of how saw palmetto has performed in men with BPH or prostatitis, here are the highlights of some of the research.

Saw palmetto for BPH and prostatitis

The most recent (published April 2018) research on the effect of saw palmetto on BPH comes from a systematic review and meta-analysis that evaluated data from 27 studies and 5,800 participants. All of the studies analyzed used a proprietary saw palmetto product which contained 160 mg of lipidosterolic extract of Serenoarepens per capsule.

After evaluation, the reviewers reported that:

When compared with placebo, the saw palmetto supplement was associated with fewer voids during the night and an increase in peak urinary flow

When compared with the BPH drug tamsulosin, the two showed similar increases in peak urinary flow

When compared with alpha blockers, the two showed similar improvements on IPSS (International Prostate Symptom Score)

Prostate volume decreased slightly

Of the 447 men treated for one year or longer, efficacy results remained the same

The most frequent adverse reaction was gastrointestinal disorders (mean incidence, 3.8%)

The reviewers concluded that saw palmetto “appears to be an efficacious and well-tolerated therapeutic option for the long-term medical treatment of LUTS/BPH.” (Vela-Navarrete)

An April 2012 pilot study reported on the effect of saw palmetto on BPH and sexual dysfunctions in a group of 82 men. During the 8-week open trial, the men took one capsule of 320 mg saw palmetto extract daily. By the end of treatment, the men’s International Prostate Symptom Score (IPSS) had declined from 14.4 to 6.9, while their Sexual Function Inventory improved from 22.4 to 31.4. Quality of life also showed improvement on the Urolife BPH QoL-9 scale (from 162.7 to 105.0). This study was reportedly the first with saw palmetto to show improvement in symptoms of BPH and sexual dysfunction. (Suter)

A long-term (24-month) study of saw palmetto was conducted in 120 men with mild or moderate lower urinary tract symptoms associated with BPH. After taking 320 mg of saw palmetto daily, the men showed statistically significant improvement in their IPSS, quality of life, residual urinary volume, prostate volume, and sexual function. (Sinescu)

Saw palmetto compared to Flomax results

What happens when you compare saw palmetto with a conventional BPH treatment such as tamsulosin (Flomax)? A one-year study published in European Urology reported on the results of this comparison conducted in 704 men. Both saw palmetto and tamsulosin led to similar improvements in symptoms, although men who took tamsulosin were more likely to experience ejaculation disorders and to experience less improvement in prostate volume. (Debruyne)

A head-to-head comparison between saw palmetto v Flomax (tamsulosin) for men with chronic prostatitis also yielded positive results. A total of 157 men with chronic prostatitis were randomly assigned to take either 160 mg saw palmetto twice daily or 0.4 mg tamsulosin for six weeks. At the end of the study period, men in both groups experienced similar improvements in their Chronic Prostatitis Symptom Index (CPSI) scores, although men who took saw palmetto had an additional benefit: a greater decline in their pain scores. (Kravchick 2012)

Saw palmetto as combination treatment for BPH

Saw palmetto also works well when combined with other selected supplements. In a 2017 Cochrane review of saw palmetto both as a solo therapy and in combination, the authors concluded that “the totality of evidence includes favorable patients’ response from clinical experience, impact of placebo effect, early positive studies…and potential synergistic effects when combined with other therapies.” Those combinations include saw palmetto with lycopene and selenium as well as with stinging nettle. (Ooi)

One example can be seen in a clinical trial of 257 men who were experiencing lower urinary tract symptoms (LUTS) associated with BPH. The men were randomly assigned to take either placebo or a combination of 160 mg saw palmetto extract and 120 mg stinging nettle root extract daily for 24 weeks, followed by a 24-week control period and a 48-week period during which all the men took the combination. By the end of the study (week 96), the researchers reported a 53% improvement in the International Prostate Symptom Score (IPSS), a 19% improvement in urinary flow, and a 44% reduction in residual urine volume. (Lopatkin)

A subsequent study involved the use of saw palmetto along with stinging nettle, quercetin, and curcumin versus the antibiotic prulifloxacin in men who had chronic bacterial prostatitis. A total of 143 men were enrolled in the study, and they were randomly assigned to one of two groups: 106 received 600 mg prulifloxacin plus the four extracts for 14 days, while 37 men received the antibiotic only.

One month later, 89.6% of the men who took saw palmetto and the other supplements had no symptoms of prostatitis compared with only 27% of the men who took the antibiotic only. At a six-month follow-up, none of the men who had taken the herbal supplements and two who had taken the antibiotic alone had recurrent prostatitis. (Cai)

According to Dr. Geo Espinosa, ND, Lac, CNS, RH (AHG), director of the Integrative Urological Center at New York University Langone Medical Center, “The studies with saw palmetto and other herbal supplements strongly suggest a saw palmetto combination can lead to enhanced results when managing symptoms of BPH and prostatitis.”

In fact, failure to use saw palmetto in combination with other selected supplements is likely why some studies of saw palmetto for management of BPH have not yielded good results, according to Dr. Espinosa. A case in point is a Cochrane review (May 2012) that evaluated 17 randomized controlled trials (2,008 participants) comparing saw palmetto (usually 320 mg/day) with placebo. The reviewers found that saw palmetto was no better than placebo in improving lower urinary tract symptoms (LUTS).


The Mistake with Saw Palmetto.

I have also realized that, most practitioners prescribed the Daily Recommended Allowance of 320mg. in fact, what has been proven to also work is a strength of 640mg and not 320mg for people with BPH. Saw Palmetto should always be combined with quality backed science prostate ingredients and this is why I believed conventional Urologists understanding of Natural Urology is also very important to help their patients. This is why the Men’s formula ingredients are quality, unique and also contains saw palmetto in high concentration to support prostate and general wellness of Men. Always, do remember that, not all men also benefit from natural prostate remedies. So if you try Men’s Formula and does not work; kindly stop and see your Urologist.

Saw palmetto and prostate cancer

The potential for using saw palmetto in the fight against prostate cancer is still largely unknown, although some research has been done. In particular, two Italian studies reported that prostate cells treated with the extract underwent cell death (apoptosis). (Baron; Petrangeli)

Another study conducted at the Fred Hutchinson Cancer Research Center was not as positive. Data in the study came from 35,239 men who had participated in the VITamins and Lifestyle (VITAL) project. The investigators looked at the men’s supplement use and incidence of prostate cancer and did not find an association for use of saw palmetto. (Brasky)

NB: Let me finally leave you with this interesting story below:

Wrong-patient prostate cancer surgery costs medical group $12.25 million in malpractice case

DES MOINES, Iowa – A jury awarded $12.25 million Friday to an Iowa man who underwent debilitating prostate cancer surgery then learned he didn’t have cancer.

An Iowa Clinic pathologist mixed up slides of Rickie Huitt’s non-cancerous tissue samples with those of a man who had prostate cancer. The mistake led to an incorrect diagnosis, and a surgeon removed Huitt’s prostate gland in April 2017. The operation damaged nearby nerves, leaving Huitt impotent and incontinent.

The Iowa Clinic, which is the Des Moines area’s largest group of specialty physicians, admitted the error. But the two sides disagreed over how much compensation Huitt deserved.

The retired John Deere factory worker from Panora and his wife, Judy Huitt, filed suit, seeking $15 million in damages from the Iowa Clinic and its pathologist, Joy Trueblood. A lawyer for the clinic and the doctor recommended Friday that jurors in Polk County award $750,000.

“There’s never been a dispute that there was an unnecessary surgery,” defense lawyer Jack Hilmes told the jury Friday morning. Hilmes asked jurors to set “reasonable” damages. “Clearly, we disagree that $15 million is reasonable compensation,” he said.

The Huitts’ four-lawyer team was led by Nick Rowley, a nationally known medical-malpractice attorney who joined the case last week. Rowley told jurors that $15 million was a fair appraisal of how much the couple had suffered because of the Iowa Clinic’s negligence.

Rowley urged jurors to ignore the defense’s claim the Huitts didn’t deserve so much money because Rickie Huitt, 67, is still able to do activities such as mow his yard, attend the State Fair and pick up his granddaughters from school.

“For him, he’s lost his manhood,” Rowley said in his closing argument. “If he had lost his left leg, there wouldn’t be any reason to talk about his nose or his ears or his left hand.”

The trial, which began Tuesday, included emotional testimony from the Huitts about how the side effects of the surgery damaged their life.

Judy Huitt repeatedly teared up as she told jurors how her husband felt diminished as a husband because of his impotence. She echoed his earlier testimony that they had an active love life until his mistaken surgery. “It’s changed our world forever,” she testified Thursday.

Details of the lab mix-up weren’t discussed in the trial.

She said she and her husband were relieved the trial was over. It was embarrassing and stressful to testify about such personal problems, she said.

“It was horrible, like standing up there in front of everyone. It was raw,” she said.

When asked for comment after the verdict, Iowa Clinic spokeswoman Amy Hilmes replied in an email: “We are disappointed in the jury’s decision but have great respect for the legal process. We will be evaluating our legal options.”


Dr. Raphael Nyarkotey Obu, RND, PhD, is the Editor in Chief of the New Ghana Alternative Medicine Journal (GAMJ), President of Alternative Medical Association of Ghana (AMAG), RNG Medicine Research Lab and Nyarkotey College of Holistic Medicine, Tema, Community, 7. He is the formulator, developer of Men’s Formula for Prostate Health, Women’s Formula for wellness and Nyarkotey Tea for Cardiovascular Health. My columns are for educational purposes only. If you try any of my products and dissatisfied with it; kindly consult your Doctor. Enquiry call 0541234556 or appointment at Nyarkotey College of Holistic Medicine, Tema, community 7, Post office.  For those interested in the upcoming Traditional and Alternative Medicine conference, submit your Abstract via: collegeofholisticmedicine@gmail.com or call 0241083423/0208244716


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