Saw Palmetto versus Proscar for BPH
reviewed by X. Li, Ph. D.
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.
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.
reviewed by X. Li, Ph. D.
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.
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.
