Saw Palmetto for BPH: What the Trials Found

The review searched to September 2022 and pooled 27 randomized trials with 4,656 men. Nineteen tested saw palmetto alone against placebo, and eight tested combination herbal products (Cochrane review, saw palmetto 2023).

Its conclusion was that saw palmetto alone provides little to no benefit for lower urinary tract symptoms from an enlarged prostate. Adverse events were about the same as placebo. The reviewers were less certain about combination products.

That last point matters, because Prostadine is a combination product. The review cannot say it works, and it cannot say it fails. It says the evidence for the best-known ingredient on its own is weak.

MSK reports conflicting data, with some trials showing improvement and others none (MSK, Saw Palmetto). Older, smaller and less well-controlled studies tended to look better, which is a common pattern. Better-designed trials, with larger groups and a placebo, tended to look worse.

Some men feel better on it, and that can be real, partly through the natural swings of symptoms. A trial's job is to separate that from the effect of the herb, and the herb has mostly not survived that test.

Reviews and trials cover a certain kind of man: usually aged 50 or older, with moderate symptoms, in a clinical setting, taking a standardised extract. A man with milder symptoms, a different age or a different product cannot assume the same result, positive or negative.

The absence of benefit in trials is also not proof that no man ever benefits. It means that on average, against placebo, the herb did not show a difference in the main symptom score. That is a high bar, and the right one for a product sold for symptoms.

Keep both points in view. The evidence is weak, and it is not a reason to fear the herb, which looks safe. It is a reason to spend money carefully and to keep a doctor involved in a problem that can have treatable causes.