Treatment of benign prostatic hyperplasia (BPH) with Serenoa serrulata

Serenoa (Serenoa serrulata, Hook F), commonly called Saw palmetto (or Sabal), is a dwarf palm native to the East Coast of North America. By the end of the 19th century the berries of this plant had gained a reputation for use in the treatment of urinary and reproductive dysfunction and as an aphrodisiac. In the first half of this century the berries were cited in the USA Pharmocopoeia for the treatment of dysuria. The traditional therapeutic profile of the berries includes tonic, immune stimulant, expectorant and sedative properties. However, it is the anti-inflammatory and urinary antiseptic properties of the berries which have been emphasised in modern research studies, particular attention being paid to its use in treatment of BPH. A number of double-blind studies have been undertaken with Serenoa extracts for the treatment of patients with BPH. These show a significant improvement in signs of the condition compared with placebo within 90 days. Attention has focused on beta-sitosterol as the principle active constituent of the berries, lipophyllic extracts of which have been shown to inhibit the activity of 5-alpha reductase. This is the enzyme in the prostate that is responsible for the conversion of testosterone to dehydrotestosterone (DHT), high concentrations of which promote prostate cell division.

This review will outline the traditional medicinal use of Serenoa, describe the modern research studies that have been undertaken with it and compare its action with that of other medicinal herbs used to improve prostate health.