In a surprise to advocates of treating the symptoms of an enlarged prostate with saw palmetto, a significant study reports that saw palmetto appears to have NO benefit on enlarged prostate symptoms.
Commenting on the study, which was published in the Journal of the American Medical Association, the experts at the Natural Medicines Comprehensive Database (NMCD) say:

Saw palmetto is now falling out of favor for treating symptoms of BPH. Many men swear by it, but the evidence is stacking up against it.
Two NIH-sponsored studies now suggest that saw palmetto is no more effective than placebo. Due to these and other negative findings, the evidence-based effectiveness rating for saw palmetto is being downgraded to “Possibly Ineffective.”
Advise men not to rely on saw palmetto for BPH symptoms. Explain that benefits are modest at best.

The “National Kidney & Urologic Diseases Information Clearinghouse at the National Institutes of Health” notes that “a man’s prostate enters a growing phase around age 25 and never stops” and that “more than half of men in their 60s and up to 90% of men who reach their 70s suffer symptoms of an enlarged prostate, known formally as benign prostatic hyperplasia or BPH.”
Bloomberg News reports that, “Millions of men have been taking the supplement for decades as a natural remedy to ease symptoms of a swollen prostate, especially in Europe.”
AFP reports, “Measurements showed the drug, even when increased in dosage over 72 weeks, had no impact on urinary symptoms such as nighttime urination or incontinence, and did not improve sexual function or allow men to sleep better.”
MedPage Today reports, “Although a 2002 Cochrane review that included 21 clinical trials found that saw palmetto extracts significantly reduced nocturia, increased self-rated improvement, and improved peak uroflow, an update conducted in 2009 found that only the effect on nocturia remained significant. Other recent studies have questioned the efficacy of the extract as well. The largest of them, the STEP study, found that a standard dose of 320 mg/day did not have any effect on symptom scores or any secondary endpoints.”
However, advocates contend that the present study only shows that “saw palmetto extract is not helpful when given alone” and that it can be “given with other extracts, including those from stinging nettles or the bark of the Pygeum africanum, an African evergreen.
The NMCD rates stinging nettle as “having insufficient evidence for effectiveness” in the treatment of BPH. However, NMCD rates as LIKELY EFFECTIVE:

• Beta-sitosterol and
• Pygeum

• African wild potato,
• Pumpkin, and
• Rye grass

Non-herbal treatment options for prostate enlargement include “medication and surgery.”