Serenoa repens has now gained an excellent reputation for combating disorders of the prostate.

In fact, it represents the basis of all the most common over-the-counter products sold for various types of pathologies, fromenlargement to prostate cancer.

Serenoa repens, also known as Dwarf Palm or Saw Palmetto, is a small palm tree native to the West Indies and the Atlantic coast of North America.

Native Americans used the berries as food and as a remedy for a wide variety of problems related to the urinary and reproductive systems. European settlers soon learned to use it as well.

For at least 200 years, the dried extract was used for various ailments: fatigue, weakness, urogenital problems, and so on.

A meta-analysis published in 2000 in the journal Journal of the American Medical Association (source) highlighted theefficacy of Serenoa extracts in the treatment of symptoms inenlargement of the prostate (and in some cases also benefits for male pattern baldness).

However, the results of a clinical trial published in the prestigious journal New England Journal of Medicine in 2006 (source) overturned this evidence, indicating that treatment with Serenoa Repens did not improve the symptoms of benign prostatic hyperplasia.

Does Serenoa repens alter PSA levels?

No differences were observed between the group that received Serenoa extracts and the group that received a placebo for all the parameters considered, such as symptom evaluation, urinary flow, changes in prostate volume, post-void residual bladder volume, quality of life, adverse effects, and even the level of PSA.

The direct effect of Serenoa repens on PSA levels is minimal, while the indirect effect (i.e., the reduction of the state of inflammation chronic prostate disease) is more important.

If you have been taking serenoa repens for a long time, the PSA value could therefore be interpreted as a more reliable value, not influenced by the inflammatory state.

However, this aspect should not lead us to believe that taking Serenoa repens is sufficient to make the PSA test a reliable screening exam for prostate cancer.

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For how long should it be taken?

The discrepancy between the meta-analysis and the clinical study could partly lie in the different preparation methods of Serenoa repens extracts.

A recent study published in the prestigious scientific journal European Urology (source) cross-referenced data from 22 clinical trials with similar characteristics to try to answer a question that many men ask: does taking Serenoa repens really benefit the prostate?

This meta-analysis highlighted a clinically significant improvement in symptoms related to prostate enlargement in men who took Serenoa repens extracts for a period longer than 12 months.

Conversely, taking Serenoa repens for periods shorter than 12 months does not seem to provide any clinically significant improvement.

Does Serenoa repens really benefit the prostate?

Overall, extracts of Serenoa repens have shown less effectiveness compared to all medications alpha blokers or 5 ARI inhibitors such as finasteride, in the treatment of prostatic pathologies, but with some fewer side effects.

Apart from Permixon, which is a drug, all preparations based on Serenoa Repens are included in those over-the-counter products for which a prescription is not required and exactly like other supplements there is a widespread belief that it can be recommended at random because "they don't do any harm".

In reality, supplements used incorrectly can have significant side effects. As this study demonstrates, there can be benefits.

But together with the indication to use Serenoa we would also need a "action plan” suggested by a professional based on the patient's needs.

European guidelines (EAU) include the hexanic extract of Serenoa repens (Permixon) among the options for the treatment of LUTS/BPH symptoms, especially for patients who wish to avoid sexual side effects (source1, source2).

The 2023 AUA guidelines do not specifically mention Permixon, but mention the use of herbal remedies as an option, recommending individualized therapies based on the risk-benefit profile (source).

A Updated Cochrane Review on World Journal of Men's Health (January 2024) concludes that Serenoa repens extracts have modest-negligible effects on IPSS in the short term, but does not exclude benefits with prolonged use (source1, source2).

References:

Meta-analysis 2000: http://www.jaoa.org/cgi/reprint/100/2/89

Clinical Trial 2006: https://www.ncbi.nlm.nih.gov/pubmed/16467543

Meta-analysis 2020: https://www.eu-focus.europeanurology.com/article/S2405-4569(20)30018-3/fulltext