{"entity":{"id":"saw-palmetto","kind":"technology","name":"Saw palmetto","aka":["Serenoa repens","Sabal"],"tldr":"Saw palmetto is widely taken for an enlarged prostate, with conflicting trial results. It does not change prostate-specific antigen levels and there is no evidence it treats prostate cancer. It has been linked to bleeding, including during an operation, and Memorial Sloan Kettering advises checking with a doctor before using it during radiotherapy.","summary":"Saw palmetto fruit extracts have anti-androgenic and anti-inflammatory activity in the laboratory. Memorial Sloan Kettering's About Herbs entry describes conflicting trial data for lower urinary tract symptoms from benign prostatic enlargement, and a large study in which saw palmetto did not change serum PSA more than placebo, even at high doses. In the laboratory an extract inhibited growth of normal prostate cells and increased their sensitivity to radiation without affecting prostate cancer cells; because of this possible increase in normal-tissue complications MSK advises consulting a physician before using it during radiotherapy, and no data on symptom control during radiotherapy have been published. Saw palmetto was one of the eight herbs in PC-SPES. Most side effects are mild and similar to placebo, but case reports include prolonged bleeding during tumour surgery, haematuria with coagulopathy, a haemopericardium with rivaroxaban, a postoperative haematoma, pancreatitis and severe liver damage. MSK lists possible additive effects with anticoagulants, antiplatelet drugs and NSAIDs and inhibition of CYP3A4, 2D6 and 2C9 in vitro. Stopping it before surgery is sensible.","status":"phase-2","asOf":"2026-11-04","links":[{"label":"MSK About Herbs: Saw palmetto (page last updated 16 October 2023)","url":"https://www.mskcc.org/cancer-care/integrative-medicine/herbs/saw-palmetto"},{"label":"NCI PDQ: PC-SPES","url":"https://www.cancer.gov/about-cancer/treatment/cam/hp/pc-spes-pdq"}],"tags":["complementary","supportive-care","evidence:insufficient"],"related":["pomegranate-extract","red-clover-isoflavones"],"cancers":["prostate"],"sections":["supportive-care"],"technologies":["integrative-oncology","dietary-supplements-treatment-interactions"],"targets":[],"drugs":[],"companies":[],"institutions":[],"pathways":[],"terms":[],"trials":[],"people":[],"bottlenecks":["b-misinformation","b-toxicity-qol"],"keyPapers":[],"journals":[],"dependsOn":[],"notes":[],"principle":"Fatty acids and phytosterols that inhibit 5-alpha-reductase and androgen binding in vitro, the basis of its use for prostate enlargement.","strengths":["Mild side effects in most trials","Some trial support for urinary symptoms of benign enlargement"],"limitations":["No evidence against prostate cancer; does not alter PSA","Bleeding case reports including during surgery","Possible normal-tissue radiosensitisation in vitro"]},"route":"/technologies/saw-palmetto/","neighbours":{"technology":[{"id":"dietary-supplements-treatment-interactions","kind":"technology","name":"Dietary supplements during cancer treatment: interactions and harms","route":"/technologies/dietary-supplements-treatment-interactions/"},{"id":"integrative-oncology","kind":"technology","name":"Evidence-based integrative oncology","route":"/technologies/integrative-oncology/"},{"id":"pomegranate-extract","kind":"technology","name":"Pomegranate juice and extract","route":"/technologies/pomegranate-extract/"},{"id":"red-clover-isoflavones","kind":"technology","name":"Red clover isoflavones","route":"/technologies/red-clover-isoflavones/"}],"cancer":[{"id":"prostate","kind":"cancer","name":"Prostate cancer","route":"/cancers/prostate/"}],"section":[{"id":"supportive-care","kind":"section","name":"Supportive Care & Survivorship","route":"/fronts/supportive-care/"}],"bottleneck":[{"id":"b-misinformation","kind":"bottleneck","name":"Misinformation and unproven therapies","route":"/bottlenecks/b-misinformation/"},{"id":"b-toxicity-qol","kind":"bottleneck","name":"Toxicity and quality of life are undervalued","route":"/bottlenecks/b-toxicity-qol/"}]}}