Will saw palmetto affect my PSA result?

Saw palmetto does not significantly alter PSA, unlike finasteride and dutasteride which roughly halve PSA. This is useful when monitoring for prostate cancer risk.

Natural Supplements for Prostate Health

Name: Dr (TCM) Attilio D'Alberto
Brand: Dr (TCM) Attilio D'Alberto
SKU: hd-local-wokingham-rg-40
Rating: 5 (227 reviews)

By Dr (TCM) Attilio D'Alberto | Traditional Chinese Medicine Practitioner, Wokingham

Benign prostatic hyperplasia (BPH) — the non-cancerous enlargement of the prostate gland — affects roughly half of men over 50 and 80% over 70. The symptoms it produces — frequent urination day and night, urgency, weak stream, hesitancy, dribbling and incomplete emptying — are tedious, embarrassing and disruptive to sleep, but rarely life-threatening. Many men prefer to avoid the side effects of alpha-blockers and 5-alpha reductase inhibitors, and a well-chosen combination of supplements, dietary changes, acupuncture and Chinese herbs can produce meaningful symptom relief in mild to moderate disease. This page summarises what works, what doesn't, and how to combine natural treatment with conventional care safely.

On this page

The prostate and what BPH does to it
Symptoms — when to take them seriously
Investigations
TCM patterns behind BPH
Evidence-based supplements
Chinese herbal medicine
Acupuncture
Diet for the prostate
Lifestyle and bladder habits
When medication or surgery is needed
FAQs

The prostate and what BPH does to it

The prostate is a walnut-sized gland sitting just below the bladder, surrounding the urethra. It produces about a third of seminal fluid. From around age 30, the prostate begins to grow slowly under the influence of dihydrotestosterone (DHT — the more potent metabolite of testosterone, produced by 5-alpha reductase). By 60, the gland in many men is two to three times its young-adult size. The growth occurs in the inner (transitional) zone, which directly squeezes the urethra and produces obstructive urinary symptoms.

BPH is not prostate cancer and does not increase cancer risk, although the two often coexist simply because both are common in older men.

Symptoms — when to take them seriously

Storage symptoms — frequency, urgency, nocturia, urge incontinence.
Voiding symptoms — hesitancy, weak/intermittent stream, straining, terminal dribbling.
Post-micturition — feeling of incomplete emptying, post-void dribbling.

Severity is usually scored with the IPSS (International Prostate Symptom Score, 0-35).

See your GP urgently if you have visible blood in urine or semen, severe sudden retention, fevers, weight loss, or persistent perineal/pelvic pain — these need investigation beyond simple BPH.

Investigations

Urinalysis to rule out infection and microscopic haematuria.
PSA — interpreted in context of age, prostate volume and rate of change. A single mildly raised PSA is not necessarily cancer.
DRE (digital rectal examination) — feels gland size and consistency.
Bladder ultrasound — measures post-void residual.
Uroflowmetry — measures stream rate.
MRI prostate if PSA is elevated or DRE abnormal — modern multiparametric MRI now precedes biopsy in most NHS pathways.

TCM patterns behind BPH

In Chinese medicine, BPH is one expression of long bi — disordered urination — and combines several patterns:

Kidney yang deficiency — the most common pattern in older men. Cold lower back, weak stream, frequent night urination, low libido, cold extremities.
Kidney yin deficiency with empty heat — burning urgency, dryness, night sweats, premature ejaculation.
Damp-heat in the lower jiao — burning, urgent, sometimes blood-tinged urination; often with prostatitis or UTI overlay.
Blood stasis — pelvic discomfort, perineal pain, retention, often after long-standing inflammation.
Spleen qi deficiency with damp — overall fatigue, heaviness, dribbling.
Liver qi stagnation — symptoms worse with stress; pelvic tension.

Evidence-based supplements

The supplements with the best clinical evidence:

Saw palmetto (Serenoa repens) 320 mg standardised extract daily — the most studied. Inhibits 5-alpha reductase (the same mechanism as finasteride) and has anti-inflammatory and anti-androgenic effects. Multiple RCTs show modest improvement in IPSS and flow rate; comparable to alpha-blockers in mild to moderate BPH; better tolerated.
Beta-sitosterol 60-130 mg daily — a plant sterol concentrated in pumpkin seed, rye grass and pygeum. Strong evidence across several RCTs for improved flow rate and reduced post-void residual.
Pygeum (Prunus africana) 100-200 mg daily — Cochrane review supports symptom and flow improvement. Often combined with saw palmetto and beta-sitosterol.
Stinging nettle root (Urtica dioica) 300-600 mg daily — modest BPH benefit, often combined with saw palmetto.
Zinc 15-30 mg daily — the prostate has the highest zinc concentration of any tissue. Zinc deficiency is associated with prostate enlargement; supplementation supports prostate health. Take with food and copper (1-2 mg) to avoid copper deficiency on long-term use.
Lycopene 10-30 mg daily — concentrated in tomato, watermelon, pink grapefruit. Anti-proliferative effects on prostate tissue; observational evidence of reduced BPH and prostate cancer.
Vitamin D3 — deficiency is consistently linked with worse urinary symptoms and prostate disease.
Selenium 100-200 mcg — supports prostate antioxidant defence; do not exceed 200 mcg long-term.
Quercetin 500 mg twice daily — RCT evidence in chronic prostatitis/CPPS.
Pollen extract (Cernilton) — older but reasonable evidence in BPH and chronic prostatitis.

Combination products with several of these (typically saw palmetto + beta-sitosterol + pygeum + nettle + zinc + lycopene) work as well as the individual components and are easier to take consistently.

Chinese herbal medicine for the prostate

Chinese herbal medicine has been treating "long bi" (urinary obstruction) and the cluster of symptoms we now call BPH and chronic prostatitis for over 1,500 years, and modern research has begun to map the mechanisms behind that long clinical experience. The benefits seen in clinic and trials include reduced prostate volume in some men, improved urinary flow rate, reduced post-void residual, lower IPSS scores, fewer nocturnal voids, reduced inflammatory markers in chronic prostatitis, and better tolerability than alpha-blockers and 5-alpha reductase inhibitors. A large body of Chinese-language randomised trials (with the usual caveats about study quality) consistently supports this; English-language systematic reviews of formulas such as Cernilton, Qian Lie Shu Tong and modified Ba Zheng San have shown clinically meaningful effects in BPH and chronic prostatitis (CPPS).

Mechanisms documented in laboratory and clinical research include:

5-alpha reductase inhibition — reducing DHT-driven prostate growth (overlaps with saw palmetto and finasteride).
Anti-androgenic effects at the prostate without lowering systemic testosterone (so libido is preserved).
Anti-inflammatory effects on prostatic tissue — relevant to both BPH and CPPS.
Antioxidant activity — reduces oxidative damage to prostate cells.
Improved pelvic and prostatic blood flow — relevant for blood-stasis presentations.
Smooth-muscle relaxation at the bladder neck — improving flow.
Diuretic effects — clearing dampness in TCM terms.

Key formulas and what they do

Jin Gui Shen Qi Wan — the classical Kidney yang tonic; the workhorse formula for BPH with weak stream, nocturia, cold lower back and dribbling. Reduces nocturia and improves flow in trials.
Liu Wei Di Huang Wan — Kidney yin tonic; useful where dryness, hot flushes and night sweats coexist with BPH.
Zhi Bai Di Huang Wan — Kidney yin deficiency with empty heat; burning urgency, dryness, premature ejaculation alongside BPH symptoms.
Suo Quan Wan — for frequent and incontinent urination from Kidney yang deficiency; reduces nocturia.
Ba Zheng San — clears damp-heat for acute urinary obstruction with burning, cloudy urine and infection picture; useful in acute BPH flare or UTI overlay.
Long Dan Xie Gan Tang — for damp-heat in the lower jiao with significant inflammation; particularly useful in chronic prostatitis.
Wu Ling San — incomplete emptying with bladder fluid retention; supports diuretic clearance.
Qian Lie Shu Tong (or Qian Lie An) — modern proprietary patent formulas specifically for BPH/prostatitis; combine blood-moving, damp-clearing and Kidney-tonifying actions; reasonable RCT evidence.
Shao Fu Zhu Yu Tang or modified Xue Fu Zhu Yu Tang — for blood-stasis presentations with perineal pain, retention or chronic prostatitis.

Key individual herbs and their prostate-relevant actions

Huang Qi (Astragalus) — tonifies qi, supports immune function, and has documented anti-inflammatory effects on the prostate.
Fu Zi and Rou Gui — warm Kidney yang; reduce nocturia and weak stream from cold-deficient BPH.
Shu Di Huang — nourishes Kidney yin and jing; backbone of yin-tonifying formulas for BPH with dryness.
Shan Yao — tonifies Spleen and Kidney; supports gentle long-term improvement.
Gou Qi Zi (Goji berries) — Liver and Kidney yin tonic; gentle daily food-grade tonic.
Wu Yao — warms and astringes urination; reduces frequency and nocturia.
Yi Zhi Ren — warms Kidney yang and astringes urine; classical herb for nocturia and incontinence.
Che Qian Zi — drains dampness through urination; widely used in BPH formulas.
Fu Ling — drains dampness, calms the spirit; supports urinary clearance.
Huang Bai and Zhi Mu — clear empty heat from the Kidney; classical pairing for BPH with empty-heat symptoms.
Jin Yin Hua — clears heat and toxins; useful in chronic prostatitis with infection picture.
Niu Xi — moves blood and directs herbs to the lower jiao; useful in blood-stasis presentations.
Tao Ren — moves blood and resolves stasis; relevant in long-standing BPH and chronic prostatitis.
Wang Bu Liu Xing — moves blood and unblocks the lower jiao; commonly used in modern prostate formulas.

I prescribe pharmaceutical-grade granules from Sun Ten in Taiwan, blended into a tailored formula based on the dominant TCM pattern, presenting symptoms, conventional medication, and any other relevant medical history. Most men feel benefit within 4-6 weeks, with full effects at 12 weeks.

Acupuncture

Several RCTs and a Cochrane review support electroacupuncture for moderate BPH symptoms, with effect sizes similar to standard medical therapy. Mechanisms include reduced prostatic inflammation, modulation of pelvic autonomic tone and improved bladder function.

Typical points: CV 3, CV 4, CV 6, BL 23, BL 28, BL 32, KI 3, SP 6, SP 9. Treatment is usually weekly for 8-12 sessions, then monthly maintenance.

Diet for the prostate

Tomatoes and tomato products — cooked tomato sauces give the highest absorbable lycopene.
Pumpkin seeds — natural source of beta-sitosterol and zinc.
Cruciferous vegetables — broccoli, cauliflower, kale, watercress, brussels sprouts; contain indole-3-carbinol and sulforaphane.
Green tea — EGCG has anti-proliferative effects on prostate tissue.
Oily fish — anti-inflammatory.
Soy in moderation — isoflavones modulate androgen activity favourably.
Reduce red and processed meat, dairy, refined sugar and alcohol.
Reduce caffeine, particularly later in the day if nocturia is troublesome.

Lifestyle and bladder habits

Stop fluids 2-3 hours before bed if nocturia is the main problem.
Bladder retraining — try to extend the gap between voids gradually.
Double voiding — wait 30 seconds and try again to reduce post-void residual.
Avoid prolonged sitting and tight clothing; modest exercise 30 minutes daily.
Strength training — preserves testosterone and lean mass; protective.
Lose excess weight — central obesity worsens BPH.
Pelvic floor exercises — particularly useful with post-void dribble and after surgery.
Avoid drugs that worsen retention — antihistamines, decongestants, some antidepressants and antimuscarinics.

When medication or surgery is needed

Alpha-blockers (tamsulosin, alfuzosin) — relax prostate smooth muscle; quick symptom relief; can cause dizziness and retrograde ejaculation.
5-alpha reductase inhibitors (finasteride, dutasteride) — shrink the gland over months; useful in larger glands; reduce libido and erectile function in some men.
Combined therapy — both classes together for moderate-severe BPH.
Tadalafil 5 mg daily — improves both BPH symptoms and erectile function.
Surgery (TURP, HoLEP, UroLift, Rezum) — for severe symptoms not controlled medically, or for retention, recurrent UTI, bladder stones or kidney damage.

Natural supplements and Chinese medicine are most useful in mild to moderate BPH (IPSS up to 19), and as adjuncts that allow lower medication doses with fewer side effects in moderate disease.

Frequently asked questions

Does saw palmetto really work for BPH?

Yes for many men with mild to moderate symptoms. Trials show improvement comparable to alpha-blockers, with fewer side effects. Allow 8-12 weeks before judging. Use a standardised lipidic extract (320 mg daily).

Can I take supplements with finasteride or tamsulosin?

Generally yes — the supplements above are safe alongside conventional medication, and many men use them to reduce side effects or doses. Tell your GP or urologist what you are taking.

Will saw palmetto affect my PSA?

Saw palmetto does not significantly alter PSA, unlike finasteride and dutasteride which roughly halve it. This is useful when monitoring for cancer risk.

Is BPH the same as prostate cancer?

No. BPH is benign overgrowth and does not become cancer. Both are common in older men and can coexist, which is why PSA and DRE are still important.

How long until I see improvement?

Acupuncture and supplement effects build over 8-12 weeks. Chinese herbal medicine typically shows benefit by week 4-6.

Can Chinese medicine help chronic prostatitis or pelvic pain syndrome?

Yes — chronic prostatitis (CPPS) often responds well to a combination of acupuncture, damp-heat-clearing or blood-moving herbs, pelvic floor physio and lifestyle change.