Efficacy and Safety of a Proprietary Free Fatty Acid Rich Saw Palmetto Extract (USPlus? PRO) for Lower Urinary Tract Symptoms in Males: A Randomized, Double-Blind, Placebo-Controlled Trial
Background: Lower urinary tract symptoms (LUTS) affect most men aged 50+ and can significantly impair quality of life. Saw palmetto extracts have been evaluated for LUTS with mixed results, likely due to differing extraction quality, dosing, and study design. This study aimed to evaluate the efficacy and safety of USPlus PRO saw palmetto extract on LUTS in males. Methods: This randomized, placebo-controlled trial enrolled 80 males aged 45 - 80 years with LUTS. Participants were randomized 1:1 to two daily 160 mg USPlus PRO soft gels (providing 240 mg free fatty acids) or matched placebo for 12 weeks. Primary outcomes included changes in International Prostate Symptom Score (IPSS) and urinary frequency. Secondary outcomes included Brief Sexual Function Inventory (BSFI), quality of life, liver function, and safety. Results: Data from 62 participants were analyzed (USPlus PRO n = 30; Placebo n = 32). At Week 12, a statistically significant between group difference in IPSS total score was observed (p = 0.047). A clinically meaningful IPSS response (≥25% reduction) was evident in the USPlus PRO group by week 4. At week 12, statistically significant improvements were observed in the USPlus PRO group for the IPSS voiding subscore (IPSS-V) (p = 0.027), incomplete emptying (p = 0.002), weak stream (p = 0.026), BSFI total scores (p = 0.041), and erection domain scores (p = 0.039). Safety outcomes were comparable between groups. Conclusions: USPlus PRO saw palmetto extract provided significant, clinically meaningful improvements in LUTS, notably voiding symptoms, incomplete emptying, and weak stream over 12 weeks. Furthermore, significant improvements in sexual function were found. USPlus PRO demonstrated a favorable safety profile and may be a beneficial treatment option for LUTS (Clinical Trial ID NCT06266000).
References
[1]
Abrams, P., Cardozo, L., Fall, M., Griffiths, D., Rosier, P., Ulmsten, U., et al. (2003) The Standardisation of Terminology in Lower Urinary Tract Function: Report from the Standardisation Sub-Committee of the International Continence Society. Urology, 61, 37-49. https://doi.org/10.1016/s0090-4295(02)02243-4
Parsons, J.K., Bergstrom, J., Silberstein, J. and Barrett-Connor, E. (2008) Prevalence and Characteristics of Lower Urinary Tract Symptoms in Men Aged ≥ 80 Years and Older. Urology, 72, 318-321. https://doi.org/10.1016/j.urology.2008.03.057
[4]
Launer, B.M., McVary, K.T., Ricke, W.A. and Lloyd, G.L. (2020) The Rising Worldwide Impact of Benign Prostatic Hyperplasia. BJUInternational, 127, 722-728. https://doi.org/10.1111/bju.15286
[5]
Kupelian, V. (2006) Prevalence of Lower Urinary Tract Symptoms and Effect on Quality of Life in a Racially and Ethnically Diverse Random Sample. ArchivesofInternalMedicine, 166, Article No. 2381. https://doi.org/10.1001/archinte.166.21.2381
[6]
Arnold, M.J., Gaillardetz, A. and Ohiokpehai, J. (2023) Benign Prostatic Hyperplasia: Rapid Evidence Review. AmericanFamilyPhysician, 107, 613-622.
[7]
Shao, I.H., Wu, C.C., Hsu, H.S., Chang, S.C., Wang, H.H., et al. (2016) The Effect of Nocturia on Sleep Quality and Daytime Function in Patients with Lower Urinary Tract Symptoms: A Cross-Sectional Study. ClinicalInterventionsinAging, 11, 879-885. https://doi.org/10.2147/cia.s104634
[8]
Gewanter, R.M., Sandhu, J.S., Tin, A.L., Gross, J.P., Mazzarella, K., Urban, J., et al. (2023) Assessment of Patients with Prostate Cancer and Their Understanding of the International Prostate Symptom Score Questionnaire. AdvancesinRadiationOncology, 8, Article ID: 101200. https://doi.org/10.1016/j.adro.2023.101200
Abreu-Mendes, P., Silva, J. and Cruz, F. (2020) Pharmacology of the Lower Urinary Tract: Update on LUTS Treatment. TherapeuticAdvancesinUrology, 12, 1-16. https://doi.org/10.1177/1756287220922425
[11]
Michel, M.C., Miller, K., Schneider, T., Ude, C. and Oelke, M. (2025) Characteristics of Men Using Non-Prescription Medicines to Treat Their Lower Urinary Tract Symptoms. WorldJournalofUrology, 43, Article No. 283. https://doi.org/10.1007/s00345-025-05560-1
[12]
Strum, S. (2021) Serenoa repens (Saw Palmetto) for Lower Urinary Tract Symptoms (LUTS): The Evidence for Efficacy and Safety of Lipidosterolic Extracts. Part II. Uro, 1, 139-154. https://doi.org/10.3390/uro1030016
[13]
Franco, J.V.A., Trivisonno, L.F., Sgarbossa, N., Alvez, G.A., Fieiras, C., Escobar Liquitay, C.M., et al. (2024) Serenoa repens for the Treatment of Lower Urinary Tract Symptoms Due to Benign Prostatic Enlargement: An Updated Cochrane Review. TheWorldJournalofMen’sHealth, 42, 518-530. https://doi.org/10.5534/wjmh.230222
[14]
De Monte, C., Carradori, S., Granese, A., Di Pierro, G.B., Leonardo, C. and De Nunzio, C. (2014) Modern Extraction Techniques and Their Impact on the Pharmacological Profile of Serenoa repens Extracts for the Treatment of Lower Urinary Tract Symptoms. BMCUrology, 14, Article No. 63. https://doi.org/10.1186/1471-2490-14-63
[15]
D’Agate, S., Wilson, T., Adalig, B., Manyak, M., Palacios-Moreno, J.M., Chavan, C., et al. (2019) Impact of Disease Progression on Individual IPSS Trajectories and Consequences of Immediate versus Delayed Start of Treatment in Patients with Moderate or Severe LUTS Associated with BPH. WorldJournalofUrology, 38, 463-472. https://doi.org/10.1007/s00345-019-02783-x
[16]
Winograd, J., Lama, J., Codelia-Anjum, A., Bhojani, N., Elterman, D.S., Zorn, K.C., et al. (2024) Measuring the Efficacy of Serenoa repens (USPlus) Extract with Mobile Uroflowmetry. The Canadian Journal of Urology, 31, 12053-12059.
[17]
Debruyne, F., Boyle, P., Calais Da Silva, F., Gillenwater, J.G., Hamdy, F.C., Perrin, P., et al. (2004) Evaluation of the Clinical Benefit of Permixon and Tamsulosin in Severe BPH Patients—Permal Study Subset Analysis. EuropeanUrology, 45, 773-780. https://doi.org/10.1016/j.eururo.2004.01.015
[18]
Braun, M.H., Sommer, F., Haupt, G., Mathers, M.J., Reifenrath, B. and Engelmann, U.H. (2003) Lower Urinary Tract Symptoms and Erectile Dysfunction: Co-Morbidity or Typical “Aging Male” Symptoms? Results of the “Cologne Male Survey”. EuropeanUrology, 44, 588-594. https://doi.org/10.1016/s0302-2838(03)00358-0
[19]
Corbin, J.D. (2004) Mechanisms of Action of PDE5 Inhibition in Erectile Dysfunction. InternationalJournalofImpotenceResearch, 16, S4-S7. https://doi.org/10.1038/sj.ijir.3901205
[20]
Yang, S., Chen, C., Li, Y., Ren, Z., Zhang, Y., Wu, G., et al. (2013) Saw Palmetto Extract Enhances Erectile Responses by Inhibition of Phosphodiesterase 5 Activity and Increase in Inducible Nitric Oxide Synthase Messenger Ribonucleic Acid Expression in Rat and Rabbit Corpus Cavernosum. Urology, 81, 1380.e7-1380.e13. https://doi.org/10.1016/j.urology.2012.12.062
[21]
Chughtai, B., Bhojani, N., Zorn, K.C. and Elterman, D. (2023) Variability of Commercial Saw Palmetto-Based Supplements for the Management of Benign Prostatic Hyperplasia/lower Urinary Tract Symptoms. JUOpenPlus, 1, e00037. https://doi.org/10.1097/ju9.0000000000000040
[22]
Irwig, M.S. and Kolukula, S. (2011) Persistent Sexual Side Effects of Finasteride for Male Pattern Hair Loss. TheJournalofSexualMedicine, 8, 1747-1753. https://doi.org/10.1111/j.1743-6109.2011.02255.x