Carcinoma of the prostate is the most common tumor in men in the United States, with an estimated 240,890 new cases and 33,720 deaths expected in 2011. A wide range of estimates of the impact of the disease are notable. The disease is histologically evident in as many as 34% of men in their fifth decade and in up to 70% of men aged 80 years and older.[2,3] Prostate cancer will be diagnosed in almost one-fifth of U.S. men during their lifetime, yet only about 3% of men will be expected to die of the disease. The estimated reduction in life expectancy of men who die of prostatecancer is approximately 9 years.
This fact sheet provides basic information about the herb saw palmetto -- common names, uses, potential side effects, and resources for more information. Saw palmetto grows in the southern United States.Common Names--saw palmetto, American dwarf palm tree, cabbage palm
Latin Names--Serenoa repens, Sabal serrulata
The extraordinarily high rate of clinically occult prostate cancer in the general population compared with the 20-fold lower likelihood of death from the disease indicates that many of these cancers have low biologic risk. Concordant with this observation are the many series of patients with prostate cancer managed by surveillance alone with relatively good survival rates at 5 and 10 years of follow-up. Data demonstrate, however, that with prolonged 10-year follow-up of moderately differentiated (which constitute the majority of tumors detected ) and poorly differentiated tumors, there is a substantial risk of disease progression and death from prostate cancer.
Because of marked variability in tumor differentiation from one microscopic field to another, many pathologists will report the range of differentiation among the malignant cells that are present in a biopsy using the Gleason grading system. This grading system includes five histologic patterns distinguished by the glandular architecture of the cancer. The architectural patterns are identified and assigned a grade from 1 to 5 with 1 being the most differentiated and 5 being the least differentiated. The sum of the grades of the predominant and next most prevalent will range from 2 (well-differentiated tumors) to 10 (undifferentiated tumors).[9,10] Systematic changes to the histological interpretation of biopsy specimens by anatomical pathologists have occurred during the prostate-specific antigen (PSA) screening era (i.e., since about 1985) in the United States. This phenomenon, sometimes called "grade inflation," is the apparent increase in the distribution of high-grade tumors in the population for a period of time but in the absence of a true biological or clinical change. It is possibly the result of an increasing tendency for pathologists to read tumor grade as more aggressive, resulting in a higher preponderance to treat these cancers aggressively.
Treatment options available for prostate cancer include radical prostatectomy, external-beam radiation therapy, brachytherapy, cryotherapy, androgen deprivation with luteinizing hormone-releasing hormone analogs and/or antiandrogens, intermittent androgen deprivation, cytotoxic agents, and surveillance. Of all the means of management, only radical prostatectomy has been found to be superior to surveillance in men with localized prostate cancer in terms of reduced rates of metastases (relative hazard [RH] = 0.63; 95% confidence interval [CI], 0.41-0.96) and disease specific (RH = 0.5; 95% CI, 0.27-0.91) and overall mortalities. However, the relative efficacy of radical prostatectomy to the other forms of treatment has not been adequately addressed. Confounding issues in the treatment of prostate cancer include side effects with treatment, inability to predict the natural history of a given cancer, patient comorbidity that may affect an individual's likelihood of surviving long enough to be at risk for disease morbidity and mortality, and an increasing body of evidence suggesting that careful PSA monitoring following treatment may indicate a substantial fraction of treatment failures.