You're going to have to do a step better than Quackwatch. It's a great place to start, but it's hardly a definitive source.
What you and many others don't realize is that many of the studies these "anti alternative" fanatics cite are poorly done. To wit...
Lack of herbal supplement characterization in published randomized controlled trials.CONCLUSION: Documented characterization of herbal supplements in published randomized controlled trials is inadequate. Investigators may be unaware of the extent to which herbal quality-control issues may detract from the value of otherwise well-designed clinical trials. The scientific and clinical utility of future herbal randomized controlled trials would be enhanced if authors provided evidence that the herbal products studied were of high quality.
Wolsko PM, Solondz DK, Phillips RS, Schachter SC, Eisenberg DM.
Am J Med. 2005 Oct;118(10):1087-93
I keep telling this to people again, and again, and again. There's very poor regulation in the supplement industry. Unless you are purchasing from a quality company that regularly has its products tested by an independent lab, you are throwing your money down the bloody toilet.
You would think that The Ivory Tower would know better. But I see crappy studies making it into the peer-reviewd literature all the time. A smart researcher knows to look at the methods section to see whether or not the I's are dotted and T's are crossed.
You railed against saw palmetto. You'd be surprised at the volume of supportive literature on it already. And I'm talking quality, peer reviewed journals.
There are 3 accepted "drug" treatments of BPH (Benign prostatic hyperplasia)
1) 5alpha-reductase inhibitors. This would include finasteride, commonly sold as Proscar. Lower concentrations of finasteride are sold to men to slow down or prevent male pattern baldness.
2) alpha1-adrenergic antagonists. Flowmax is the common on. As you can see, it works by an entirely different mechanism.
3) Herbal remedies such as saw palmetto and pygeum. Of all the herbal medicines sold in health food stores, saw palmetto is one of the superstars. It works, and is the standard of care in Europe. But you need to get a standardized extract (tested so you get a known amount of the active ingredient) and you need to purchase it from a company which regularly has its products tested for purity and potency.
Here are a few citations to whet your appetite. The jury is still out. It will remain out for a while. And why? What's in it for a major drug company to fund such a study, Meta? Think about it. Why sabotage a cash cow? It is in the interest of the pharmaceutical companies to suppress such studies.
It's going to take academia using government (NIH) funds to sort it out. But that will happen eventually. Meanwhile, you'll have to go to European medical journals to sort out the truth today.
Urologe A. 2005 May;44(5):513-20.
Phytotherapy for BPS. Which products can still be prescribed?
[Article in German]
Madersbacher S, Schatzl G, Brossner C, Dreikorn K.
Abteilung fur Urologie und Andrologie, Donauspital, Wien, Osterreich. email@example.com
For decades, plant extracts have been amongst to the most popular drugs for lower urinary tract symptoms (LUTS) due to benign prostatic hyperplasia (BPH)/benign prostatic enlargement (BPE). Only a few of the many published studies meet the criteria of the WHO-BPH consensus conference. The few placebo-controlled, long-term (>/=6 months) studies suggest a positive effect of some extracts (saw palmetto, beta-sitosterol, urtica, rye-grass, saw palmetto/urtica combination) on LUTS; an effect on uroflow, post-void residual volume, prostate volume and PSA was not consistently demonstrable. Randomised trials against an active comparator (alpha1-blocker, 5alpha-reductase inhibitors) are difficult to interpret. Due to the lack of prospective studies, several meta-analyses have been published that can not, however, replace prospective studies. None of the BPH-guidelines currently recommend plant extracts, yet universally conclude that this is an interesting approach. Further prospective studies using WHO standards are required to reliably determine the role of such extracts in the management of elderly men with LUTS due to BPH/BPE.
Aging Male. 2004 Jun;7(2):155-69
Preventing diseases of the prostate in the elderly using hormones and nutriceuticals.
Comhaire F, Mahmoud A.
Ghent University Hospital, Gent, Belgium.
The prostate has only one function, namely to secrete fluid containing substances that are needed for reproduction. This requires an extremely high concentration of androgens in the tissues. Benign prostatic hypertrophy (BPH) seems to be related to the long-term exposure of the prostate to the strong androgen 5alpha-dihydrotestosterone (DHT) and, possibly, to estrogens. The relation between prostate cancer and androgens is suggested to be U-shaped, with both extremes of androgen concentrations being associated with increased risk of invasive cancer. In the treatment of patients with BPH, the lipidic liposterolic extracts of Serenoa repens were as effective as the pharmaceutical inhibitors of the 5alpha-reductase enzyme or alpha1-adrenergic blockers in relieving urinary symptoms. In addition to moderately inhibiting the 5alpha-reductase activity, Serenoa seems to exert anti-inflammatory and complementary cellular actions with beneficial effects on the prostate. Unlike the pharmaceutical 5alpha-reductase inhibitors, finasteride and dutasteride, Serenoa does not suppress serum PSA, facilitating the follow-up and the early detection of prostate cancer. We suggest a strategy to prevent prostate cancer that aims at providing men with partial androgen deficiency correct testosterone substitution with a sustained release buccal bio-adhesive tablet. In addition, food supplementation with extracts of Serenoa repens and a combination of the antioxidants selenium, (cis)-lycopene and natural vitamin E, together with fish oil rich in long-chain polyunsaturated essential fatty acids of the omega-3 group seems warranted. Clearly, a holistic approach including careful clinical and biological monitoring of the aging man and his prostate remains mandatory.