Green therapies for a grey disease

Konstantinos Stamatiou

Abstract


Phytotherapeutic agents are used for many years as an adjunctive therapy of benign prostatic hypertrophy. The similarity of the symptoms of the lower urinary tract associated with chronic prostatitis with those caused by benign prostatic hypertrophy and the anecdotally observed efficacy of the phytotherapeutic agents in the improvement of pelvic pain justifies their use in the treatment of chronic nonbacterial prostatitis. Many clinicians and researchers have investigated the role of herbal medicinal products against the symptoms of the lower urinary tract however a careful review of the reported studies showed that specific studies for nonbacterial prostatitis are limited. Even if in these studies the target, the material and the methods varies, most support their usefulness. Despite the general belief that phytotherapeutic agents’ have a dual mechanism of action (both hormonal and anti-inflammatory) it seems that they actually exhibit a moderate anti-inflammatory effect the exact mechanism of which is not fully investigated.

 

Τα φυτοθεραπευτικά χρησιμοποιούνται εδώ και πολλά χρόνια ως συμπληρωματική θεραπεία στην καλοήθη υπερτροφία του προστάτη. Η ομοιότητα των συμπτωμάτων του κατώτερου ουροποιητικού στη χρόνια προστατίτιδα με αυτά που προκαλούνται από την καλοήθη υπερτροφία του προστάτη και η παρατηρούμενη αποτελεσματικότητα των φυτοθεραπευτικών στη βελτίωση του πυελικού πόνου δικαιολογεί τη χρήση τους στη θεραπεία της χρόνιας μη βακτηριακής προστατίτιδας. Πολλοί κλινικοί γιατροί και ερευνητές έχουν διερευνήσει το ρόλο των φυτικών φαρμακευτικών προϊόντων κατά των συμπτωμάτων του κατώτερου ουροποιητικού συστήματος, ωστόσο μια προσεκτική εξέταση των υφιστάμενων μελετών έδειξαν ότι οι εξειδικευμένες για τη μη βακτηριακή προστατίτιδα είναι περιορισμένες. Ακόμα και αν σε αυτές τις μελέτες ο στόχος, το υλικό και οι μέθοδοι ποικίλλουν οι περισσότερες υποστηρίζουν τη χρησιμότητά τους. Παρά τη γενική πεποίθηση ότι τα φυτοθεραπευτικά, έχουν διπλό μηχανισμό δράσης (ορμονικό και αντί-φλεγμονώδη) φαίνεται ότι εμφανίζουν μία μέτρια αντιφλεγμονώδη δράση της οποίας ο ακριβής μηχανισμός δεν έχει πλήρως διερευνηθεί.


Keywords


chronic nonbacterial prostatitis; chronic pelvic pain syndrome; lower urinary tract symptoms; pharmacotherapy; phytotherapeutic drugs; xρόνια μη βακτηριακή προστατίτιδα; σύνδρομο χρόνιου πυελικού άλγους; συμπτώματα από το κατώτερο ουροποιητικό σύστημα;

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References


Rees J, Abrahams M, Doble A, Cooper A. Prostatitis Expert Reference Group (PERG). Diagnosis and treatment of chronic bacterial prostatitis and chronic prostatitis/chronic pelvic pain syndrome: A consensus guideline. BJU Int. 2015;116(4):509 - 25

Delavierre D, Rigaud J, Sibert L, Labat JJ. Specific treatments for chronic bacterial prostatitis and chronic pelvic pain syndrome Prog Urol. 2010;20(12):1066 - 71

Snow DC, Shoskes DA. Pharmacotherapy of prostatitis. Expert Opin Pharmacother. 2010;11(14):2319 - 30

Lopatkin NA, Apolikhin OI, Sivkov AV, Aliaev IuG, et al. Results of a multicenter trial of serenoa repens extract in patients with chronic abacterial prostatitis. Urologiia. 2007;(5):3 - 7

Giulianelli R, Pecoraro S, Sepe G, Leonardi R, et al. Multicentre study on the efficacy and tolerability of an extract of Serenoa repens in patients with chronic benign prostate conditions associated with inflammation. Arch Ital Urol Androl. 2012;84(2):94 - 8

Morgia G, Mucciardi G, Galì A, Madonia M, et al. Treatment of chronic prostatitis/chronic pelvic pain syndrome category IIIA with Serenoa repens plus selenium and lycopene (Profluss) versus S. repens alone: an Italian randomized multicenter - controlled study. Urol Int. 2010;84(4):400 - 6

Morgia G, Mucciardi G, Madonia M, Castelli T, et al. Treatment of chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS) with Serenoa repens plus selenio and licopene (Profluss): a randomized multicenter placebo - controlled study (2008 AUA Meeting). J Urol. 2008;179(4):32

Magri V, Marras E, Restelli A, Wagenlehner FM, et al. Multimodal therapy for category III chronic prostatitis/chronic pelvic pain syndrome in UPOINTS phenotyped patients. Exp Ther Med. 2015;9(3):658 - 666

Kaplan SA, Volpe MA, Te AE. A prospective, 1 - year trial using saw palmetto versus finasteride in the treatment of category III prostatitis/chronic pelvic pain syndrome. J Urol. 2004;171(1):284 - 8

Bertaccini A, Giampaoli M, Cividini R. et al. Observational database serenoa repens (DOSSER): overview, analysis and results. A multicentric SIUrO (Italian Society of Oncological Urology) project. Arch Ital Urol Androl. 2012;84(3):117 - 22

Dedhia RC, McVary KT. Phytotherapy for lower urinary tract symptoms secondary to benign prostatic hyperplasia. J. Urol. 2008;179(6):2119 - 2125

Bent S, Kane C, Shinohara K, et al. Saw palmetto for benign prostatic hyperplasia. N. Engl J Med. 2006;354(6):557 - 566

Barry MJ, Meleth S, Lee JY, Kreder KJ, et al. Effect of increasing doses of saw palmetto extract on lower urinary tract symptoms: A randomized trial. JAMA. 2011;306(12):1344 - 51

Sinescu I, Geavlete P, Multescu R, et al. Long - term efficacy of Serenoa repens treatment in patients with mild and moderate symptomatic benign prostatic hyperplasia. Urol Int. 2011;86(3):284 - 9

Reissigl A, Djavan B, Pointner J. Prospective placebo - controlled multicenter trial on safety and efficacy of phytotherapy in the treatment of chronic prostatitis/chronic pelvic pain syndrome. J Urol. 2004;171:61.Abstract 233

Debruyne F, Koch G, Boyle P. et al. (Groupe d’étude PERMAL). Comparison of a phytotherapeutic agent (Permixon) with an alpha - blocker (Tamsulosin) in the treatment of benign prostatic hyperplasia: A 1 - year randomized international study. Prog Urol. 2002;12(3):384 - 92

Pavone C, Abbadessa D, Tarantino ML, et al. Associating Serenoa repens, Urtica dioica and Pinus pinaster. Safety and efficacy in the treatment of lower urinary tract symptoms. Prospective study on 320 patients. Urologia. 2010;77(1):43 - 51

Boyle P, Robertson C, Lowe F, Roehrborn C. Updated meta - analysis of clinical trials of Serenoa repens extract in the treatment of symptomatic benign prostatic hyperplasia. BJU Int. 2004;93(6):751 - 756

Wilt T, Ishani A, Mac Donald R. Serenoa repens for benign prostatic hyperplasia. Cochrane Database Syst Rev 2002;3:CD001423

Tacklind J, MacDonald R, Rutks I, Wilt TJ. Serenoa repens for benign prostatic hyperplasia. Cochrane Database Syst Rev 2009;2:CD001423

Squadrito F, Morgia G. The association of Serenoa repens, Lycopene and Selenium is superior to Serenoa repens alone in reducing benign prostatic hyperplasia. Urologia 2011;78(4):297 - 9

Barlet A, Albrecht J, Aubert A, et al. Efficacy of Pygeum africanum extract in the medical therapy of urination disorders due to benign prostatic hyperplasia: Evaluation of objective and subjective parameters. A placebo controlled double - blind multicenter study. Wien Klin Wochenschr 1990;102:667 - 673

Chatelain C, Autet W, Brackman F. Comparison of once and twice daily dosage forms of Pygeum africanum extract in patients with benign prostatic hyperplasia: A randomized, double - blind study, with long - term open label extension. Urology 1999;54:473 - 478

Ishani A, MacDonald R, Nelson D, et al. Pygeum africanum for the treatment of patients with benign prostatic hyperplasia: A systematic review and quantitative meta - analysis. Am J Med 2000;109:654 - 664

Breza J, Dzurny O, Borowka A, Hanus T, et al. Efficacy and acceptability of tadenan (Pygeum africanum extract) in the treatment of benign prostatic hyperplasia (BPH): A multicentre trial in central Europe. Curr Med Res Opin. 1998;14(3):127 - 39

Carani C, Salvioli V, Scuteri A, et al. Urological and sexual evaluation of treatment of benign prostatic disease using Pygeum africanum at high doses. Arch Ital Urol Nefrol Androl 1991;63:341 - 345

Evans DT, Jaleel H, Keefe A. Retrospective review of clinical practice in chronic pelvic pain syndrome i.e. category III chronic prostatitis at two hospital sites over five years 2000 - 2005 (an audit). Int J STD AIDS 2007;18(4):276 - 80

Shoskes DA, Nickel JC, Kattan MW. Phenotypically directed multimodal therapy for chronic prostatitis/chronic pelvic pain syndrome: A prospective study using UPOINT. Urology 2010;75(6):1249 - 53

Shoskes DA, Zeitlin SI, Shahed A, Rajfer J. Quercetin in men with category III chronic prostatitis: a preliminary prospective, double - blind, placebo - controlled trial. Urology 1999;54:960 - 963

Buck AC, Cox R, Rees RW, et al. Treatment of outflow tract obstruction due to benign prostatic hyperplasia with the pollen extract, cernilton. A double - blind, placebo - controlled study. Br J Urol. 1990;66:398 - 404

Hayashi J, Mitsui H, Yamakawa G, et al. Clinical evaluation of Cernilton in benign prostatic hypertrophy. Hinyokika Kiyo. 1986;32(1):135 - 41

Yasumoto R, Kawanishi H, Tsujino T, et al. Clinical evaluation of long - term treatment using cernitin pollen extract in patients with benign prostatic hyperplasia. Clin Ther. 1995;17(1):82 - 7

Becker H, Ebeling L. Konservative therapie der benignen prostata - hyperplasie (BPH) mit Cernilton®N: Ergebnisse einer plazebokontrollierten doppleblindstudie. Urologe B. 1988;28:301 - 6

Maekawa M, Kishimoto T, Yasumoto R, et al. Clinical evaluation of Cernilton on benign prostatic hypertrophy: A multiple center double - blind study with Paraprost. Hinyokika Kiyo. 1990;36(4):495 - 516

Dutkiewicz S. Usefulness of Cernilton in the treatment of benign prostatic hyperplasia. Int Urol Nephrol. 1996;28(1):49 - 53

MacDonald R, Ishani A, Rutks I, Wilt TJ. A systematic review of Cernilton for the treatment of benign prostatic hyperplasia. BJU Int. 2000;85(7):836 - 41

Rugendorff EW, Weidner W, Ebeling L, Buck AC. Results of treatment with pollen extract (Cernilton N) in chronic prostatitis and prostatodynia. Br J Urol. 1993;71:433 - 438

Buck AC, Rees RW, Ebeling L. Treatment of chronic prostatitis and prostatodynia with pollen extract. Br J Urol. 1989;64:496 - 499

Wagenlehner F, Schneider H, Ludwig M, et al. A Pollen Extract (Cernilton) in Patients with Inflammatory Chronic Prostatitis - Chronic Pelvic Pain Syndrome: A Multicentre, Randomised, Prospective, Double - Blind, Placebo - Controlled Phase 3 Study. Eur Urol. 2009;56(3):544

Qian X, Kong X, Qian Y, et al. Therapeutic efficacy of Cernilton in benign prostatic hyperplasia patients with histological prostatitis after transurethral resection of the prostate. Int J Clin Exp Med. 2015;8(7):11268 - 75

Jodai A, Maruta N, Shimomae E, et al. A long - term therapeutic experience with Cernilton in chronic prostatitis. Hinyokika Kiyo 1988;34(3):561 - 8

Suzuki T, Kurokawa K, Mashimo T, et al. Clinical effect of Cernilton in chronic prostatitis. Hinyokika Kiyo 1992;38(4):489 - 94

Xu J, Qian WQ, Song JD. A comparative study on different doses of cernilton for preventing the clinical progression of benign prostatic hyperplasia. Zhonghua Nan Ke Xue 2008;14(6):533 - 7

Apolikhin OI, Aliaev IuG, Sivkov AV, et al. A comparative clinical randomized trial of cernilton efficacy and safety in patients with chronic abacterial prostatitis. Urologiia. 2010;(1):29 - 34

Cornara L, La Rocca A, Marsili S, Mariotti MG. Traditional uses of plants in the Eastern Riviera (Liguria, Italy). J. Ethnopharmacol. 2009;125:16 - 30

Tamaki M, Nakashima M, Nishiyama R, et al. Assessment of clinical usefulness of Eviprostat for benign prostatic hyperplasia - comparison of Eviprostat tablet with a formulation containing two - times more active ingredients. Hinyokika Kiyo 2008;54(6):435 - 45

Iwamura H, Koie T, Soma O, et al. Eviprostat has an identical effect compared to pollen extract (Cernilton) in patients with chronic prostatitis/chronic pelvic pain syndrome: A randomized, prospective study. BMC Urol. 2015;15(1):120

Vogl S, Picker P, Mihaly - Bison J, et al. Ethnopharmacological in vitro studies on Austria’s folk medicine - An unexplored lore in vitro anti - inflammatory activities of 71 Austrian traditional herbal drugs. J Ethnopharmacol. 2013;149(3):750 - 71

Steenkamp V, Gouws MC, Gulumian M, et al. Studies on antibacterial, anti - inflammatory and antioxidant activity of herbal remedies used in the treatment of benign prostatic hyperplasia and prostatitis. J Ethnopharmacol. 2006;103(1):71 - 5

Li JP, Chong T, Chen HW, et al. Qianlieping capsule plus alpha - blocker for chronic non - bacterial prostatitis: analysis of 220 cases. Zhonghua Nan Ke Xue 2012;18(9):856 - 8

Shang XJ, Geng Q, Duan JM et al. Efficacy and safety of Longjintonglin Capsule for the treatment of type III prostatitis. Zhonghua Nan Ke Xue 2014;20(12):1109 - 12

Yang J, Te AE. Saw palmetto and finasteride in the treatment of category - III prostatitis/ chronic pelvic pain syndrome. Curr Urol Rep. 2005;6(4):290 - 5

Hill B, Kyprianou N. Effect of permixon on human prostate cell growth: lack of apoptotic action. Prostate 2004;61(1):73 - 80

Marks LS, Hess DL, Dorey FJ, et al. Tissue effects of saw palmetto and finasteride: Use of biopsy cores for in situ quantification of prostatic androgens. Urology 2001;57(5):999 - 1005

Iglesias - Gato D, Carsten T, Vesterlund M, et al. Androgen - independent Effects of Serenoa repens Extract (Prostasan®) on Prostatic Epithelial Cell Proliferation and Inflammation. Phytother Res. 2012;26(2):259 - 64

Wadsworth Τ, Carroll J, Mallinson R. et al. Saw Palmetto extract suppresses Insulin - Like Growth Factor - I signaling and induces stress - activated protein kinase/c - Jun N - terminal kinase phosphorylation in human prostate epithelial cells. Endocrinology 2004;145(7):3205 - 3214

Bonvissuto G, Minutoli L, Morgia G, et al. Effect of Serenoa repens, lycopene, and selenium on proinflammatory phenotype activation: An in vitro and in vivo comparison study. Urology 2011;77(1):248.e9 - 16

Altavilla D, Bitto A, Polito F, et al. The combination of Serenoa repens, selenium and lycopene is more effective than serenoa repens alone to prevent hormone dependent prostatic growth. J Urol. 2011;186(4):1524 - 9

Mitropoulos D, Kyroudi A, Zervas A, et al. In vivo effect of the lipido - sterolic extract of Serenoa repens (Permixon) on mast cell accumulation and glandular epithelium trophism in the rat prostate. World J Urol. 2002;19(6):457 - 61

Suardi N, Gandaglia G, Nini A, et al. Effects of Difaprost® on voiding dysfunction, histology and inflammation markers in patients with benign prostatic hyperplasia who are candidates for surgical treatment. Minerva Urol Nefrol. 2014;66(2):119 - 25

Comalada M, Camuesco D, Sierra S, et al. In vivo quercitrin anti - inflammatory effect involves release of quercetin, which inhibits inflammation through down - regulation of the NF - kappaB pathway. Eur J Immunol. 2005;35(2):584 - 92

Shoskes DA, Nickel JC. Quercetin for chronic prostatitis/chronic pelvic pain syndrome. Urol Clin North Am. 2011;38(3):279 - 84

Williams RJ, Spencer JP, Rice - Evans C. Flavonoids: antioxidants or signalling molecules? Free Radical Biology & Medicine 2004;36(7):838 - 49

Barnes S, Prasain J, D’Alessandro T, et al. The metabolism and analysis of isoflavones and other dietary polyphenols in foods and biological systems. Food & Function 2011;2(5):235 - 44

Duclos A, Shoskes D. “Chronic Prostatitis/Chronic Pelvic Pain Syndrome” in: Potts J, Ed., Genitourinary Pain and Inflammation: Diagnosis and Management. Springel, 2008, pp. 175 - 199

Askari G, Ghiasvand R, Feizi A, Mustafa S, et al. The effect of quercetin supplementation on selected markers of inflammation and oxidative stress. J Res Med Sci. 2012;17(7): 637 - 641

Prossnitz ER, Barton M. Estrogen biology: New insights into GPER function and clinical opportunities. Molecular and Cellular Endocrinology 2014;389(1 - 2):71 - 83

Chen HJ, Wang ZP, Chen YR, et al. Effects of pollen extract EA - 10, P5 on chronic prostatitis or infertility with chronic prostatitis. Acta Pharmacol Sin. 2002;23(11):1035 - 9

Kamijo T, Sato S, Kitamura T. Effect of cernitin pollen - extract on experimental nonbacterial prostatitis in rats. Prostate. 2001;49(2):122 - 31

Asakawa K, Nandachi N, Satoh S, et al. Effects of cernitin pollen - extract (Cernilton) on inflammatory cytokines in sex - hormone - induced nonbacterial prostatitis rats. Hinyokika Kiyo. 2001;47(7):459 - 65

Shoskes DA, Albakri Q, Thomas K, Cook D. Cytokine polymorphisms in men with chronic prostatitis/chronic pelvic pain syndrome: Association with diagnosis and treatment response. J Urol. 2002;168(1):331 - 5

D’Agostino M, Dini A, Pizza C, et al. Sterols from Equisetum arvense. Boll Soc Ital Biol Sper. 1984;60:2241 - 2245

Yamane H, Watanabe M, Satoh Y, et al. Identification of cytokinins in two species of pteridophyte sporophytes. Plant Cell Physiol. 1983;24:1027

Barbarin V, Nihoul A, Misson P, et al. The role of pro - and anti - inflammatory responses in silica - induced lung fibrosis. Respir Res. 2005;6:112

Kusaka T, Nakayama M, Nakamura K, et al. Effect of silica particle size on macrophage inflammatory responses. PLoS One. 2014;9(3):e92634

Khayyal MT, El - Ghazaly MA, Abdallah DM, et al. Mechanisms involved in the anti - inflammatory effect of a standardized willow bark extract. Arzneimittelforschung. 2005;55(11):677 - 87

Steinmann J, Buer J, Pietschmann T, Steinmann E. Anti - infective properties of epigallocatechin - 3 - gallate (EGCG), a component of green tea. Br J Pharmacol. 2013; 168(5):1059 - 1073

Vaughan, John Griffith; Patricia Ann Judd; David Bellamy (2003). The Oxford Book of Health Foods. Oxford University Press. p. 127.

Mahran GH, Saber AH, el - Alfy T. Spectrophotometric determination of protoanemonin, anemonin and ranunculin in Ranunculus sceleratus L. Planta Med. 1968;16(3):323 - 8

Oka M, Ueda M, Oyama T, et al. Effect of the phytotherapeutic agent Eviprostat on 17 beta - estradiol - induced nonbacterial inflammation in the rat prostate. Prostate 2009;69(13):1404 - 10

Breza J, Dzurny O, Borowka A, et al. Efficacy and acceptability of Tadenan (Pygeum africanum extract) in the treatment of benign prostatic hyperplasia (BPH): a multicentre trial in central Europe. Curr Med Res Opin. 1998;14:127 - 139

Andro MC, Riffaud JP. Pygeum africanum extract for the treatment of patients with benign prostatic hyperplasia: a review of 25 years of published experience. Curr Ther Res 1995;56:796 - 817

Odell WD, Parker LN. Control of adrenal androgen production. Endocr Res. 1984 - 1985;10(3 - 4):617 - 30

Robinette CL. Sex - hormone induced inflammation and fibromuscular proliferation in the rat lateral prostate. Prostate 1988;12:271 - 286

Luchetta G, Weill A, Becker N, et al. Reactivation of the secretion from the prostatic gland in cases of reduced fertility. Biological study of the seminal fluid modifications. Urol Int 1984;39:222 - 224

Simons AJ, Dawson IK, Dugunba B, Tchoundjeu Z. Passing problems: Prostate and prunus. Herbal Gram. 1998;43:49 - 53

Yablonsky F, Nicolas V, Riffaud JP, Bellamy F. Antiproliferative effect of Pygeum africanum extract on rat prostatic fibroblasts. J Urol. 1997 Jun;157(6):2381 - 7

Paubert - Braquet M, Cave A, Hocquemiller R, et al. Effect of Pygeum africanum extract on A23187 - stimulated production of lipoxygenase metabolites from human polymorphonuclear cells. J Lipid Mediat Cell Signal. 1994;9:285 - 290

Gomes CM, Disanto ME, Horan P, et al. Improved contractility of obstructed bladders after Tadenan treatment is associated with reversal of altered myosin isoform expression. J Urol 2000;163:2008 - 2013

Levin RM, Das AK, Haugaard N, et al. Beneficial effects of Tadenan therapy after two weeks of partial obstruction in the rabbit. Neurourol Urodyn 1997;16:583 - 599

Wang QT, Zhang LL, Wu HX, Wei W. The expression change of β - arrestins in fibroblast - like synoviocytes from rats with collagen - induced arthritis and the effect of total glucosides of paeony. J Ethnopharmacol. 2011;133(2):511 - 6

Koo ΗJ, Lim KH, Jung HJ, Park EH. Anti - inflammatory evaluation of gardenia extract, geniposide and genipin. J Ethnopharmacol. 2006;103(3);496 - 500




DOI: http://dx.doi.org/10.19264/hj.v28i2.120