Currently the conventional treatment for nonbacterial prostatitis involves drugs for BPH (benign prostatic hyperplasia), which are not always effective. Therefore the challenge to treat chronic prostatitis/chronic pelvic pain syndrome has prompted some men to look beyond conventional medications and to explore alternatives.

Prostatitis, a condition in which the prostate becomes inflamed and causes a range of urinary tract symptoms, affects about half of all men at some point during their lives. Of the four types of prostatitis, two involve bacteria (acute bacterial prostatitis and chronic bacterial prostatitis),  which make up only about 5% of all cases. Another uncommon form is asymptomatic inflammatory prostatitis.  All three of these forms of prostatitis are typically treated with antibiotics.

The most common and most challenging type of prostatitis to treat is nonbacterial chronic prostatitis/chronic pelvic pain syndrome. Nonbacterial chronic prostatitis symptoms include a strong urge to urinate immediately, weak urinary stream, difficulty starting urinary stream, dribbling, frequent urination during the night, pain and/or burning during urination, genital or pelvic pain, blood in the urine or semen, and painful ejaculation.

What is Special about Pollen?

Pollen extract comes from a number of plant sources, and when it is gathered from specific flowering plants, then the end product can be standardized, which means it contains the same amount of active ingredients in each batch. Most of the studies that have involved the use of pollen and its effect on prostatitis have included the use of pollen called cernilton/Graminex.

Graminex is composed of pollen from rye, corn, and timothy, and this combination has been used to help manage prostatitis and enlarged prostate (benign prostatic hyperplasia) in Europe for nearly four decades. The property that makes pollen extract special is its ability to fight inflammation. This extract has been shown to cause the bladder to contract while also allowing the urethra to relax, which improves urinary flow.

Pollen and Prostatitis Studies

Here are some examples of how pollen extracts performed in studies of men with prostatitis.

• Ninety men with chronic prostatitis were divided into two groups: those without complicating factors (72 men) and those with complicating factors (18 men). All the men took cernilton three times a day for six months and were tested at three and six months. After six months, 56 men who did not have complicating factors said they had a favorable response to cernilton: 26 had no symptoms and 30 had significant improvement. Among the 18 men with complicating factors, only one said he had a response to pollen. (Rugendorff)
• A group of 60 men with chronic prostatitis/chronic pelvic pain syndrome were assigned to receive either pollen extract or a placebo for six months in a double-blind study. At the end of the six months, men who had taken pollen extract reported either a significant improvement or elimination of their prostatitis symptoms. Therefore the authors concluded that pollen extract was “superior to placebo in providing symptomatic relief in men with chronic nonbacterial prostatitis/chronic pelvic pain syndrome.” (Elist)
• A randomized, double-blind, placebo-controlled phase 3 study compared cernilton with placebo in men with chronic prostatitis/chronic pelvic pain syndrome. Seventy men took pollen extract and 60 men took placebo daily for 12 weeks. Compared with men in the placebo group, those who took pollen reported significant improvements in total symptoms, pain, and quality of life, and this was achieved without severe side effects. (Wagenlehner)

Before taking pollen extract, consult your healthcare provider and discuss any allergies you may have to flowers, grass, or other plants. He or she can help you determine if this extract is safe to use and at which dose.

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References

Elist J. Effects of pollen extract preparation Prostat/Poltit on lower urinary tract symptoms in patients with chronic nonbacterial prostatitis/chronic pelvic pain syndrome: a randomized, double-blind, placebo-controlled study. Urology 2006 Jan; 67(1): 60-63

Rugendorff EW et al. Results of treatment with pollen extract (Cernilton N) in chronic prostatitis and prostatodynia. Br J Urol 1993 Apr; 71(4): 433-38

Wagenlehner FM et al. A pollen extract (Cernilton) in patients with inflammatory chronic prostatitis-chronic pelvic pain syndrome: a multicentre, randomized, prospective, double-blind, placebo-controlled phase 3 study. Eur Urol 2009 Sep; 56(3): 544-51

Numerous studies have shown that saw palmetto works for prostate conditions and in particular can improve urinary tract symptoms in men who have BPH. This is important because one benefit of using saw palmetto for BPH rather than the conventional medications, such as alpha-blockers and 5-alpha-reductase inhibitors, is that the herbal remedy is not associated with erectile dysfunction whereas the drugs have been shown to disrupt sexual function.

In this new study, 82 men with moderate to severe symptoms of BPH plus sexual problems (e.g., erectile dysfunction or loss of libido) were assigned to take 320 mg daily of saw palmetto extract daily for eight weeks. At the end of the eight weeks, the International Prostate Symptom Score (IPSS) was significantly reduced by 51% and erectile dysfunction, libido, and other sexual functions had improved by an average of nearly 40%.

According to Dr. Eugen Riedi, MD, a urologist in Switzerland and the study’s lead researcher, “This is one of the first therapies ever to show an improvement of BPH symptoms and of sexual dysfunctions at the same time.” Saw palmetto also was well tolerated and patient compliance was “excellent.”

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The researchers, who presented their findings at the 9^th European Congress on Obesity in Lyon, France, studied overweight men who received testosterone injections for up to five years to treat erectile dysfunction and other symptoms associated with low testosterone, which can include loss of sex drive, depression, fragile bones, and difficulty concentrating, among others. According to one of the researchers, Farid Saad, DVM, the weight loss “was an incidental finding that was entirely unexpected.”

All the men in the study received two injections of testosterone during the first six weeks of treatment and then an injection every three months. Men who were treated the longest lost more than an average of 30 pounds and also had improvements in blood pressure, LDL cholesterol, and blood glucose levels.

Low testosterone levels are common among men who are obese. Excess weight leads to elevated levels of estrogen, which in turn lowers testosterone levels. Therefore, obese men who lose weight can increase their testosterone levels naturally.

Low testosterone levels may also be associated with type 2 diabetes, and can be one of the risk factors for prostate cancer. Men who are considering testosterone therapy for any reason should discuss the benefits and risks with their healthcare provider and also investigate natural ways to increase testosterone.

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Over the years, experts have identified a number of causes of erectile dysfunction causes ranging from lifestyle and nutrition choices (smoking, alcohol use, dietary habits, exercise), use of drugs and medications, side effect of prostate cancer treatment,  psychological causes, and blunt trauma. Certain medical and environmental factors (e.g., diabetes, cardiovascular disease, exposure to toxins) also have been named as causes of erectile dysfunction.

Investigators from the University of Florence and the University of Manchester explain that as many as 60% of men with hyperthyroidism could have erectile dysfunction. Hyperthyroidism is characterized by excessive production of two thyroid hormones, thyroxine and triiodothyronine, which have an impact on bodily functions such as heart rate.

In the study, which included 6,573 men, the researchers found that men with hyperthyroidism were 14 times more likely than men without the thyroid disease to experience erectile dysfunction. The reverse was not observed, however: men with erectile dysfunction were not at greater risk of developing hyperthyroidism.

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The list of symptoms associated with low testosterone or testosterone deficiency in men includes reduced sex drive, depression, erectile dysfunction, weight gain, loss of strength, and muscle loss. These conditions may appear as testosterone levels decline with age: men lose about 1% of their testosterone per year after reaching middle age.

In a new study from the University of Edinburgh, researchers found that low testosterone levels are linked to insulin resistance, a hallmark of type 2 diabetes. This study, which was conducted in mice, is the first to directly identify how low testosterone in fat tissue has a role in onset of the disease.

An especially important finding was noted by Dr. Kerry McInnes, from the University of Edinburgh’s Endocrinology Unit, who stated “This study shows that low testosterone is a risk factor for diabetes no matter how much a person weighs.” This sentiment was supported by Dr. Iain Frame, director of research at Diabetes UK, who said “this study provides evidence that there can be increased risk even when body mass is not affected,” and that “a healthy balanced diet is important for everyone and particularly for those already at high risk of developing Type 2 diabetes.”

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Curcumin has been turning up increasingly in labs and clinical studies as scientists uncover more and more of its medicinal abilities. One area in which curcumin has demonstrated cancer-fighting potential is in prostate cancer, where the spice has been shown to enhance hormone therapy, kill cancer cells, and inhibit cancer cell growth.

Individuals with advanced colon cancer are typically given a combination of three chemotherapy drugs, but 40% to 60% of patients do not respond, and among those who do, the side effects can be so severe, people cannot continue treatment. Experts propose curcumin may increase the sensitivity of colon cancer cells to chemotherapy so these patients can be treated at a lower dose, for a longer time, and with fewer side effects.

About 40 patients with bowel cancer will be enrolled in the study, 30 of whom will be given curcumin and the remainder will receive chemotherapy only. According to Professor William Steward, ECMC director at the University of Leicester and the study’s chief investigator, “Investigating the potential of plant chemicals to treat cancer is an intriguing area that we hope could provide clues to developing new drugs in the future.”

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Propolis is a mixture of beeswax and other secretions with resins that bees gather from conifer and poplar trees. People have used propolis for centuries as a remedy for a wide range of ailments, from wounds to acne and cancer. Both propolis and another bee-related substance, bee pollen, are highly valued for their healing qualities and benefits.

According to the study’s senior author Richard B. Jones, PhD, assistant professor in the Ben may Department for Cancer Research and Institute for Genomics and Systems Biology, “If you feed CAPE to mice daily, their tumors will stop growing. After several weeks, if you stop the treatment, the tumors will begin to grow again at their original pace.”

The propolis-derived compound was tested on various cancer cell lines as well as on human prostate tumors grafted into mice. Six weeks of treatment with CAPE reduced tumor volume growth rate by 50%.

The researchers then used an innovative testing technique to analyze the impact of CAPE treatment and found that “CAPE basically stops the ability of prostate cancer cells to sense that there’s nutrition available,” noted Jones. CAPE could be a promising treatment to accompany chemotherapies designed to kill tumor cells.

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How does Saw Palmetto Work?

The simple answer to the question is yes, saw palmetto has been shown to be effective in managing BPH symptoms (including urinary tract symptoms) and prostatitis, and it’s too early to tell how effective it may be in the fight against prostate cancer. But here is why saw palmetto works.

One of the main components is beta-sitosterol, a substance that inhibits the activity of an enzyme called 5-alpha-reductase. This enzyme promotes the growth of prostate cells, and thus contributes to an enlarged prostate. Saw palmetto also appears to reduce levels of dihydrotestosterone (DHT), a hormone which, at elevated levels, causes the prostate to become enlarged.

To get a better idea of how saw palmetto has performed in men with BPH or prostatitis, here are the highlights of some of the research.

Saw Palmetto for BPH and Prostatitis

A new (April 2012) pilot study reported on the effect of saw palmetto on BPH and sexual dysfunctions in a group of 82 men. During the 8-week open trial, the men took one capsule of 320 mg saw palmetto extract daily. By the end of treatment, the men’s International Prostate Symptom Score (IPSS) had declined from 14.4 to 6.9, while their Sexual Function Inventory improved from 22.4 to 31.4. Quality of life also showed improvement on the Urolife BPH QoL-9 scale (from 162.7 to 105.0). This study was reportedly the first with saw palmetto to show improvement in symptoms of BPH and sexual dysfunction. (Suter)

A long-term (24-month) study of saw palmetto was conducted in 120 men with mild or moderate lower urinary tract symptoms associated with BPH. After taking 320 mg of saw palmetto daily, the men showed statistically significant improvement in their IPSS, quality of life, residual urinary volume, prostate volume, and sexual function. (Sinescu 2011)

What happens when you compare saw palmetto with a conventional BPH treatment such as tamsulosin (Flomax)? A one-year study published in European Urology reported on the results of this comparison conducted in 704 men. Both saw palmetto and tamsulosin led to similar improvements in symptoms, although men who took tamsulosin were more likely to experience ejaculation disorders and to experience less improvement in prostate volume. (Debruyne 2002)

A head-to-head comparison between saw palmetto v Flomax (tamsulosin) for men with chronic prostatitis also yielded positive results. A total of 157 men with chronic prostatitis were randomly assigned to take either 160 mg saw palmetto twice daily or 0.4 mg tamsulosin for six weeks. At the end of the study period, men in both groups experienced similar improvements in their Chronic Prostatitis Symptom Index (CPSI) scores, although men who took saw palmetto had an additional benefit: a greater decline in their pain scores. (Kravchick 2012)

Saw Palmetto as Combination Treatment

Saw palmetto also works well when combined with other selected supplements. One example can be seen in a clinical trial of 257 men who were experiencing lower urinary tract symptoms (LUTS) associated with BPH. The men were randomly assigned to take either placebo or a combination of 160 mg saw palmetto extract and 120 mg stinging nettle root extract daily for 24 weeks, followed by a 24-week control period and a 48-week period during which all the men took the combination. By the end of the study (week 96), the researchers reported a 53% improvement in the International Prostate Symptom Score (IPSS), a 19% improvement in urinary flow, and a 44% reduction in residual urine volume. (Lopatkin 2007)

A subsequent study involved the use of saw palmetto along with stinging nettle, quercetin, and curcumin versus the antibiotic prulifloxacin in men who had chronic bacterial prostatitis. A total of 143 men were enrolled in the study, and they were randomly assigned to one of two groups: 106 received 600 mg prulifloxacin plus the four extracts for 14 days, while 37 men received the antibiotic only.

One month later, 89.6% of the men who took saw palmetto and the other supplements had no symptoms of prostatitis compared with only 27% of the men who took the antibiotic only. At a six-month follow-up, none of the men who had taken the herbal supplements and two who had taken the antibiotic alone had recurrent prostatitis. (Cai 2009)

According to Dr. Geo Espinosa, ND, Lac, CNS, RH (AHG), director of the Integrative Urological Center at New York University Langone Medical Center, “The studies with saw palmetto and other herbal supplements strongly suggest a saw palmetto combination can lead to enhanced results when managing symptoms of BPH and prostatitis.”

In fact, failure to use saw palmetto in combination with other selected supplements is likely why some studies of saw palmetto for management of BPH have not yielded good results, according to Dr. Espinosa. A case in point is an updated Cochrane review (May 2012) that evaluated 17 randomized controlled trials (2,008 participants) comparing saw palmetto (usually 320 mg/day) with placebo. The reviewers found that saw palmetto was no better than placebo in improving lower urinary tract symptoms (LUTS).

Saw Palmetto and Prostate Cancer

The potential for using saw palmetto in the fight against prostate cancer is still largely unknown, although some research has been done. In particular, two Italian studies reported that prostate cells treated with saw palmetto extract underwent cell death (apoptosis). (Baron 2009; Petrangeli 2009)

Another study conducted at the Fred Hutchinson Cancer Research Center was not as positive. Data in the study came from 35,239 men who had participated in the VITamins and Lifestyle (VITAL) project. The investigators looked at the men’s supplement use and incidence of prostate cancer and did not find an association for use of saw palmetto. (Brasky 2011)

Taking Saw Palmetto

Research indicates that 320 mg daily of saw palmetto is an effective dose. Saw palmetto taken with other selected herbal remedies, including quercetin, stinging nettle, and curcumin, may enhance the benefits. Side effects associated with the use of saw palmetto are generally mild and may include back pain and headache.

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References

Baron A et al. Sereona repens extract targets mitochondria and activates the intrinsic apoptotic pathway in human prostate cancer cells. BJU Int 2009 May; 103(9): 1275-83

Brasky TM et al. Specialty supplements and prostate cancer risk in the VITamins and Lifestyle (VITAL) cohort. Nutr Cancer 2011; 63(4): 573-82

Cai T et al. Serenoa repens associated with Urtica dioica (ProstaMEV) and curcumin and quercitin (FlogMEV) extracts are able to improve the efficacy of prulifloxacin in bacterial prostatitis patients: results from a prospective randomized study. Int J Antimicrob Agents 2009 Jun; 33(6): 549-53

Debruyne Fet al. Comparison of a phytotherapeutic agent (Permixon) with an alpha-blocker (Tamsulosin) in the treatment of benign prostatic hyperplasia: a 1-year randomized international study. Eur Urol 2002; 41(5):497-506.

Kravchick SG et al at the 27^th Annual European Association of Urology Congress, February 24-28, 2012, Paris, France.

Lopatkin N et al. Efficacy and safety of a combination of Sabal and Urtica extract in lower urinary tract symptoms—long-term follow-up of a placebo-controlled, double-blind, multicenter trial. Int Urol Nephrol 2007; 39(4): 1137-46.

Macdonald R et al. Serenoa repens monotherapy for benign prostatic hyperplasia (BPH): an updated Cochrane systematic review. BJU Int 2012 May 2

Petrangeli E et al. Lipido-sterolic extract of Serenoa repens (LSESr, Permixon) treatment affects human prostate cancer cell membrane organization. J Cell Physiol2009 Apr; 219(1): 69-76.

Sinescu I et al. Long-term efficacy of serenoa repens treatment in patients with mild and moderate symptomatic benign prostatic hyperplasia. Urol Int 2011; 86(3): 284-49

Suter A et al. Improving BPH symptoms and sexual dysfunctions with a saw palmetto preparation? Results from a pilot trial. Phytotherapy Research 2012 Apr 23

At the University of Pittsburgh School of Medicine, Jian-Hua Luo, MD, PhD, associate professor in the Divisions of Molecular and Cellular Pathology and Anatomic Molecular Pathology, and his team conducted a genome analysis on 238 samples of prostate tumor tissue, benign prostate tissue near a tumor, and blood from men undergoing radical prostatectomy. The samples came from men with rapidly rising PSA levels, slowly rising PSA levels, and those with no relapse more than five years after surgery.

Luo noted that “Our analysis indicates that CNV occurred in both cancer and non-cancer tissues, and CNV of these tissues predicts prostate cancer progression.”  Using CNV from tumors, the model correctly predicted 73% of cases of prostate cancer relapse and 75% of cases for rapid PSA doubling time. The use of blood samples correctly predicted 81% of prostate cancer relapse and 69% of cases for rapid PSA doubling time.

In the near future, men who get a diagnosis of prostate cancer and wonder “now what?” may go to their doctor and have access to a tool beyond the PSA test that can better answer that question for them. As Luo noted, “Despite some limitations…CNV analysis on the genome of blood, normal prostate, or tumor tissues holds promise to become a more efficient and accurate way to predict the behavior of prostate cancer.”

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The researchers collected and evaluated blood samples from 1,621 white adults who were enrolled in the Cardiovascular Health Study in the early 1990s. Over an 11-year follow-up period, the investigators looked at each individual’s blood vitamin D levels and when a defining medical event occurred: heart attack (186), cancer (335), death (360), and hip fractures (137).

The risk of these medical events occurring among older adults rose when their vitamin D concentration dropped lower than 20 ng/mL (nanograms per milliliter). According to the study’s leader, Dr. Ian de Boer, assistant professor of medicine in the Division of Nephrology, “This target level for adults is considerably lower than that set by other expert panels.”

In fact, the Vitamin D Council recommends individuals take sufficient vitamin D to ensure their blood levels are between 50 ng/mL and 80 ng/mL, which is the range determined as necessary for optimal health. Everyone should have a blood test to identify their vitamin D level before starting vitamin D supplementation to determine how much they need to take to reach optimal blood levels.

The University of Washington study also pointed out that an association between low blood concentration levels of vitamin D and the risk of a major medical condition varied by season. That’s because people are more likely to get vitamin D from the sun during summer months, which is when blood levels tend to be higher, and to have the lowest blood levels in the winter.

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