Use of Phytotherapy to Treat Prostate Cancer



Prostatitis happens to be one of the most prevalent conditions in urology. It is the most common urologic problem encountered in young men and accounts for a significant portion of men older than 50 years of age. Unfortunately, the etiology, natural history and appropriate therapy for these patients is very unclear and poorly understood. While there is little controversy over the therapy for documented acute or chronic bacterial infections, the large majority of patients fall into the ‘‘nonbacterial’’ or ‘‘prostatodynia’’ group [chronic pelvic pain syndrome (CPPS), NIH prostatitis categories IIIa and IIIb]. Patient and physician dissatisfaction with these syndromes is high, making it an area ripe for patient interest in non-traditional and alternative therapies. However, a major criticism of these alternative therapies is the common lack of properly designed scientific clinical trials. In fact, even those therapies considered as ‘‘standard’’ treatment for nonbacterial prostatitis have also not been evaluated in an accepted scientific fashion. For example, antibiotics are the most commonly prescribed therapy for nonbacterial prostatitis/prostatodynia, yet there is not a single prospective randomized placebo controlled trial documenting their effectiveness.

Phytotherapy for prostatitis is a natural treatment that combines two supplements for prostatitis, quercetin and pollen extracts, in specific formulations. Phytotherapy is helpful for men suffering from chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS) and other prostate disorders such as enlarged prostate. Pollen and quercetin work well in combination to help restore prostate health. Both supplements are anti-inflammatories that can be helpful in reducing prostate inflammation. In addition, quercetin is a bioflavonoid nutrient that you can find in apples, red grapes, red wine, onions, berries, and tea. It has antioxidant properties and plays a role in inhibiting the production and release of inflammation-causing substances in the body. Pollen extracts have a slightly different mechanism of action from quercetin, and that is why the two work well in combination. Pollen fights inflammation and causes the bladder to contract, making it helpful for relieving urinary symptoms associated with prostatitis. One of the more common pollen extracts, called Graminex, contains pollen from timothy, rye, and corn. It is also commonly referred to as “Cernilton”.

Category I prostatitis (acute bacterial)

The standard evaluation and therapy of category I prostatitis is straightforward and non-controversial. This is a serious bacterial infection with systemic cytokine release that can be fatal if not treated with appropriate antibiotics and supportive measures. Herbal or other alternative approaches to therapy, particularly those that prevent or delay conventional therapy, should be strongly discouraged.

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Category II prostatitis (chronic bacterial)

In patients with documented recurrent bacterial prostatic infection, the mainstay of therapy is long-term antibiotics. Prolonged antibiotic use can create undue discomfort by altering intestinal flora. The use of probiotics, such as active culture yogurt, lactobacilli and other similar preparations, may reduce the incidence of gastrointestinal side effects. Many men with category II prostatitis also have recurrent UTI, and there is considerable interest in phytochemical therapy to prevent and treat cystitis. In current practice, cranberry juice has been used in women with cystitis. The theory is that cranberry juice may reduce Escherichia coli adherence and biofilm load in uroepithelial cells, however, there is a lack of randomized placebo controlled data. On a further note, there is no published data on the efficacy of cranberry juice in prostatic infections, and in fact it is possible that the acidity of the product could actually exacerbate symptoms.
Another well known supplement is zinc. It was one of the earliest factors identified in seminal plasma with an antimicrobial effect. The initial discovery that many men with chronic bacterial prostatitis have low levels of zinc in the semen has led to the longstanding recommendation for zinc supplements in men with all forms of prostatitis. Unfortunately, oral intake of zinc does not appear to raise zinc levels in semen. Furthermore, more recent studies question whether zinc levels are actually abnormal in prostatitis There are no published clinical trials that demonstrate the efficacy of zinc supplements for either treating or preventing prostatitis.
Prostatic drainage or ‘‘massage’’ was the mainstay of therapy for chronic prostatitis long before effective antimicrobials were available. In some patients whose prostates are congested with inflammatory debris, prostatic massage may drain obstructed areas not accessible to antibiotics. With the advent of antibiotics, prostatic massage has fallen out of favor to the point of being considered an ‘‘alternative’’ therapy by many urologists. There is some evidence that at least a subset of patients who do not improve with antibiotics alone get durable sterilization of prostatic secretions and symptom relief with the combination of antibiotics and prostatic massage.

Category III prostatitis (chronic pelvic pain syndrome)

CPPS is by far the most common symptomatic prostatitis syndrome. The etiology and pathophysiology is controversial and in fact the disorder likely represents different underlying etiologies which produce a common symptom complex. In the absence of infection, there is evidence for an inflammatory or autoimmune component to CPPS. Even in the absence of visible WBC (white blood cellsy, EPS (Extracellular polysaccharides) and semen of men with CPPS have elevated levels of inflammatory cytokines and oxidative stress. Furthermore, the symptomatic response to antibiotics in CPPS patients may be due to direct anti-inflammatory effects of these drugs rather than their antimicrobial effects. Finally, much of the pain of CPPS is likely related to pelvic muscle spasm, which may be secondary to the infective or inflammatory conditions mentioned above.


Typical therapies include antibiotics, alpha blockers, non-steroidal anti-inflammatories, muscle relaxants and thermal therapy. Scientific proof for the efficacy of these approaches is surprisingly weak. Phytotherapy has been used most commonly in this category of prostatitis and evidence for efficacy is actually more compelling than for other standard therapies.

Phytotherapy in CPP

Cernilton, an extract of bee pollen, has been used in prostatic conditions for its presumed anti-inflammatory and anti-androgenic effects. In a small open label study, 13 of 15 patients reported symptomatic improvement. In a larger more recent open label study, 90 patients received one tablet of Cernilton N tid for 6 months. Patients with ‘‘complicating factors’’ (prostatic calculi, urethral stricture, bladder neck sclerosis) had minimal response with only one of 18 showing improvement. In the ‘‘uncomplicated’’ patients, however, 36% were cured of their symptoms and 42% improved. Symptomatic improvement was associated with improved uroflow parameters, reduced inflammation and a decrease in complement C3/coeruloplasmin in the ejaculate. Side effects in studies of cernilton for BPH and prostatitis have been negligible.
Quercetin is a polyphenolic bioflavonoid commonly found in red wine, green tea and onions. It has documented anti-oxidant and anti-inflammatory properties and inhibits inflammatory cytokines implicated in the pathogenesis of CPPS such as IL-8. Finally, quercetin shows in vitro inhibition of androgen independent prostate cancer cell lines.

Several mechanisms may contribute to the beneficial effects of quercetin in CPPS. CPPS is associated with elevated oxidative stress in EPS and semen and patients who improve with quercetin have a reduction in oxidative stress metabolite F2-isoprostane in their EPS.
Furthermore, quercetin therapy reduces inflammation as measured by prostaglandin E2 levels in EPS and increases the levels of prostatic beta-endorphins . Finally, quercetin does have weak antibacterial and antifungal properties which might conceivably play a role in CPPS.

Other alternative therapies

An important concept regarding CPPS is the notion that there are specific anatomic areas that are centers for pain and discomfort. Specific causes could be linked to muscle spasms in the perineum or pelvic floor muscles, anatomic abnormalities such as hip arthritis, trauma, or previous surgery. CPPS may also be secondarily linked to voiding dysfunction, constipation, or unusual sexual activities. More difficult to evaluate are those associated with psychologic issues such as anxiety or stress. Consequently there are numerous physical therapies to address these issues. Examples are yoga, heat therapy, neural modulation, acupuncture, meditation and even self-hypnosis. Although interesting, these have yet to be evidence based.


Prostatitis and in particular CPPS can be frustrating for both patient and physician. For documented bacterial infections, antibiotics are still the therapy of choice, but probiotics are useful in dousing their side effects. In CPPS, there is credible clinical and scientific evidence that phytotherapy with cernilton or quercetin is safe, well tolerated and effective in the majority of patients. Other agents such as saw palmetto, Pygeum, and stinging nettle either have been shown to be ineffective in CPPS or lack credible evidence in this patient population.


1. Aziz NH, Farag SE, Mousa LA, Abo-Zaid MA (1998) Comparative antibacterial and antifungal effects of some phenolic compounds. Microbios 93:43–54
2. Buck AC, Rees RW, Ebeling L (1989) Treatment of chronic prostatitis and prostatodynia with pollen extract. Br J Urol 64:496–499
3. Chen C, Gao Z, Liu Y, Shen L (1995) Treatment of chronic prostatitis with laser acupuncture. J Tradit Chin Med 15:38–41
4. Gerber GS, Kuznetsov D, Johnson BC, Burstein JD (2001) Randomized, double-blind, placebo-controlled trial of saw palmetto in men with lower urinary tract symptoms. Urology 58:960–965

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