Plant extracts show effect in chronic prostatitis

[Anonymous]

Plant extracts show effect in chronic
prostatitis.

Scott Tennant 04/01/2001 Urology Times

Arlington, VA--Despite some inherent
drawbacks, phytotherapeutic agents have
been shown to have a positive effect on
men with chronic prostatitis and deserve the
same types of placebo-controlled trials
afforded more conventional drugs, reports a
Cleveland Clinic Florida urologist.

Daniel A. Shoskes, MD, reviewed the state
of phytotherapy for chronic prostatitis at the
International Prostatitis Collaborative
Network workshop here. His work with
phytotherapeutic agents--particularly
quercetin--has made him a strong
proponent of using the plant extracts to
treat an often-baffling disease. "We are
beginning to have more objective endpoints
to measure in this disorder, and certainly
the phytotherapeutic agents should be
given the same rigor of proof we use for
any other drug or therapeutic action we
take," he said.

According to Dr. Shoskes, there has been
only one randomized, double-blind, placebo-
controlled study of phytotherapeutics for
chronic prostatitis. He and colleagues
randomized 30 men to placebo or quercetin-
-a bioflavonoid--500 mg twice daily for 1
month. In an unblinded follow-up, an
additional 17 men took Prosta-Q (a
supplement containing quercetin and
bioflavonoid absorption enhancers) for 1
month.

Improvement was defined as at least a 25%
decrease in NIH symptom score. The
investigators found that 67% of men taking
purified quercetin and 83% of those taking
Prosta-Q improved, as did 20% of placebo
patients (Urology 1999; 54:960-3).

On a molecular level, Dr. Shoskes was also
involved in a study examining oxidative
stress in the prostatic fluids of men with
chronic pelvic pain syndrome. The data
showed a significant drop in 8-alpha
isoprostane (a marker of oxidative stress
that has been found to be elevated in
prostatitis patients) when subjects took
Prosta-Q (J Androl 2000; 21:669-75).

Dr. Shoskes noted a number of other
benefits from phytotherapeutic agents,
including potentially unique mechanisms of
action, low cost, favorable side effect
profiles, and the general public perception
that "anything natural must be good."

However, he also acknowledged the
drawbacks of phytotherapy, such as:

* the agents are not FDA-regulated

* a lack of pharmacokinetic data

* unknown interactions with other drugs.

It was this last point that most concerned
one urologist in the audience, who
speculated that some chronic prostatitis
patients may be taking phytotherapeutics
and thereby negating the effects of other
medical therapy prescribed by their
physicians.

"Absolutely, that's possible," said Dr.
Shoskes. "For example, quercetin binds with
the topo-isomorase site on E coli, which is
the same site to which quinolone antibiotics
bind. Theoretically, if a patient takes large
doses of quercetin while taking something
like ciprofloxacin [Cipro] or moxifloxacin
[Avelox], they could be inactivating the
ability of the quinolone to do its job."

Dr. Shoskes and session moderator J. Curtis
Nickel, MD, both decried the fact that
phytotherapeutic agents are unregulated
and can sometimes vary greatly from lot to
lot.