Prostatitis present with lower urinary tract symptoms that range from mild to severe.
A significant proportion of men with prostatitis will experience a substantial reduction in their quality of life and require treatment to manage their symptoms.
Alternative treatment approaches such as plant-based supplements have been explored for the treatment of this disease and the associated symptoms.
Supplementation with zinc, saw palmetto, Cernilton, quercetin, Pygeum, vitamin C, and probiotics have proven effective in managing and preventing prostatitis. They have strong safety profiles and cause fewer side effects compared to conventional therapies.
Here, we discuss the evidence relating to the role of these supplements in the treatment of prostatitis.
What is prostatitis?
Prostatitis is swelling and inflammation of the prostate gland. It is a common condition that can develop in men of all ages.
However, the causes of prostatitis are not well understood. Local inflammation that affects the pelvic area causes most of the cases and less common bacterial infection.
Four types of prostatitis originate from different sources. They include:
- Chronic prostatitis (also known as chronic pelvic pain syndrome)
- Chronic bacterial prostatitis,
- Acute bacterial prostatitis (often presenting suddenly)
Asymptomatic inflammatory prostatitis.
Though the symptomatic types present with similar symptoms, some symptoms are unique to each type, as discussed below.
Typically, symptom severity was reported by the National Institutes of Health chronic prostatitis symptom index (NIH-CPSI score). Here, we use the NIH-CPSI score to discuss the evidence on the efficacy of treatment approaches.
What are the symptoms of prostatitis?
Prostatitis causes a range of symptoms that differ depending on the type and source of the inflammation. Except for the asymptomatic form of the condition, it often presents with urinary problems, difficult ejaculation, and pain around the pelvic area.
Some of the shared symptoms include:
- Frequent urination and Nocturia – The bladder can store urine until it is convenient to use the toilet. However, a swelled prostate press against the urethra, which block the flow of urine and irritate the bladder wall. The irritation causes the bladder muscles to contract even when it contains small amounts of urine, leading to frequent urination.
- Decreased urine flow – some patients experience a weak urine stream and dribble at the end of urination. This problem makes it difficult to empty the bladder, increasing the risk of urinary tract infection and further complications.
- Ejaculation – symptomatic types of prostatitis often lead to pain and difficultly with ejaculation.
- Pelvic pain – prostatitis causes general pain around the pelvic areas, including the genitals, testicles, rectum, and bladder.
- Blood in urine and semen.
- Bowel disturbances.
Some symptoms are specific to the type of prostatitis, including:
Chronic prostatitis (chronic pelvic pain syndrome) – is characterized by an irritation of the nerves around the pelvic area. Patients have an increased risk of allergies, fibromyalgia, chronic fatigue syndrome, and anxiety disorders (Anderson et al., 2018).
Chronic bacterial prostatitis – is an uncommon type of prostatitis caused by bacteria infection. It often causes a burning sensation while urinating.
Acute Bacterial prostatitis – is another uncommon bacterial prostatitis that causes a sudden onset of symptoms. Specific symptoms include chills, fever, foul-smelling urine.
Asymptomatic inflammatory prostatitis – is an inflammation of the prostate without symptoms. It is often discovered while checking for other conditions.
Zinc is essential to the maintenance of the human body and plays a wide range of roles, including catalytic, regulatory, and structural functions (Sauer et al., 2020). The prostate gland accumulates the highest amount of zinc compared to other human organs, suggesting an essential role in normal prostate functions (Costello and Franklin, 1998).
Studies have shown that zinc deficiency induces oxidative stress and DNA damage, which is a critical factor in the development of many prostate conditions (Ho et al., 2003). Further, previous studies report an association between zinc levels and prostatitis (Cui et al., 2015). Prostatitis tissue has reduced levels of zinc, suggesting a role in the development of the disease (Anderson and Fair, 1976).
Deng and colleagues investigated the efficacy of organic zinc in the treatment of chronic bacterial prostatitis in a randomized control trial (Deng et al., 2004). The study supplemented a group of patients with organic zinc after routine antibiotic treatment, and the other received just the standard antibiotic treatment.
The results demonstrated that supplementation with organic zinc significantly decreased pain, urinary symptoms, and maximum urethra closure pressure compared with the control group.
Another study investigated the utility of zinc supplementation in chronic prostatitis (Goodarzi et al., 2013). The study used a randomized trial involving 120 patients with chronic prostatitis, where the treatment group received oral zinc sulfate (220 mg daily), and the control group received a placebo. Zinc supplementation significantly reduced NIH-CPSI scores and pain index after 12 weeks of treatment compared to the placebo group. These results show that zinc supplements may benefit patients with prostatitis.
Saw palmetto garnered a great deal of attention in prostate health based on circumstantial. It is rich in free fatty acids and is commonly used to improve prostate health around the world. Preliminary studies suggested saw palmetto might have similar activity to finasteride (pharmaceutical treatment).
However, further studies to explore this efficacy returned mixed results. One study compared the effectiveness of saw palmetto to finasteride in men with chronic prostatitis. After one year of treatment, the authors observed no significant benefit for saw palmetto. Interestingly, many participants choose to continue the saw palmetto therapy regardless of the achieved statistical significance (Kaplan et al., 2004).
Another trial tested the response of saw palmetto extract called Permixon in 61 patients with chronic prostatitis. Here, 65% of patients who received Permixon reported improvements in NIH-CPSI symptom scores, pain, and voiding.
Though the prostate volume was unchanged between the treatment and control groups, the results suggest that Permixon (saw palmetto) may provide clinical benefit for prostatitis (Reissigl et al., 2003). Further studies are required to determine the effective dosage and components of saw palmetto supplements.
The pollen extract Cernilton has shown urological benefits through its anti-inflammatory properties. Prostatitis is characterized by inflammation, suggesting that Cernilton may be useful in treating its symptoms. An old study reported a 78% improvement in symptoms of chronic prostatitis (Rugendorff et al., 1993).
A more recent study by Florian and colleagues investigated the efficacy of pollen extract (Cernilton) in a multicentre randomized, double-blind controlled trial. The authors randomized participants to receive oral pollen extract or placebo for 12 weeks and evaluated symptomatic improvements.
The study demonstrated significant improvements in pain, quality of life, and NIH-CPSI score compared to the placebo group. The results show that Cernilton is an alternative therapeutic option for treating prostatitis.
Quercetin is a natural pigment (flavonoids) present in many fruits and vegetables. It has potent antioxidant, anti-inflammatory, and immunomodulatory properties (Baghel et al., 2012), which has been studied to treat many conditions.
Studies have shown that quercetin supplementation may be beneficial in treating prostate conditions. A randomized, double-blind trial investigated the safety and efficacy quercetin (Shoskes et al., 1999). The study randomized 30 men with chronic prostatitis to receive 500 mg quercetin twice daily or placebo for one month.
Patients who received quercetin treatment observed a significant improvement in the NIH-CPSI score compared to the placebo group (Shoskes et al., 1999). A subsequent study using the same dosage of quercetin also found improvement in symptoms (Shoskes et al., 2002), demonstrating the utility of this flavonoid in treating prostatitis.
Pygeum is a lipophilic (fat dissolvable) extract derived from the African prune tree. Pygeum affects prostate function by modulating androgen activity and suppressing inflammation (McClure, 2002). A study demonstrated that Pygeum extract (200 mg per day) improved prostatitis urinary symptoms after 60 days (Carani et al., 1991). The study also showed that combination therapy involving Pygeum and standard antibiotics treatment further improved symptoms.
Vitamin C has roles in many biological functions, including protein production, wound healing, absorption of nutrients, and oxidative stress reduction. The prostate gland is particularly susceptible to oxidative stress. Seminal oxidative stress is high in patients with prostatitis(Ihsan et al., 2018), implicating oxidative stress in this condition.
Oxidative stress arises from elevated reactive oxygen species and depressed antioxidant functions, suggesting that vitamin C is a viable therapeutic option. The potent antioxidant activity of vitamin C improves prostatitis symptoms in animal models (Xu et al., 2005). Human studies also show that vitamin C, in combination with other therapies, can improve the symptoms of prostatitis (Kullisaar et al., 2008).
Several studies have investigated the utility of probiotics as a safe alternative for treating and preventing human diseases, including lower urinary tract infections.
For bladder problems, animal studies show that direct injection of favorable bacteria into the bladder can help prevent or treat urinary tract infections caused by specific microorganisms (Fraga et al., 2005). This observation and those by other studies suggest that probiotics may help rebalance the bladder and urethra’s microbial ecology. This modification of the urinary track ecology is a potential therapeutic strategy for prostatitis.
A recent study evaluated the efficacy of probiotic and saw palmetto for preventing chronic bacterial prostatitis compared to saw palmetto alone. The study measured the reduction in prostatitis and NIH-CPSI symptom index episodes, showing that probiotics increased the reduction in symptoms at 24 and 36 weeks (Chiancone et al., 2019). Thus, the inclusion of probiotics in the management of prostatitis may be beneficial. However, it is not clear if probiotics will benefit patients with non-bacterial prostatitis.
Men of all ages can develop prostatitis, which causes significant urinary symptoms and impacts quality of life. The benefits of natural plant compounds in its treatment are becoming realized as our knowledge of the disease increases. Many patients may benefit from alternative approaches for the management of prostatitis symptoms.