Integrative urology: a spectrum of complementary and alternative therapy

Musulju improves benign prostatic hyperplasia by regulating inflammatory and apoptotic proteins

Alternative medicine is a widely accepted therapeutic approach for the management of various diseases. The Korean medicine, musulju (MSJ), has been traditionally used to improve vital energy in men with reduced physical strength and a weakened urinary system. The present study determined the mechanisms underlying the protective effect of MSJ against benign prostatic hyperplasia (BPH), a common disorder in elderly men that involves inflammation‑mediated imbalance between cell proliferation and death. MSJ treatment was demonstrated to decrease prostate weight, cell proliferation, and the protein expression of proliferating cell nuclear antigen in a rat model of BPH. In addition, MSJ markedly reduced serum testosterone levels, 5α‑reductase2 mRNA expression and BPH‑associated upregulation of inflammatory proteins, inducible nitric oxide synthase and cyclooxygenase 2. Furthermore, MSJ induced apoptosis by regulating B‑cell lymphoma (Bcl)‑2 protein expression and the Bcl‑2:Bax ratio, leading to caspase 3 activation. Taken together, MSJ demonstrated antiproliferative effects in BPH model rats by regulating the expression levels of proteins involved in inflammation and apoptosis. The effects of MSJ may be attributed to its alternative therapeutic properties.

Effects of pumpkin seed oil and saw palmetto oil in Korean men with symptomatic benign prostatic hyperplasia

This study was to investigate the role of complementary and alternative medicine in the prevention and treatment of benign prostatic hyperplasia. For this purpose, a randomized, double-blind, placebo-controlled trial was performed over 12 months on 47 benign prostatic hyperplasia patients with average age of 53.3 years and international prostate symptom score over 8. Subjects received either sweet potato starch (group A, placebo, 320 mg/day), pumpkin seed oil (group B, 320 mg/day), saw palmetto oil (group C, 320 mg/day) or pumpkin seed oil plus saw palmetto oil (group D, each 320 mg/day). International prostate symptom score, quality of life, serum prostate specific antigen, prostate volume and maximal urinary flow rate were measured. In groups B, C and D, the international prostate symptom score were reduced by 3 months. Quality of life score was improved after 6 months in group D, while those of groups B and C were improved after 3 months, compared to the baseline value. Serum prostate specific antigen was reduced only in group D after 3 months, but no difference was observed in prostate volume in all treatment groups. Maximal urinary flow rate were gradually improved in groups B and C, with statistical significance after 6 months in group B and after 12 months in group C. None of the parameters were significantly improved by combined treatment with pumpkin seed oil and saw palmetto oil. From these results, it is suggested that administrations of pumpkin seed oil and saw palmetto oil are clinically safe and may be effective as complementary and alternative medicine treatments for benign prostatic hyperplasia.

Complementary and alternative medicine for chronic prostatitis/chronic pelvic pain syndrome

To discuss challenges concerning treatment for chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS) and review complementary and alternative medical (CAM) therapies being evaluated for this condition, we performed a comprehensive search of articles published from 1990-2005 using the PubMed, Medline databases. Data from the articles were abstracted and pooled by subject. Keywords cross-searched with CP/CPPS included: complementary, alternative, integrative, therapies, interventions, nutrition, antioxidants, herbs, supplements, biofeedback and acupuncture. Listed articles with no abstracts were not included. Various CAM therapies for CP/CPPS exist including biofeedback, acupuncture, hyperthermia and electrostimulation. Additionally, a variety of in vitro and in vivo studies testing herbal and nutritional supplements were found. Saw palmetto, cernilton and quercetin were the most frequently tested supplements for CP/CPPS. Although many CAM therapies demonstrate positive preliminary observations as prospective treatments for CP/CPPS, further exploratory studies including more randomized, controlled trials are necessary for significant validation as treatment options for this complex disorder.

Prevalence and patterns of self-initiated nutritional supplementation in men at high risk of prostate cancer

OBJECTIVE

To define the prevalence and patterns of self-initiated herbal and vitamin supplementation among men at high risk of developing prostate cancer, as there is increasing public awareness of prostate cancer screening, risk-factor assessment and prevention, leading to increasing interest in the use and systematic study of nutritional therapies for prostate cancer prevention.

SUBJECTS AND METHODS

Since 1996 our institution has prospectively maintained a prostate cancer-risk registry through its Prostate Cancer Risk Assessment Program (PRAP). Eligibility includes African-American men, any man with at least one first-degree relative or two or more second-degree relatives with prostate cancer, or men who tested positively for the BRCA1 gene mutation. A 420-item self-administered questionnaire was completed and included the use of nutritional supplements and complementary therapies. We divided men into groups who used supplements to lessen their cancer risk and those who did not. The prevalence and patterns of use were evaluated and the two groups then compared for differences in demographic, socio-economic and risk-perception variables.

RESULTS

In all, 345 high-risk men were enrolled in the PRAP over a 5-year period. Data on the use of dietary or herbal supplements were available on 333 men (97%), of whom over half (170) reported taking one or more supplements to prevent prostate cancer. Supplement use was divided into eight categories, including vitamins, minerals, extracts from fruits/seeds, organic compounds, flowers/bulbs, leaves/bark, roots, or animal products. Most commonly used for self-initiated chemoprevention were vitamins (95%), minerals (28%), and fruit/seed extracts (18%). More than a quarter of men (27%) took three or more agents. Men taking proactive preventative measures were statistically more likely to be Caucasian and aged > 60 years (P < 0.05). African-Americans were less likely to self-initiate preventative steps. Men taking supplements tended to return more often for follow-up and participate in PRAP longer, while those not taking supplements tended to earn less and report less self-perceived risk.

CONCLUSIONS

A significant proportion of men at risk of developing prostate cancer initiate measures they perceive to reduce their risk. Although the chemopreventative efficacy of many of these supplements remains unsubstantiated, they are widely perceived by the public to reduce the risk of developing prostate cancer. These data provide an insight into patient perceptions and misconceptions of chemopreventative strategies, and may help to refine recruitment efforts in multi-institutional prostate cancer prevention trials.

Attitudes and use of alternative therapies in UK prostate cancer patients-isn't it time we were in the know?

With increasing media interest in prostate cancer and the availability of data to patients from support groups and the Internet, the knowledge and use of alternative therapies by patients is becoming more common. The purpose of our study was to quantify patient awareness and use of alternative therapies for the prevention and treatment of prostate cancer in the UK. In May 2000, we performed a survey of men attending our urology outpatient clinic for prostate cancer evaluation or follow-up. All men diagnosed with and those at high risk (abnormal prostate specific antigen) for prostate cancer were eligible for the study. Each eligible patient was then sent an anonymous 25-item questionnaire to explore their knowledge and use of various alternative therapies for prostate cancer. Out of 195 patients who were sent the questionnaire, 168 responded, for a response rate of 86%. One hundred and sixty-four were analysed. Eight-two out of 164 (50%) were aware of alternative therapies for prevention/treatment of prostate cancer, the most common were tomatoes/tomato-based products and low-fat diet. There were 27 (16.5%) respondents taking alternative therapies for their prostate. Private patients were more aware (60.4% private vs 46.2% NHS) of complimentary therapies and were more likely to take them (27.9% private vs 12.4% NHS) than National Health Service patients. The majority of patients (60%) had not informed their GP or urologist. Fifteen therapies and 12 medication sources were recorded. Asked if doctors should discuss non-prescribed therapies, even if there is no proven benefit, 62% said 'yes' while 29% said 'no'. Alternative therapy use for prostate cancer is likely to increase. If we don't ask patients specifically whether they are taking them, patients are unlikely to tell us. Urologists and clinical oncologists treating men with prostate cancer need to be aware of alternative therapies and have some understanding of any benefit or harm, not only to be able to answer patient's questions and offer advice, but also to consider interactions with other treatments.Prostate Cancer and Prostatic Diseases (2001) 4, 235-241.

Complementary and alternative therapies in prostate cancer

Complementary and alternative therapies are used with increasing frequency in men with prostate cancer. However, little is known about the efficacy of such therapies for this cancer. While epidemiological data support the association between intake of certain micronutrients with development of prostate cancer, there exist limited prospective data that support the chemopreventative or therapeutic value of such nutritional agents in prostate cancer. To date, one of the most studied treatments has been PC-SPES, a combination of eight herbal therapies with activity against prostate cancer. Studies in cell lines of human prostate cancer demonstrate significant dose-dependent decreases in cellular viability after exposure to extracts of this agent. Clinical studies suggested that PC-SPES could reduce prostate specific antigen levels in patients with either androgen-dependent or androgen-independent prostate cancer. Toxicity was mild, although there was a low risk of thromboembolic events with such treatment. Manufacture of PC-SPES was recently halted, after revelations that the herbal combination was contaminated with warfarin, which led to a recall by the manufacturer. Subsequent analyses also revealed the presence of diethylstilbestrol (DES) and indomethacin in some lots of PC-SPES. Available data regarding other alternative therapies are reviewed as well.

Phytotherapy and other alternative forms of care for the patient with prostatitis

Chronic prostatitis is a very common and poorly understood condition with significant impact on quality of life. Given the lack of proven efficacy of conventional therapies such as antibiotics, it is not surprising that patients have turned with increasing frequency to phytotherapy and other alternative treatments. Although alternative therapies are plentiful, few have been subjected to scientific scrutiny and prospective controlled clinical trials. This review discusses therapies commonly used by patients with prostatitis and focuses in detail on those with published data. These treatments include zinc, cernitin pollen extract (bee pollen), quercetin, saw palmetto (Serenoa repens), and acupuncture. Complementary therapies may indeed have much to offer patients, particularly those with chronic degenerative conditions in which allopathic therapies have proven less successful. Alternative therapies, however, require the same scientific criteria for validation and acceptance as do conventional medical therapies.