Botanical Treatment of Bacterial Prostatitis

Commentary by: Commentary by Fraser Smith, ND

Reference: Cai T, Mazzoli S, Bechi A, 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 randomised study. Int J Antimicrob Agents. 2009;33(6):549-553.

Design: Prospective randomized study

Participants: 143 patients affected by chronic bacterial prostatitis (CBP) [National Institutes of Health (NIH) class II prostatitis].

Study Parameters Assessed: To evaluate the efficacy of Serenoa repens, Urtica dioica (ProstaMEV), curcumin, and quercitin (FlogMEV) to improve the efficacy of a 14-day course of prulifloxacin in CBP treatment, all consecutive patients attending the same sexually transmitted diseases (STD) center between September 2007 and June 2008 for symptoms related to CBP and post-prostate massage (VB3) urine culture positive for uropathogens were eligible for this study.

Patients were split into two groups: Group A received prulifloxacin associated with ProstaMEV and FlogMEV; Group B received only antibiotic therapy. Microbiological and clinical efficacies were tested by two follow-up visits at 1 month and 6 months, respectively. Quality of life (QoL) was measured using the NIH Chronic Prostatitis Symptom Index (CPSI) and International Prostatic Symptom Score (IPSS) questionnaires. Group A comprised 106 patients and Group B comprised 37 patients.

Key Findings: One month after treatment, 89.6% of patients who had received prulifloxacin associated with ProstaMEV and FlogMEV did not report any symptoms related to CBP, while only 27% of patients who received antibiotic therapy alone were recurrence-free (P < 0.0001). Significant differences were found between groups in terms of symptoms and QoL (P < 0.0001 for both). Six months after treatment, no patients in Group A had recurrence of disease, but two patients in Group B did. Questionnaire results demonstrated statistically significant differences between groups (all P < 0.001).

Practice Implications: Chronic bacterial prostatitis is a difficult and tenacious condition. Although many naturopathic physicians take a whole-person approach and address issues such as hormonal balance, overall immune function, nutrition, and overall determinants of health, the specific case in which these two botanical supplements made a great impact on recovery and QoL is worth noting. Serenoa repens and Urtica dioica are commonly used for CBP as well as the more common benign prostatic hyperplasia. The flavonoids curcumin and quercetin may have anti-inflammatory effects, as may Urtica dioica. This suggests that even patients who take a course of antimicrobial therapy may still benefit greatly from using the right botanical extracts.

Limitations: This study did not use a placebo and was not blinded. However, the study is useful in terms of looking at a positive effect on infection and QoL. The authors tried to eliminate bias resulting from lack of a placebo arm in their analysis.

The authors mention the use of multiple agents as a limitation, which is true from one vantage point. It is not clear which of the 4 botanical substances was the most important or responsible for most or all of the beneficial effects. However, as we often perceive in practice, a combination of therapeutics has a total positive effect; the complete protocol is necessary for patient progress. This does not mitigate the limitations of this study, but it is in some sense a better mirror of what goes on in practice for the very reason that the treatment is multifaceted.

Fraser Smith, ND
Fraser Smith, ND, is assistant dean of naturopathic medicine at National University of Health Sciences in Lombard, Illinois. Smith graduated from Canadian College of Naturopathic Medicine, where he later served as faculty member and eventually dean of the naturopathic program. He is also the author of the textbook An Introduction to Principles and Practices of Naturopathic Medicine (CCNM Press, 2008).

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