Solutions for Common Prostate Problems

By the time men reach their 50s or 60s, it is almost inevitable that they will experience difficulties related to their prostate gland.

Common symptoms include more frequent need to urinate, waking up during the night to “go,” or trouble even “going” at all.

These signs should not be ignored or overlooked as they can indicate serious problems, including benign prostatic hyperplasia (BPH), prostatitis, and even prostate cancer.

Fortunately, a number of natural extracts have proven value in preventing, and often reversing, symptoms of benign prostatic hyperplasia and chronic prostatitis with a high safety profile.

There is also evidence that certain supplements can help prevent prostate cancer, and even slow the rate of cancer progression if it does occur.

This article supplies essential information for men wishing to prevent prostate trouble—and solutions for those with existing issues.

The Aging Prostate Gland

 

The three most common prostate conditions are:

1. Benign prostatic hyperplasia
2. Prostatitis (inflammation of prostate)
3. Prostate cancer¹

These conditions often produce similar symptoms in their early stages, making it difficult to differentiate between them. These common symptoms can include the following:

• More frequent need to urinate
• More urgent need to urinate
• Decreased urine flow or dribbling
• Frequent nighttime awakening to urinate
• Burning with urination

The reason prostate problems are likely to cause trouble with the lower urinary tract has to do with the prostate’s location. The prostate is located between the lower part of the bladder and the rectum. It surrounds the internal part of the urethra, the tube that carries urine from the bladder to the end of the penis.

When the prostate swells, whether because of benign prostatic hyperplasia, prostate cancer, or prostatitis, it narrows the urethra, making it difficult for urine to pass freely from the bladder. As the gland continues to grow, it can produce sufficient blockage to lead to difficulty urinating, and even urinary retention, which in turn can result in bladder and kidney infections.

While most prostate problems can be readily treated—and the vast majority are not cancer-related—it is important to seek medical attention as soon as a symptom arises.¹

Researchers have identified a number of nutrients that have been found to alleviate many of the unpleasant prostate symptoms. Let’s look at the data on some of the best-known and most effective supplements that can help men optimize their prostate health.

Nature’s Solutions for Benign Prostatic Hyperplasia

Benign prostatic hyperplasia is an enlargement of the prostate gland. Approximately 25% of men in their 40s have benign prostatic hyperplasia, with a startling 80% of men in their 70s suffering from the condition.²

The good news is that benign prostatic hyperplasia (BPH) is not cancerous. It is a major risk factor for sexual dysfunction. Conventional treatments for benign prostatic hyperplasia can cause unpleasant side effects that are also a cause for sexual dysfunction.³

Fortunately, studies have shown that certain nutrients help alleviate many of the symptoms associated with benign prostatic hyperplasia and can significantly improve quality of life as a result.

Saw Palmetto

Saw palmetto is one of the most well-known natural treatments for prostate problems. Recent studies suggest that saw palmetto may also be beneficial for chronic prostatitis, prevention of prostate cancer, and even sexual dysfunction.^3,4

There is evidence to suggest that saw palmetto has similar efficacy to finasteride (Proscar^®) and tamsulosin (Flomax^®), two medications used to treat benign prostatic hyperplasia.^3,5,6 Of even greater interest, a lower incidence of associated sexual dysfunction was seen in men supplemented with saw palmetto compared to those given pharmaceuticals.⁵

A 2013 study demonstrated that elderly men treated with 320 mg of saw palmetto extract daily for eight weeks not only experienced a significant 52% improvement in their International Prostate Symptom Score (IPSS), the standard tool used to measure the severity of benign prostatic hyperplasia symptoms, but also had a significant 40% improvement in sexual dysfunction scores!³

A host of other studies compellingly demonstrate the impact of saw palmetto extract on symptoms of benign prostatic hyperplasia. Two large meta-analyses including more than 7,000 men from 38 studies showed that saw palmetto extracts produced significant improvements in the International Prostate Symptom Score, reductions in frequency of nighttime urinations, and improvements in peak urine flow rates.^7,8 Indeed, saw palmetto produced similar improvements in urinary symptoms and urinary flow compared to the drug finasteride, but with fewer adverse effects.⁷

Based on all of these studies, a 2015 review article concluded that, while drug therapy might be most effective for moderate to severe benign prostatic hyperplasia, herbal medications including saw palmetto are useful for men with mild to moderate symptoms.⁹

Not all studies demonstrate desired relief with saw palmetto,¹⁰ which is why combining it with additional nutrients is the preferred choice for most aging males.

What You Need to Know

Natural Treatments for Prostate Health

• The prostate is a walnut-sized gland that has important functions in the male reproductive system.
• With age, the prostate is known for causing problems with urination and pain, as well as cancer.
• A number of natural extracts have proven value in preventing and often reversing symptoms of benign prostatic hyperplasia and chronic prostatitis as effectively and with a much better safety profile than existing drug therapies.
• Most prostate problems are not cancer-related, and proper supplementation can lead to improved prostate health and fewer risks for problems down the line.

Stinging Nettle Root

Stinging nettle root (Urtica dioica) has been widely used as therapy for benign prostatic hyperplasia.¹¹ Both human and animal studies have shown that nettle root extract is effective not only in relieving benign prostatic hyperplasia symptoms, but also in shrinking the size of the prostate gland.^11-13

A study on nettle root extract was shown to improve lower urinary tract symptoms significantly better than placebo, with marked improvements in the International Prostate Symptom Scores, increases in peak urinary flow rates, and reductions in residual urine volume remaining in the bladder.¹²

The most compelling findings show that the combination of nettle root extract and saw palmetto extract can produce improvements similar to those of prescription benign prostatic hyperplasia medications with far fewer adverse events.^6,14,15 Of particular interest, a study involving 257 elderly men with benign prostatic hyperplasia found that the combination of the extracts reduced the International Prostate Symptom Scores by 53%, improve urinary flow by 19%, and reduced residual urine volume by 44% when compared to placebo.¹⁶

In addition, repeated studies have revealed that saw palmetto, combined with nettle extract, can reduce nighttime urination by one episode per night, a substantial and significant difference.¹⁴

Symptoms of Prostate Problems¹

Regardless of the cause, symptoms of prostate enlargement that can signal prostatitis, benign prostatic hyperplasia, or prostate cancer are similar in their early stages. They include the following:

• More frequent need to urinate
• More urgent need to urinate
• Decreased urine flow or dribbling
• Frequent nighttime awakening to urinate
• Burning with urination symptoms of prostatitis include, in addition to those of general prostate trouble:¹
• A strong and frequent urge to urinate, even when only a small amount of urine is present
• Chills, fever, low back pain, or body aches
• Pain in the lower abdomen, the groin area, or behind the scrotum
• Pressure or pain in the rectum
• Discharge from the urethra (urinary opening) during bowel movements
• Throbbing in the genital and/or rectal area
• Problems with sexuality and loss of drive
• Painful ejaculation symptoms of benign prostatic hyperplasia include, in addition to those of general prostate trouble: ¹
• Hesitation or difficulty starting a urine stream
• A weak or slow stream of urine, or just a dribble of urine
• Frequent urination, especially at night
• A sense of incomplete emptying of the bladder
• Repeated stopping and starting during a single urination
• Pushing or straining to complete bladder emptying

The symptoms of prostate cancer are often difficult to distinguish from those of benign prostatic hyperplasia. That means that men with any such symptoms should see their physicians early to allow for proper diagnosis and treatment. Annual PSA screening to detect early-stage prostate cancer is highly recommended.

Pygeum Africanum

Pygeum africanum is a plum tree from tropical Africa.¹⁷ It has been in widespread use in Central and Eastern Europe for decades and numerous human studies have demonstrated the clinical efficacy of pygeum in the management of mild to moderate benign prostatic hyperplasia.^18,19 At typical doses of 100 mg per day, the extract produces significant improvements in International Prostate Symptom Scores of 38% to 46%,¹⁹ reductions in frequency of nighttime urination of 32%,¹⁸ and increases in peak urinary flow rates of 16% to 19%.¹⁹ Quality of life, an important measure for this disruptive condition, was increased by about 30% in two studies.^18,19

A meta-analysis of 18 randomized, controlled trials involving 1,562 men has shown similar results, with overall reduction in nocturnal urination of 19% and increased urine flow of 23%. It also showed that men who took pygeum had an important reduction in the volume of urine remaining in the bladder after urination, a major risk factor for urinary tract infections. In that analysis, men using pygeum extract were more than twice as likely as those using placebo to report an overall improvement in urinary tract symptoms.²⁰

Additional Nutrients for Benign Prostatic Hyperplasia

Pumpkin seed. Studies have shown that supplementation with pumpkin seed led to clinically relevant reductions in the International Prostate Symptom Scores compared with placebo after three to 12 months.^21,22 One of these studies also showed that the combination of pumpkin seed oil and saw palmetto improved quality of life scores and showed 41.7% reduction on serum PSA levels at the end of the study when compared to baseline.²²

Pollen extracts. A meta-analysis of 444 men demonstrated that rye grass pollen extract significantly improved self-rated urinary symptoms in men with benign prostatic hyperplasia. Men in this study were also more than twice as likely to report improvement in nocturnal urination compared with placebo, and no side effects were reported.²³

Flaxseed. Flaxseed is a rich source of dietary lignans. In the intestine, they are converted by bacteria into other bioactive compounds, particularly enterolactone. A human study on dietary flaxseed lignan extract demonstrated significant reductions in the International Prostate Symptom Scores and improvements in quality of life in men with benign prostatic hyperplasia.²⁴

Prostate Cancer Prevention

Prostate cancer is the second most common malignancy experienced by men,²⁵ with more than 180,000 American men diagnosed a year, according to the American Cancer Society.²⁶

While it can be life threatening, most men do not die from prostate cancer. The five-, 10-, and 15-year survival rates for men diagnosed with prostate cancer are 99%, 98%, and 95% respectively.²⁷ In fact, it is estimated that more than 2.9 million American men are living with the disease right now.²⁶ In addition, it is among the most readily prevented cancers because it tends to grow very slowly and because nutritional approaches to prevention can be highly effective.¹⁷

Let’s take a look at five of the most effective nutrients against prostate cancer.

Lycopene

A nutrient with significant potential effects against prostate cancer is lycopene, a bright red carotenoid pigment abundant in tomatoes and other red fruits and vegetables.^28-30

High consumption of lycopene has been associated with a reduced risk of developing prostate cancer—and also with a reduced risk of dying from the disease. Among men with more aggressive prostate cancers, above-average lycopene consumption was associated with a 59% reduction in the risk of dying from the disease!³¹

Higher blood lycopene levels have also been consistently associated with reduced prostate cancer risk.³²

Additionally, lycopene inhibits the inflammatory processes that promote prostate (and many other) cancers by suppressing critical “master regulatory molecules” such as nuclear factor-kappa beta (NFkB).³³

Pygeum Africanum

In addition to combating many of the symptoms of benign prostatic hyperplasia, pygeum africanum has shown early evidence of potent anticancer effects.

One study found that when mice bred to have prostate cancers were treated with pygeum extract, they had significantly lower incidence of developing the malignancy. This same study showed that when applied directly to prostate cancer cells in culture, pygeum extract had numerous benefits, including inhibiting cell proliferation, inducing apoptosis, and binding to androgen receptors used by the tumor to sustain growth.¹⁷

Another important study showed that serum from a man using pygeum extract could decrease the proliferation of prostate cells in culture and upregulated genes involved in tumor suppression.³⁴

Lycopene May Slow Cancer Progression

Most men by middle age have been offered a blood test for prostate-specific antigen (PSA), which is produced in excessive amounts by prostate cancers and can be effectively used to help identify early-stage malignancy. PSA can also elevate in response to prostatitis and benign prostate enlargement.

Lycopene, the red pigment from tomatoes and other red fruits and vegetables, is one of the few compounds convincingly demonstrated to slow the rise of PSA in men with prostate cancer.

One study showed that, for men with advanced tumors, lycopene plus removal of the testes (to deprive the tumor of growth-promoting male hormones) was superior to surgery alone, with a significant difference in PSA levels by two years after the procedure.⁵¹ Men in this study also had fewer secondary tumors, better relief from bone pain, improved urine flow, and, most importantly, an improved survival rate compared with those undergoing testes removal only.

In another study of men with prostate cancer, 10 mg of lycopene per day significantly slowed the rate of PSA rise in 70% of treated men, and in 21%, turned the rise into a decline.⁵²

Since PSA is now known to have direct contributions to prostate cancer growth in addition to serving as a marker for the disease,⁴³ it seems sensible for men, even without known cancers, to supplement with lycopene as a way of suppressing this important risk factor.

Three Additional Nutrients to Fight Prostate Cancer

Boswellia extract. Numerous studies on cultured prostate cancer cells have shown that boswellia extract induces tumor death by apoptosis.^35-38 Other studies also show that its components may prevent tumor growth by blocking the androgen (male hormone) receptors³⁹ and by inhibiting the formation of new blood vessels (angiogenesis), further depriving tumors of nutrients.³⁶

Flaxseed. Studies confirmed that flaxseed supplementation lowers PSA levels and significantly reduces the proliferation of normal prostate cells and prostate cancer cells.^40,41 In a clinical study, supplementation with flaxseed generated favorable reductions in tumor proliferation rates in men with prostate cancer in as little as 30 days.⁴¹

Boron. According to one study, men with the highest dietary boron intakes have a 54% lower risk of developing prostate cancer compared to those with the lowest intake.⁴² Boron is known to block certain growth factors necessary for tumor development, and it has also been shown to inhibit the enzymatic action of PSA, which releases those same growth factors from their transport proteins.⁴³ In an animal study, human prostate cancers implanted in mice were smaller by 38% following low-dose boron supplementation, while serum PSA levels fell 89%. ⁴³

Relief for Chronic Prostatitis

Chronic prostatitis is a term used to describe ongoing inflammation of the prostate gland, usually in the absence of any known infection. ¹ It is often found as part of a condition known as chronic prostatitis/chronic pelvic pain syndrome, both of which are common in older men and unfortunately difficult to treat with standard medication, leaving men who suffer from this condition in considerable misery.^44-46

Fortunately, studies show that rye grass pollen extract may be a viable approach to treating this challenging condition.

One early study demonstrated that men assigned to receive rye grass pollen extract showed significant improvements in reported pain and quality of life. They also showed improvements on total scores on the NIH Chronic Prostatitis Symptom Index scale, compared with placebo.⁴⁷

Subsequent studies found similar results, with more supplemented subjects reporting significant improvements in quality of life and symptom scores.^48,49

None of these studies identified significant side effects, which suggests that rye grass pollen is both safe and effective in the treatment of chronic prostatitis, a stubborn condition that has resisted other treatment approaches.

Summary

The human prostate is a small gland with an enormous impact on a man’s health. Most of its functions are important in reproductive activity, but problems tend to arise later in life.

The most common prostate problems include benign prostatic hyperplasia, chronic prostatitis, and prostate cancer. Treatments, when available, vary in effectiveness and carry considerable side effects.

A large handful of dietary supplements has shown real promise in reducing the impact of prostate disease. While no single supplement can provide complete coverage against potential problems, those discussed here have overlapping mechanisms of action. This suggests that, taken in combination, they can contribute to reducing the risk of prostate disease, and many have been shown to help reverse the most troubling symptoms.

Starting a comprehensive prostate health supplement regimen is the smart thing to do, even (and especially) before symptoms arise.

If you have any questions on the scientific content of this article, please call a Life Extension^® Health Advisor at 1-866-864-3027.

References

1. Available at: http://www.cancer.gov/types/prostate/understanding-prostate-changes. Accessed March 9, 2016.
2. Sarma AV, Wei JT. Clinical practice. Benign prostatic hyperplasia and lower urinary tract symptoms. N Engl J Med. 2012;367(3):248-57.
3. Suter A, Saller R, Riedi E, et al. Improving BPH symptoms and sexual dysfunctions with a saw palmetto preparation? Results from a pilot trial. Phytother Res. 2013;27(2):218-26.
4. Zhan XX, Shang XJ, Huang YF. Application of saw palmetto fruit extract in the treatment of prostate diseases. Zhonghua Nan Ke Xue. 2015;21(9):841-6.
5. Fong YK, Milani S, Djavan B. Role of phytotherapy in men with lower urinary tract symptoms. Curr Opin Urol. 2005;15(1):45-8.
6. Engelmann U, Walther C, Bondarenko B, et al. Efficacy and safety of a combination of sabal and urtica extract in lower urinary tract symptoms. A randomized, double-blind study versus tamsulosin. Arzneimittelforschung. 2006;56(3):222-9.
7. Wilt T, Ishani A, Mac Donald R. Serenoa repens for benign prostatic hyperplasia. Cochrane Database Syst Rev. 2002(3):Cd001423.
8. Boyle P, Robertson C, Lowe F, et al. Updated meta-analysis of clinical trials of Serenoa repens extract in the treatment of symptomatic benign prostatic hyperplasia. BJU Int. 2004;93(6):751-6.
9. Allkanjari O, Vitalone A. What do we know about phytotherapy of benign prostatic hyperplasia? Life Sci. 2015;126:42-56.
10. Tacklind J, MacDonald R, Rutks I, et al. Serenoa repens for benign prostatic hyperplasia. Cochrane Database Syst Rev. 2009(2):Cd001423.
11. Chrubasik JE, Roufogalis BD, Wagner H, et al. A comprehensive review on the stinging nettle effect and efficacy profiles. Part II: urticae radix. Phytomedicine. 2007;14(7-8):568-79.
12. Safarinejad MR. Urtica dioica for treatment of benign prostatic hyperplasia: a prospective, randomized, double-blind, placebo-controlled, crossover study. J Herb Pharmacother. 2005;5(4):1-11.
13. Moradi HR, Erfani Majd N, Esmaeilzadeh S, et al. The histological and histometrical effects of Urtica dioica extract on rat’s prostate hyperplasia. Vet Res Forum. 2015;6(1):23-9.
14. Oelke M, Berges R, Schlafke S, et al. Fixed-dose combination PRO 160/120 of sabal and urtica extracts improves nocturia in men with LUTS suggestive of BPH: re-evaluation of four controlled clinical studies. World J Urol. 2014;32(5):1149-54.
15. Sokeland J. Combined sabal and urtica extract compared with finasteride in men with benign prostatic hyperplasia: analysis of prostate volume and therapeutic outcome. BJU Int. 2000;86(4):439-42.
16. Lopatkin N, Sivkov A, Schlafke S, et al. Efficacy and safety of a combination of Sabal and Urtica extract in lower urinary tract symptoms--long-term follow-up of a placebo-controlled, double-blind, multicenter trial. Int Urol Nephrol. 2007;39(4):1137-46.
17. Shenouda NS, Sakla MS, Newton LG, et al. Phytosterol Pygeum africanum regulates prostate cancer in vitro and in vivo. Endocrine. 2007;31(1):72-81.
18. Breza J, Dzurny O, Borowka A, et al. Efficacy and acceptability of tadenan (Pygeum africanum extract) in the treatment of benign prostatic hyperplasia (BPH): a multicentre trial in central Europe. Curr Med Res Opin. 1998;14(3):127-39.
19. Chatelain C, Autet W, Brackman F. Comparison of once and twice daily dosage forms of Pygeum africanum extract in patients with benign prostatic hyperplasia: a randomized, double-blind study, with long-term open label extension. Urology. 1999;54(3):473-8.
20. Wilt T, Ishani A, Mac Donald R, et al. Pygeum africanum for benign prostatic hyperplasia. Cochrane Database Syst Rev. 2002(1):Cd001044.
21. Vahlensieck W, Theurer C, Pfitzer E, et al. Effects of pumpkin seed in men with lower urinary tract symptoms due to benign prostatic hyperplasia in the one-year, randomized, placebo-controlled GRANU study. Urol Int. 2015;94(3):286-95.
22. Hong H, Kim CS, Maeng S. Effects of pumpkin seed oil and saw palmetto oil in Korean men with symptomatic benign prostatic hyperplasia. Nutr Res Pract. 2009;3(4):323-7.
23. MacDonald R, Ishani A, Rutks I, et al. A systematic review of Cernilton for the treatment of benign prostatic hyperplasia. BJU Int. 2000;85(7):836-41.
24. Zhang W, Wang X, Liu Y, et al. Effects of dietary flaxseed lignan extract on symptoms of benign prostatic hyperplasia. J Med Food. 2008;11(2):207-14.
25. Mariani S, Lionetto L, Cavallari M, et al. Low prostate concentration of lycopene is associated with development of prostate cancer in patients with high-grade prostatic intraepithelial neoplasia. Int J Mol Sci. 2014;15(1):1433-40.
26. Available at: http://www.cancer.org/cancer/prostatecancer/detailedguide/prostate-cancer-key-statistics. Accessed March 14, 2016.
27. Available at: http://www.cancer.net/cancer-types/prostate-cancer/statistics. Accessed March 15, 2016.
28. Borel P, Desmarchelier C, Nowicki M, et al. Lycopene bioavailability is associated with a combination of genetic variants. Free Radic Biol Med. 2015;83:238-44.
29. Holzapfel NP, Holzapfel BM, Champ S, et al. The potential role of lycopene for the prevention and therapy of prostate cancer: from molecular mechanisms to clinical evidence. Int J Mol Sci. 2013;14(7):14620-46.
30. Grainger EM, Hadley CW, Moran NE, et al. A comparison of plasma and prostate lycopene in response to typical servings of tomato soup, sauce or juice in men before prostatectomy. Br J Nutr. 2015;114(4):596-607.
31. Wang Y, Jacobs EJ, Newton CC, et al. Lycopene, tomato products and prostate cancer-specific mortality among men diagnosed with nonmetastatic prostate cancer in the Cancer Prevention Study-II Nutrition Cohort. Int J Cancer. 2016.
32. Chen P, Zhang W, Wang X, et al. Lycopene and risk of prostate cancer: a systematic review and meta-analysis. Medicine (Baltimore). 2015;94(33):e1260.
33. Assar EA, Vidalle MC, Chopra M, et al. Lycopene acts through inhibition of IkappaB kinase to suppress NF-kappaB signaling in human prostate and breast cancer cells. Tumour Biol. 2016.
34. Larre S, Camparo P, Comperat E, et al. Biological effect of human serum collected before and after oral intake of Pygeum africanum on various benign prostate cell cultures. Asian J Androl. 2012;14(3):499-504.
35. El Gaafary M, Buchele B, Syrovets T, et al. An alpha-acetoxy-tirucallic acid isomer inhibits Akt/mTOR signaling and induces oxidative stress in prostate cancer cells. J Pharmacol Exp Ther. 2015;352(1):33-42.
36. Pang X, Yi Z, Zhang X, et al. Acetyl-11-keto-beta-boswellic acid inhibits prostate tumor growth by suppressing vascular endothelial growth factor receptor 2-mediated angiogenesis. Cancer Res. 2009;69(14):5893-900.
37. Lu M, Xia L, Hua H, et al. Acetyl-keto-beta-boswellic acid induces apoptosis through a death receptor 5-mediated pathway in prostate cancer cells. Cancer Res. 2008;68(4):1180-6.
38. Buchele B, Zugmaier W, Estrada A, et al. Characterization of 3alpha-acetyl-11-keto-alpha-boswellic acid, a pentacyclic triterpenoid inducing apoptosis in vitro and in vivo. Planta Med. 2006;72(14):1285-9.
39. Yuan HQ, Kong F, Wang XL, et al. Inhibitory effect of acetyl-11-keto-beta-boswellic acid on androgen receptor by interference of Sp1 binding activity in prostate cancer cells. Biochem Pharmacol. 2008;75(11):2112-21.
40. Demark-Wahnefried W, Robertson CN, Walther PJ, et al. Pilot study to explore effects of low-fat, flaxseed-supplemented diet on proliferation of benign prostatic epithelium and prostate-specific antigen. Urology. 2004;63(5):900-4.
41. Demark-Wahnefried W, Polascik TJ, George SL, et al. Flaxseed supplementation (not dietary fat restriction) reduces prostate cancer proliferation rates in men presurgery. Cancer Epidemiol Biomarkers Prev. 2008;17(12):3577-87.
42. Cui Y, Winton MI, Zhang ZF, et al. Dietary boron intake and prostate cancer risk. Oncol Rep. 2004;11(4):887-92.
43. Gallardo-Williams MT, Chapin RE, King PE, et al. Boron supplementation inhibits the growth and local expression of IGF-1 in human prostate adenocarcinoma (LNCaP) tumors in nude mice. Toxicol Pathol. 2004;32(1):73-8.
44. Nickel JC. Treatment of chronic prostatitis/chronic pelvic pain syndrome. Int J Antimicrob Agents. 2008;31 Suppl 1:S112-6.
45. Monden K, Tsugawa M, Ninomiya Y, et al. A Japanese version of the National Institutes of Health Chronic Prostatitis Symptom Index (NIH-CPSI, Okayama version) and the clinical evaluation of cernitin pollen extract for chronic non-bacterial prostatitis. Nihon Hinyokika Gakkai Zasshi. 2002;93(4):539-47.
46. Potts JM. Therapeutic options for chronic prostatitis/chronic pelvic pain syndrome. Curr Urol Rep. 2005;6(4):313-7.
47. Wagenlehner FM, Schneider H, Ludwig M, et al. A pollen extract (Cernilton) in patients with inflammatory chronic prostatitis-chronic pelvic pain syndrome: a multicentre, randomised, prospective, double-blind, placebo-controlled phase 3 study. Eur Urol. 2009;56(3):544-51.
48. Cai T, Wagenlehner FM, Luciani LG, et al. Pollen extract in association with vitamins provides early pain relief in patients affected by chronic prostatitis/chronic pelvic pain syndrome. Exp Ther Med. 2014;8(4):1032-8.
49. Iwamura H, Koie T, Soma O, et al. Eviprostat has an identical effect compared to pollen extract (Cernilton) in patients with chronic prostatitis/chronic pelvic pain syndrome: a randomized, prospective study. BMC Urol. 2015;15:120.
50. Available at: http://www.rxlist.com/flomax-drug/side-effects-interactions.htm. Accessed Mach 17, 2016.
51. Ansari MS, Gupta NP. A comparison of lycopene and orchidectomy vs orchidectomy alone in the management of advanced prostate cancer. BJU Int. 2003;92(4):375-8; discussion 8.
52. Zhang X, Wang Q, Neil B, et al. Effect of lycopene on androgen receptor and prostate-specific antigen velocity. Chin Med J (Engl). 2010;123(16):2231-6.