Originally published 1/3/2017
When a man is experiencing pelvic pain due to prostatitis (prostate inflammation) it’s important to rule out a bacterial infection. However, in most cases of chronic prostatitis, no cause can be found. It’s commonly recommended to patients to take over the counter nonsteroidal anti-inflammatory (NSAID) products such as ibuprofen or acetaminophen, which are cheap and readily available. NSAIDs don’t cure the condition, but they can be effective in treating symptoms.
There are natural supplements to reduce inflammation that have a basis in clinical studies:
- Quercetin, a plant pigment with anti-inflammatory effects[i]
- Cernilton, a pollen extract, was better at relieving total symptoms and pain than a placebo[ii]
- Pumpkin seed oil, in combination phonophoresis (ultrasound noninvasively “pushes” the oil through the skin toward the prostate) may have a significant effect on symptoms[iii]
We also found a novel natural approach to relieve symptoms. Rather than a plant-based substance, a Sep. 2021 journal article reported use of cellular nanoparticles to treat chronic non-bacterial prostatitis. The nanoparticles are called exosomes, which are like tiny information packets manufactured by cells and released into circulation where they are received by other cells; the information includes molecular “instructions” that can influence the behavior of other cells. They are mini-telegrams used by the body so cells can communicate with each other, even from a distance. The researchers conducted an experiment with lab animals (male rats with prostatitis). Exosomes were isolated from healthy rats’ fatty stem cells (non-fetal), and then injected directly into the prostates of the rats with prostatitis. Genomic analyses of tissues revealed that the exosomes had both anti-inflammatory and anti-oxidant effects on the inflamed prostates of the animals.
We thought it was worth including this rather revolutionary method of treating chronic non-bacterial prostatitis. Although much more research would need to be done in this area, exosomes have already gained enormous scientific interest as possible healing agents for many disease conditions.
Prostatitis is one of those medical conditions that is hard to pin down and even more difficult to cure. According to the Prostatitis Foundation, “Prostatitis is an inflammation of the prostate gland, often resulting in swelling or pain. Prostatitis can result in four significant symptoms: pain, urination problems, sexual dysfunction, and general health problems, such as feeling tired and depressed.”[i] Urologists estimate that at any given time, 5-10% of men suffer from prostatitis. When patients come in complaining of pain in the pelvic bed, they will be asked about the history of the symptoms, and diagnostic tests will be done. These may include blood, urine and prostate fluid analysis as well as a digital rectal exam. There is no standard treatment, but most men with symptoms of prostatis (for which no other cause can be found) will be given a course of antibiotics. Sometimes this helps, but in most cases the same symptoms will continue or return after a temporary let-up.
An August, 2016 article on using only anti-inflammatories with no antibiotics had some promising results.[ii] For study purposes, patients with PSA greater than 4.0 ng/mL were diagnosed with prostatitis based prostate biopsy samples; none of them were found to have prostate cancer (PCa) on initial biopsy. The goal of the study was to determine if treatment using only anti-inflammatories (no antibiotics) would be well-tolerated and effective in lowering PSA.
The authors enrolled 140 participants who were divided into two equal groups of 70:
- Group 1 consisted of men found to have inflammation on biopsy (no PCa)
- Group 2 were those who were not.
Both groups were given a three month protocol of anti-inflammatories that included nimesulide (not available in the U.S.), saw palmetto, bromelain (derived from pineapples, it reduces inflammation), and quercetin (a plant pigment found in many foods, it is an antioxidant and can help reduce inflammation).
At the end of the trial period, PSA blood draws and repeat 16-core biopsies. The results are interesting:
| Group 1 (initial inflammation) | Group 2 (no initial inflammation) | |
| PSA | Average baseline PSA of 7.3 dropped to 4.6 | Average baseline PSA of 7.2 dropped to 7 |
| 2nd biopsy | 20% (14/70) diagnosed with PCa | 18.5% (13/70) diagnosed with PCa |
Study participants whose PSA was below 4 in both groups were cancer free on the repeat biopsy, but the rate of picking up PCa was almost equal in both groups, only slightly higher in Group 1. Inflammation is thought to be a possible precursor of cancer, but despite the small sample size, there is no evidence for that in this study. Also, the drop in PSA was greater in Group 1, and practically nonexistent in Group 2, suggesting that the treatment reduced inflammation but had no negative effects on men who did not have prostatitis. Perhaps nonsteroidal, over-the-counter anti-inflammatories and commonly available supplements (saw palmetto, bromelain and quercetin) have the potential to help men who suffer from nonbacterial prostatitis. However, it is important to avoid self-diagnosis and self-treatment. If you have any of the symptoms of prostatitis, see a doctor for professional evaluation. Also, multiparametric MRI on a 3 Tesla magnet can tell the difference between healthy prostate tissue vs. inflammation. Imaging before taking antibiotics or undergoing a biopsy can be very helpful in diagnosing prostatitis. If you are interested in image-based analysis, contact our Center to learn if multiparametric MRI is right for you.
NOTE: This content is solely for purposes of information and does not substitute for diagnostic or medical advice. Talk to your doctor if you are experiencing pelvic pain, or have any other health concerns or questions of a personal medical nature.
[i] Hu M, Wazir J, Ullah R, Wang W et al. Phytotherapy and physical therapy in the management of chronic prostatitis-chronic pelvic pain syndrome. Int Urol Nephrol. 2019 Jul;51(7):1081-1088.
[ii] Wagenlehner FM, Schneider H, Ludwig M, Schnitker J 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 Sep;56(3):544-51.
[iii] Tantawy SA, Elgohary HM, Kamel DM. Trans-perineal pumpkin seed oil phonophoresis as an adjunctive treatment for chronic nonbacterial prostatitis. Res Rep Urol. 2018 Sep 18;10:95-101.
[iv] http://www.prostatitis.org/
[v] Gallo L. The Effect of a Pure Anti-inflammatory Therapy on Reducing Prostate-specific Antigen Levels in Patients Diagnosed With a Histologic Prostatitis. Urology. 2016 Aug;94:198-203.
About Dr. Dan Sperling
Dan Sperling, MD, DABR, is a board certified radiologist who is globally recognized as a leader in multiparametric MRI for the detection and diagnosis of a range of disease conditions. As Medical Director of the Sperling Prostate Center, Sperling Medical Group and Sperling Neurosurgery Associates, he and his team are on the leading edge of significant change in medical practice. He is the co-author of the new patient book Redefining Prostate Cancer, and is a contributing author on over 25 published studies. For more information, contact the Sperling Prostate Center.
