Antibiotics administration is the standard treatment for chronic bacterial prostatitis. however, the standard treatment for CP/CPPS has not yet been established. To date, various treatments for CP/CPPS have been reported, including α-blockers, antibiotics, anti-inflammatory agents, phytotherapeutics, and various other modalities.[4–12] However it is believed that these treatments have little effect on major symptoms, such as pain and urinary disturbance, experienced in CP/CPPS that reduce the QOL.
In general, patients with CP/CPPS undergo long-term treatment, and therefore, phytotherapeutics such as pollen extract, quercetin, Saw palmetto, or terpenes may be useful because they have few side effects. However, there is no scientific evidence supporting these agents, and only few prospective controlled clinical trials have been conducted.
Since a long time, Cernilton has been used for the treatment of prostatitis. Wagenlehner et al. conducted a prospective, randomized, double-blind, placebo-controlled study to study the effect of Cernilton in patients with CP/CPPS (NIH IIIA). They reported that compared with a placebo, Certilton improved total symptom, pain, and QOL without any side effects.
Eviprostat is a phytotherapeutic agent commonly used to treat prostatic hypertrophy in Japan.[13–15] An experiment using nonbacterial prostatitis model suggested that Evoprostat is potentially effective for the treatment of CP/CPPS. Oka et al previously reported that by using a model of non-bacterial prostatitis (NBP) induced in castrated aging rats by the injection of 17b-estradiol, they showed that the increased production of oxidativestress marker malondialdehyde (MDA) and the proinflammatory cytokines TNF-a, IL-6, and IL-8 in prostate tissue homogenates from NBP rats. Eviprostat treatment significantly suppressed oxidative stress and proinflammatory cytokines in the NBP rats. Sugimoto et al reported that chemokines, including CCL2/MCP-1 and CXCL1/CINC-1, were elevated in the prostate and urine of NBP rats, and Eviprostat potently suppressed the increases in CCL2/MCP-1 and CXCL1/CINC-1.
The aim of the present study was to compare the efficacy and safety of Eviprostat to that of the pollen extract in the management of CP/CPPS.
In the intention-to-treat analysis, 100 Category III CP/CPPS patients were randomly allocated to Eviprostat (n=50) or the pollen extract (n =50). Response (defined as a decrease in the NIH-CPSI total score by at least 25 %) in the Eviprostat group and the pollen extract group was 88.2 and 78.1 %, respectively. There was no significant difference in the total, pain, urinary, and QOL scores of the NIH-CPSI between the two groups at 8 weeks.
This study has several limitations. Study samples were very small, it is necessary to examine the therapeutic effects of Eviprostat with a placebo control and this study was conducted in only Japanese populations.
In the present study, we conducted a prospective, randomized trial to compare the therapeutic effects of Eviprostat and Certilton, the standard treatment for CP/CPPS in Japan, and found that both agents improved CP/CPPS without any side-effects. We believe that Eviprostat is a very promising phytotherapeutic agent for the treatment of CP/CPPS in the future.
BMC Urol. 2015;15(120) © 2015 BioMed Central, Ltd.