Eviprostat Has an Identical Effect Compared to Pollen Extract (Cernilton) in Patients With Chronic Prostatitis/Chronic Pelvic Pain Syndrome

A Randomized, Prospective Study

Hiromichi Iwamura; Takuya Koie; Osamu Soma; Teppei Matsumoto; Atsushi Imai; Shingo Hatakeyama; Takahiro Yoneyama; Yasuhiro Hashimoto; Chikara Ohyama

Disclosures

BMC Urol. 2015;15(120) 

In This Article

Discussion

Antibiotics administration is the standard treatment for chronic bacterial prostatitis.[19] however, the standard treatment for CP/CPPS has not yet been established.[20] 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.[21]

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.[5] 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.[6] 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.[6]

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.[13] 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.[14]

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.

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