• Quercetin in Men with Category III Chronic Prostatitis: A Preliminary Prospective, Double-Blind, Placebo-Controlled Trial
• Oxidative stress in prostatic fluid of patients with chronic pelvic pain syndrome
  
  

 

Quercetin in Men with Category III Chronic Prostatitis: A Preliminary Prospective, Double-Blind, Placebo-Controlled Trial

DANIEL A. SHOSKES, SCOTT I. ZEITLIN, ASHA SHAHED, AND JACOB RAJFER

 

ABSTRACT
Objectives. The National Institutes of Health (NIH) category III chronic prostatitis syndromes (nonbacterial
chronic prostatitis and prostatodynia) are common disorders with few effective therapies. Bioflavonoids
have recently been shown in an open-label study to improve the symptoms of these disorders in a significant
proportion of men. The aim of this study was to confirm these findings in a prospective randomized,
double-blind, placebo-controlled trial.
Methods. Thirty men with category IIIa and IIIb chronic pelvic pain syndrome were randomized in a
double-blind fashion to receive either placebo or the bioflavonoid quercetin 500 mg twice daily for 1 month.
The NIH chronic prostatitis symptom score was used to grade symptoms and the quality-of-life impact at the
start and conclusion of the study. In a follow-up unblind, open-label study, 17 additional men received 1
month of a supplement containing quercetin, as well as bromelain and papain (Prosta-Q), which enhance
bioflavonoid absorption.
Results. Two patients in the placebo group refused to complete the study because of worsening symptoms,
leaving 13 placebo and 15 bioflavonoid patients for evaluation in the blind study. Both the quercetin and
placebo groups were similar in age, symptom duration, and initial symptom score. Patients taking placebo
had a mean improvement in NIH symptom score from 20.2 to 18.8 (not significant), while those taking the
bioflavonoid had a mean improvement from 21.0 to 13.1 (P 5 0.003). Twenty percent of patients taking
placebo and 67% of patients taking the bioflavonoid had an improvement of symptoms of at least 25%. In
the 17 patients who received Prosta-Q in the open-label study, 82% had at least a 25% improvement in
symptom score.
Conclusions. Therapy with the bioflavonoid quercetin is well tolerated and provides significant symptomatic
improvement in most men with chronic pelvic pain syndrome.

UROLOGY 54: 960–963, 1999. © 1999, Elsevier Science Inc.

 

 

Oxidative stress in prostatic fluid of patients with chronic pelvic pain syndrome

ASHA R. SHAHED AND DANIEL A. SHOSKES
From the Division of Urology, Harbor-UCLA Medical Center, Torrance, California.

ABSTRACT

The etiology of chronic pelvic pain syndrome (CPPS)/chronic prostatitis category III remains unknown. Whereas a subsetof men respond to antimicrobial therapy, Gram positive bacteria isolated from expressed prostatic secretions (EPS) are often considered to be commensal rather than pathogenic. We wished to study oxidative stress as a marker of tissue injury and response in EPS of men with CPPS to determine whether infection with Gram positive bacteria is associated with increased oxidative stress. A total of 300 EPS specimens from 100 men with CPPS were collected for microscopy, culture, and biochemical and molecular assays. Oxidant injury was measured by 8-isoprostane F2_ (IsoP) levels and total antioxidant capacity as Trolox equivalents. Total RNA from EPS was used for gene expression of heme oxygenase-1 (HO-1) and granzyme B. The only bacteria found in EPS were Gram positive. For our analysis, these men were classified as having chronic bacterial prostatitis (category II). IsoP levels (pg/mL) were highest in men with category II prostatitis (7315 _ 1428) followed by nonbacterial prostatitis (category IIIa, 2043 _ 561), prostatodynia (category IIIb, 319± 81), and asymptomatic controls (298±99). IsoP levels decreased significantly after successful treatment with antibiotics or an antioxidant supplement (Prosta-Q). Antioxidant capacity was detected in 11 out of 18, 4 out of 16, and 1 out of 16 men tested with category II, IIIa, and IIIb prostatitis, respectively. No correlation was observed between IsoP levels and the number of white blood cells in EPS. HO-1 and granzyme B expression was highest in men with category II prostatitis than in men with either category III prostatitis or asymptomatic controls. On the basis of elevated oxidative stress, clinical response to antibiotics, and post-treatment reduction in oxidative stress, we conclude that Gram positive bacteria in some men with CPPS may be pathogens. It is speculated that oxidative stress may be a key pathway in some men with CPPS that can be targeted with antioxidant therapy.
Key words: Chronic prostatitis, inflammation, gene expression, isoprostane, Quercetin.