Chronic nonbacterial prostatitis, which is also known as chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS), accounts for 90 to 95 percent of all prostatitis cases, yet it doesn’t get much attention.
In fact, the average CP/CPPS patient generally deals with symptoms for years before receiving an accurate diagnosis and treatment. There is no FDA-approved drug for this condition, but leading experts and specialists in this area do recommend dietary supplements. Combining them with conventional prescription medication (used off-label) has also become part of the standard of care.
What is Chronic Prostatitis?
Prostatitis is inflammation of the prostate, the small gland that surrounds the urethra. Due to its location, inflammation can lead to urinary problems and pain, significantly impacting quality of life. Prostatitis can be caused by bacteria, but more commonly it’s not (and the cause is often unknown). Category III (types a and b) is the most common form, and it is commonly referred to as chronic pelvic pain syndrome, or CPPS. However, this is really an umbrella term since CPPS can include other diseases like interstitial cystitis, and we’ll see it used more that way in the future.
People with CP/CPPS can experience a variety of symptoms beyond urinary problems. Experts have developed a clinical guide called UPOINT to address different groups of symptoms and treatment options that are commonly used.
Home Remedies For Chronic Prostatitis
1. Cernilton (a pollen extract mixture) dosages vary
Cernilton, which is a pollen extract, has anti-inflammatory effects, and it’s been tested in a variety of trials for CP/CPPS. Cernilton from the latest clinical trial was a microbial digestion of a mixture of the pollen extracts (called cernitins) Secale cereale (cereal rye or grass), Phleum pratense (Timothy grass), and Zea mays (corn). The largest and one of the most well-done studies with this supplement for CP/CPPS followed 139 men who took either Cernilton or a placebo.
Approximately 45 percent of the subjects were on prior prescription medications for CP/CPPS or a related condition. Researchers found significant reductions in pain and significant improvements in quality of life and total symptoms after 12 weeks with Cernilton compared to the placebo. Approximately 70 percent of the patients on Cernilton had a large (25 percent) reduction in symptoms, compared to 49 percent of those on the placebo (there is a large placebo response rate in these studies, which is why placebo-controlled trials are so crucial to prove efficacy). Urinary scores or function did not improve, and side effects were similar to the placebo. Participants in this trial took two Cernilton capsules every 8 hours; the active ingredient in each capsule was 60 milligrams of Cernitin T60 (water-soluble) and 3 milligrams Cernitin GBX (fat-soluble).
This is one of the most impressive clinical trials performed to date with a dietary supplement for CP/CPPS. Currently, there have been seven positive human clinical studies with pollen extract and CP/CPPS—six with Cernilton and one with a product known as Prostat/Poltit. Clinical efficacy with the supplements ranged from 63 to 87 percent, compared to 36 to 49 percent for the placebo.
The issue with Cernilton is that it has a long history with multiple companies, which can be quite difficult to sort through when you’re trying to order this or a similar product. (For example, Cernilton started with AB Cernelle in Sweden, and then it was also licensed in the United States by Cernitin America and discontinued. Graminex currently sells one option, and the most recent randomized clinical trial was supported by Strathmann AG & Co. and AB Cernelle, both in Europe.) Always look for the three active pollen ingredients.
Dosages in studies varied based on the product, so you may have to experiment with it. I find it interesting that these supplements help reduce pain and improve quality of life but do not improve urinary function, which is similar to other effective supplements for CP/CPPS. This is why most patients take a combination of supplements and prescription medication. In my experience, some men do see an improvement in urinary function or flow with Cernilton and other supplements mentioned in this section, but they’re in the minority.
2. Quercetin and quercetin complex 500 milligrams twice a day
Quercetin is an anti-inflammatory compound found in green tea, red wine, and onions. It seems to block cell cytokine release, which may help reduce inflammatory reactions. In an impressive but small randomized, placebo- controlled trial at UCLA, 67 percent of CP/CPPS patients who took 500 milligrams of quercetin twice daily for 4 weeks experienced a large improvement in pain and quality of life (but not urinary function).
Only 20 percent in the placebo group experienced improvements. Also, white blood cells in prostatic secretions (a measure of inflammation) dropped by 66 percent in the quercetin group (no significant change in the placebo-takers). A third group (not placebo controlled) of 17 patients received quercetin with bromelain and papain (digestive enzymes found in pineapple and papaya, respectively)—known as a quercetin complex—to enhance absorption, and 82 percent experienced a significant improvement in symptoms after 1 month (the product used is called Prosta-Q).
3. SAM-e (S-adenosylmethionine) 600 to 1,200 milligrams a day
SAM-e is widely used as a prescription drug in Europe for a variety of conditions, especially osteoarthritis and depression (see the Osteoarthritis and Joint Pain section, and the Depression section), and as a result it’s receiving more attention in the United States. Researchers are not sure how it controls pain, but it does play a primary role in several neurotransmitter pathways in the body, which basically means it likes to impact multiple areas.
A recent review of numerous clinical trials with SAM-e versus a placebo or NSAIDs (most over-the-counter pain relievers and some prescription anti- inflammatory medications, including Celebrex) concluded that the existing evidence indicates SAM-e is at least as effective as NSAIDs (nonsteroidal anti- inflammatory drugs) at reducing pain but with a lower rate of side effects. In fact, people taking SAM-e were almost 60 percent less likely to experience a side effect compared to NSAID users. SAM-e has a slower onset of action for pain reduction, but by the end of the first or second month of use, the efficacy is similar to many popular NSAIDs.
Dosages range from 600 to 1,200 milligrams per day for at least 30 to 90 days. It can be ridiculously expensive, but if you’re willing to shop around, you can find some good deals.
The problem with SAM-e or any other supplement for CP/CPPS (apart from Cernilton and quercetin) is that there is no adequate clinical trial suggesting it helps. However, in my experience, SAM-e does help reduce CP/CPPS-related pain and improve mood. This is one of the only sections of the book where I rank something without a clinical trial. I just can’t ignore the pain-reducing effects of SAM-e.
What Supplement is Useless For Treating Chronic Prostatitis?
It has essentially failed as a supplement for prostate enlargement, which is why it has shown little ability to reduce CP/CPPS symptoms.
Stinging nettle. This supplement and most others touted for prostate health either have not been studied adequately or have failed.
What Lifestyle Changes Can Help With Chronic Prostatitis?
Heart healthy = prostate healthy!
I have said this in medical journals for more than 10 years, and lifestyle studies are proving it as well. Anything that helps your heart will help your prostate. Specifically, researchers have found that tobacco use and higher caloric intake, both risk factors for heart disease, may be risk factors for CP/CPPS as well. And it’s not just about diet and not smoking: A clinical study from Florence, Italy, found that men with CP/CPPS who walked vigorously three times a week for 40 minutes (achieving an intensity of 70 to 80 percent of their maximum heart rate) reported an improvement in symptoms, pain, and quality of life. (Sadly, approximately 25 percent of the participants dropped out of the study by 18 weeks, which is one of the serious limitations of lifestyle-change trials.) Exercise releases pain-fighting compounds in the body. In my experience, patients also see improvements in urinary function when they exercise more often (5 to 7 days a week).
Take a bath
Magnesium sulfate baths (a.k.a. sitz baths) can reduce the pain associated with CP/CPPS.
Keep a food diary
For some people, certain foods and beverages can make symptoms worse, so keep track of what you eat for several weeks and note whether there are any changes in your CP symptoms. Surveys suggest spicy foods, coffee, hot peppers, alcohol, tea, and chili can make symptoms worse.
What Else to Know About Treating Chronic Prostatitis?
Acupuncture or percutaneous tibial nerve stimulation (PTNS), which is just a conventionally modified form of acupuncture (Google it, please), should also be a standard of care for CP/CPPS. These techniques have led to some significant improvements in urinary function. In a perfect world, a patient would be offered a prescription drug, supplements, and acupuncture or PTNS for their CP/CPPS!