Prostate Restored
Prostate Restored
Photo: Kristina Paukshtite
observed a reduction of prostate size with pumpkin seed oil [20]. This effect has been confirmed by other in vitro and animal studies [21,22,23]. In line with our findings, Vahlensieck et al. demonstrated a clinically relevant reduction of IPSS compared to placebo after 12 months of taking pumpkin seed extract [13].
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Read More »In the current study, we found that both tamsulosin and pumpkin (Cucurbita pepo) seed oil significantly reduced BPH symptoms assessed by IPSS. However, the decrease in IPSS from baseline to 1 month and 3 months was significantly higher in the tamsulosin group compared to the pumpkin group, while the decrease from 1 to 3 months was similar. Moreover, no patients in the pumpkin group experienced drug side effects, while dizziness (5.9%), headache (2.9%), retrograde ejaculation (2.9%), and erythema with pruritus occurred in the tamsulosin group. With a global prevalence of 20–62% in men over 50 years, BPH is considered a very common condition [15]. BPH causes LUTS which markedly affect the quality of life in many patients [16, 17]. Multiple strategies have been proposed and used for the relief of BPH-related symptoms. Alpha-blockers such as tamsulosin are regarded as the first-line options. By selectively blocking α 1 A-adrenergic receptors leading to the relaxation of the prostate smooth muscles, tamsulosin is reported to improve dysuria and other BPH symptoms [18]. Although tamsulosin is generally preferred due to its lower side effects compared to other alpha-blockers, it can still cause some complications and unwanted reactions, including dizziness, headache, and retrograde ejaculation [19]. We also observed some of these side effects in patients taking tamsulosin. The effects of tamsulosin and pumpkin seed oil on BPH symptoms have separately been investigated in multiple studies, yet none have compared them with regard to BPH symptom relief. In vitro and in vivo experiments have shown promising results for pumpkin seeds. In their study on Sprague–Dawley rats, Gossell-Williams et al. observed a reduction of prostate size with pumpkin seed oil [20]. This effect has been confirmed by other in vitro and animal studies [21,22,23]. In line with our findings, Vahlensieck et al. demonstrated a clinically relevant reduction of IPSS compared to placebo after 12 months of taking pumpkin seed extract [13]. They used 500 mg Cucurbita pepo seed oil extract capsules twice a day. Nevertheless, the period of treatment was much longer in their study reflecting the long-term effects of pumpkin seeds compared to the 3-month period of treatment in our study. In a study on 100 patients by Shirvan et al., pumpkin seed oil (360 mg Cucurbita pepo twice a day) was compared with prazosin for the treatment of BPH symptoms [24]. They found pumpkin seed oil to be safe and effective but not as effective as prazosin. Their findings were consistent with ours. We also found a significant reduction in IPSS with both tamsulosin and pumpkin seed oil from baseline 3 months; nonetheless, the reduction in IPSS from baseline to the end of 1 month and 3 months was significantly higher with tamsulosin. Moreover, they further evaluated patients after 6 months of ttreatment, while we only assessed the results after 3 months. The results of a large study by Friederich et al. on 2245 BPH patients taking pumpkin seed extract (1–2 500 mg Cucurbita pepo capsules) for 3 months have also confirmed the effectiveness of this herbal medications showing a 41.4% decrease in IPSS and 46.1% improvement in their QoL [14]. Dihydrotestosterone, converted from testosterone by 5α-reductase, is responsible for the overgrowth of the prostate gland which is characteristic of BPH. [25]. Targeting this pathway has been the mainstay of medical treatment in BPH. Pumpkin seeds appear to affect BPH through the same pathway [10]. Anti-inflammatory properties of pumpkin seeds have been proposed as another mechanism for the effectiveness of pumpkin seed oil in BPH [26]. BPH is associated with the inflammation of the prostate gland and overexpression of cytokines, leukotriene, inducible nitric oxide synthase, NF-κB, and cyclooxygenase-2 is linked with prostatitis [27]. Another proposed mechanism is the diuretic effects of pumpkin seed due to its fatty acids content [28]. Of note, IPSS is a subjective tool to assess the improvement of BPH symptoms. An objective method to evaluate BPH improvement is maximum urine flow and we found no significant change in this variable in any of the groups. One reason for this can be that we had included patients with > 15 ml/s maximum urine flow at baseline only because they complained of BPH symptoms and this could have interfered with the results.
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Read More »Also, we did not observe significant reductions in PSA and prostate volume with pumpkin seed oil. The results of the study by Hong et al. were similar, as they found no significant reduction in PSA and prostate volume after 3 months in patients receiving 320 mg/day pumpkin seed oil. They did not specify the Cucurbita species used in their study (29). As the effect of pumpkin seed oil has been attributed to its phytosterol content, higher doses of pumpkin seed oil potentially include higher amounts of phytosterol leading to increased effects. Nevertheless, patients’ adherence to medications would be of concern with higher doses. The strength of the current study was the homogeneity of patients taking tamsulosin or pumpkin seed oil regarding the potential effectors, as well as baseline characteristics, including symptom severity, QoL, serum PSA, maximum urine flow, and prostate and PVR volumes. This study was not without limitations. First, it has been conducted on a limited number of patients. The study did not reach the minimal sample size of 35; 6 patients were lost to follow-up in the tamsulosin group and 34 patients remained in this group. Further studies with a larger sample size are required to confirm our findings. Second, we only evaluated the efficacy of pumpkin seeds for a 3-month period of treatment and its long-term effects need to be determined in future studies. Also, patients’ adherence to treatment, which we failed to assess, is another factor that could have influenced the results. Moreover, we included patients with IPSS < 8 who were mildly symptomatic. Although the initial design of the study was to only include patients with moderate to severe BPH symptoms, we also included mildly symptomatic patients due to the persistent complaint of these patients of BPH symptoms causing them discomfort, as well as the limited recruitment time.
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