Korean J Urol.  2008 Mar;49(3):193-202. 10.4111/kju.2008.49.3.193.

Complementary and Alternative Medicine(CAM) in Urology

• Yoo C
• Kim CS

• KMID: 1204619
• DOI: http://doi.org/10.4111/kju.2008.49.3.193

Abstract

An increasing use of complementary and alternative medicine(CAM) is apparent both in Asian and in Western countries for the management of numerous diseases to improve symptoms and to improve general health and well being. Many patients with benign prostatitc hyperplasia(BPH) and lower urinary tract symptoms(LUTS), erectile dysfunction(ED), urinary tract infection(UTI) are using CAM. Complementary and alternative medicines for urologic malignancies such as renal cell carcinoma, bladder cancer, and prostate cancer are also one of the important issues in the management of patients. Dietary supplements and nutraceuticals are commonly used modality for the patients with BPH/LUTS or ED. Vegetables and cruciferous fruits showed significant preventive effect on urologic malignancies in many studies. Phytotherapy for BPH including beta-sitosterols, saw palmetto, pygeum, and nettles etc, is under vigorous research for their therapeutic effect. No solid evidence showing better effective treatment modality for ED than placebo was found yet in CAM area. Recently, a potent NO donor, L-arginine is under research with promising results. Cranberry juice has been used for the patients with recurrent UTI but safety was a limit for its use. Various antioxidants have been studied for prevention of urological malignancies. Lycopene, isoflavone, vitamin A, C, and E, and polyphenols showed the possibility of decreasing cancer incidence in many studies but their effect is still controversial. Vitamin D is known to be associated with cancer progression and the effect of combination treatment with other chemotherapeutic agents for advanced cancer is under trial. CAM is used by a number of patients with urological diseases and urologists need to have both accurate knowledge and apprehension of CAM. The possible effects and side effects should be defined and offered to the urologic patients by urologists.

Keyword

Complementary and alternative medicine; Benign prostatic hyperplasia; Urinary tract infections; Erectile dysfunction; Urological malignancy

MeSH Terms

Incidence

Reference

1. Zimmerman RA, Thompson IM Jr. Prevalence of complementary medicine in urologic practice. A review of recent studies with emphasis on use among prostate cancer patients. Urol Clin North Am. 2002; 29:1–9.

2. Kim CS, Park S, Lee SB, Lee JM, Chung H, Chung MK, et al. The use of complementary and alternative medicine in patients with a urological malignancy. Korean J Urol. 2006; 47:620–4.

3. Hanafy HM, Saad SM, El-Rifaie M, Al-Ghorab MM. Early arabian medicine: contribution to urology. Urology. 1976; 8:63–7.

4. Wilt TJ, Ishani A, Stark G, MacDonald R, Lau J, Mulrow C. Saw palmetto extracts for treatment of benign prostatic hyperplasia: a systematic review. JAMA. 1998; 280:1604–9.

5. Kim JY. Market analysis and research and development strategy on traditional korean medicine. Report from Korea Institute of Oriental Medicine, Seoul, Korea. 2006.

6. Shin HK, Bae SH. A study on implication by comparing current status of educational systems between Korea and China in connection with traditional medicine of each country. J KIOM. 2005; 11:83–95.

7. Lee KK, Bae SH, Shin HK. An investigation about the present states of clinical trial for traditional medicine in Korea, China, Taiwan and Japan. J KIOM. 2005; 12:13–22.

8. Fair WR. Back to the future - the role of complementary medicine in urology. J Urol. 1999; 162:411–20.

9. McClure MW. An overview of holistic medicine and complementary and alternative medicine for the prevention and treatment of BPH, prostatitis, and prostate cancer. World J Urol. 2002; 20:273–84.

10. Dreikorn K. Complementary and alternative medicine in urology. BJU Int. 2005; 96:1177–84.

11. Oh WK, Small EJ. PC-SPES and prostate cancer. Urol Clin North Am. 2002; 29:59–66.

12. Park BH, Kim SW, Kim SW, Kim JJ, Kim HS, Min KS, et al. Evaluation of complementary and alternative medicine for treating patients with erectile dysfunction. Korean J Urol. 2006; 47:987–93.

13. Bravi F, Bosetti C, Dal Maso L, Talamini R, Monella M, Negri E, et al. Food groups and risk of benign prostatic hyperplasia. Urology. 2006; 67:73–9.

14. Capodice JL, Katz AE. What patients take without telling you: holistic approach for BPH. World J Urol. 2006; 24:378–82.

15. Wilt T, Ishani A, MacDonald R, Stark G, Mulrow C, Lau J. Beta-sitosterols for benign prostatic hyperplasia. Cochrane Database Syst Rev. 2000; 2:CD001043.

16. Klippel KF, Hiltl DM, Schipp B. A multicentric, placebo-controlled, double-blind clinical trial of beta-sitosterol (phytosterol) for the treatment of benign prostatic hyperplasia. German BPH-Phyto Study group. Br J Urol. 1997; 80:427–32.

17. Yablonsky F, Nicolas V, Riffaud JP, Bellamy F. Antiproli-ferative effect of Pygeum africanum extract on rat prostatic fibroblasts. J Urol. 1997; 157:2381–7.

18. Chatelain C, Autet W, Brackman F. Comparison of once and twice daily dosage forms of Pygeum africanum extract in patients with benign prostatic hyperplasia: a randomized, double-blind study, with longterm open label extension. Urology. 1999; 54:473–8.

19. Breza J, Dzurny O, Borowka A, Hanus T, Petrik R, Blane G, et al. Efficacy and acceptability of Tadenan (Pygeum africanum extract) in the treatment of benign prostatic hyperplasia (BPH): a multicentre trial in central Europe. Curr Med Res Opin. 1998; 14:127–39.

20. Edgar AD, Levin R, Constantinou CE, Denis L. A critical review of the pharmacology of the plant extract of Pygeum africanum in the treatment of LUTS. Neurourol Urodyn. 2007; 26:458–63.

21. Habib FK, Ross M, Ho CK, Lyons V, Chapman K. Serenoa repens (Permixon) inhibits the 5alpha-reductase activity of human prostate cancer cell lines without interfering with PSA expression. Int J Cancer. 2005; 114:190–4.

22. Vela Navarrete R, Garcia Cardoso JV, Barat A, Manzarbeitia F, Lopez Farre A. BPH and inflammation: pharmacological effects of Permixon on histological and molecular inflammatory markers. Results of a double blind pilot clinical assay. Eur Urol. 2003; 44:549–55.

23. Debruyne F, Boyle P, Calais Da Silva F, Gillenwater JG, Handy FC, Perrin P, et al. Evaluation of the clinical benefit of Permixon and tamsulosin in severe BPH patients-PERMAL study subset analysis. Eur Urol. 2004; 45:773–9.

24. Zlotta AR, Teillac P, Raynaud JP, Schulman CC. Evaluation of male sexual function in patients with Lower Urinary Tract Symptoms (LUTS) associated with Benign Prostatic Hyperplasia (BPH) treated with a phytotherapeutic agent (Permixon), tamsulosin or finasteride. Eur Urol. 2005; 48:269–76.

25. Bent S, Kane C, Shinohara K, Neuhaus J, Hudes FS, Goldberg H, et al. Saw palmetto for benign prostatic hyperplasia. N Engl J Med. 2006; 354:557–66.

26. Sokeland J. Combined sabal and urtica extract compared with finasteride in men with benign prostatic hyperplasia: analysis of prostate volume and therapeutic outcome. BJU Int. 2000; 86:439–42.

27. Lopatkin N, Sivkov A, Walther C, Schlafke S, Medvedev A, Avedeichuk J, et al. Longterm efficacy and safety of a combination of sabal and urtica extract for lower urinary tract symptoms–a placebo-controlled, double-blind, multicenter trial. World J Urol. 2005; 23:139–46.

28. Carbajal D, Molina V, Mas R, Arruzazabala ML. Therapeutic effect of D-004, a lipid extract from Roystonea regia fruits, on prostate hyperplasia induced in rats. Drugs Exp Clin Res. 2005; 31:193–7.

29. Fujita R, Liu J, Shimizu K, Konishi F, Noda K, Kumamoto S, et al. Anti-androgenic activities of Ganoderma lucidum. J Ethnopharmacol. 2005; 102:107–12.

30. Shibata Y, Kashiwagi B, Arai S, Fukabori Y, Suzuki K. Administration of extract of mushroom Phellinus linteus induces prostate enlargement with increase in stromal component in experimentally developed rat model of benign prostatic hyperplasia. Urology. 2005; 66:455–60.

31. Kupiec T, Raj V. Fatal seizures due to potential herb-drug interactions with Ginkgo biloba. J Anal Toxicol. 2005; 29:755–8.

32. Ernst E, Pittler MH. Yohimbine for erectile dysfunction: a systematic review and metaanalysis of randomized clinical trials. J Urol. 1998; 159:433–6.

33. Susset JG, Tessier CD, Wincze J, Bansal S, Malhotra C, Schwacha MG. Effect of yohimbine hydrochloride on erectile impotence: a double-blind study. J Urol. 1989; 141:1360–3.

34. Kernohan AF, McIntyre M, Hughes DM, Tam SW, Worcel M, Reid JL. An oral yohimbine/L-arginine combination (NMI 861) for the treatment of male erectile dysfunction: a pharmacokinetic, pharmacodynamic and interaction study with intravenous nitroglycerine in healthy male subjects. Br J Clin Pharmacol. 2005; 59:85–93.

35. Kim JY, Lee HJ, Kim JS, Ryu JH. Induction of nitric oxide synthase by saponins of heat-processed ginseng. Biosci Biotechnol Biochem. 2005; 69:891–5.

36. Choi HK, Seong DH, Rha KH. Clinical efficacy of Korean red ginseng for erectile dysfunction. Int J Impot Res. 1995; 7:181–6.

37. Hong B, Ji YH, Hong JH, Nam KY, Ahn TY. A double-blind crossover study evaluating the efficacy of Korean red ginseng in patients with erectile dysfunction: a preliminary report. J Urol. 2002; 168:2070–3.

38. Klotz T, Mathers MJ, Braun M, Bloch W, Engelmann U. Effectiveness of oral L-arginine in first-line treatment of erectile dysfunction in a controlled crossover study. Urol Int. 1999; 63:220–3.

39. Stanislavov R, Nikolova V. Treatment of erectile dysfunction with pycnogenol and L-arginine. J Sex Marital Ther. 2003; 29:207–13.

40. Stothers L. A randomized trial to evaluate effectiveness and cost effectiveness of naturopathic cranberry products as prophylaxis against urinary tract infection in women. Can J Urol. 2002; 9:1558–62.

41. Jepson RG, Craig JC. A systematic review of the evidence for cranberries and blueberries in UTI prevention. Mol Nutr Food Res. 2007; 51:738–45.

42. Galeone C, Pelucchi C, Talamini R, Negri E, Montella M, Ramazzotti V, et al. Fibre intake and renal cell carcinoma: a case-control study from Italy. Int J Cancer. 2007; 121:1869–72.

43. Lee JE, Hunter DJ, Spiegelman D, Adami HO, Bernstein L, van den Brandt PA, et al. Intakes of coffee, tea, milk, soda and juice and renal cell cancer in a pooled analysis of 13 prospective studies. Int J Cancer. 2007; 121:2246–53.

44. Rashidkhani B, Akesson A, Lindblad P, Wolk A. Major dietary patterns and risk of renal cell carcinoma in a prospective cohort of Swedish women. J Nutr. 2005; 135:1757–62.

45. Kunze E, Chang-Claude J, Frentzel-Beyme R. Life style and occupational risk factors for bladder cancer in Germany. A case-control study. Cancer. 1992; 69:1776–90.

46. Chiu HF, Tsai SS, Yang CY. Nitrate in drinking water and risk of death from bladder cancer: an ecological case-control study in Taiwan. J Toxicol Environ Health A. 2007; 70:1000–4.

47. Bushman JL. Green tea and cancer in humans: a review of the literature. Nutr Cancer. 1998; 31:151–9.

48. Michaud DS, Spiegelman D, Clinton SK, Rimm EB, Willett WC, Giovannucci E. Prospective study of dietary supplements, macronutrients, micronutrients, and risk of bladder cancer in US men. Am J Epidemiol. 2000; 152:1145–53.

49. Kamat AM, Lamm DL. Chemoprevention of bladder cancer. Urol Clin North Am. 2002; 29:157–68.

50. Newling DW, Robinson MR, Smith PH, Byar D, Lockwood R, Stevens I, et al. Tryptophan metabolites, pyridoxine (vitamin B6) and their influence on the recurrence rate of superficial bladder cancer. Results of a prospective, randomised phase III study performed by the EORTC GU Group. EORTC Genito-Urinary Tract Cancer Cooperative Group. Eur Urol. 1995; 27:110–6.

51. Steineck G, Hagman U, Gerhardsson M, Norell SE. Vitamin A supplements, fried foods, fat and urothelial cancer. A case-referent study in Stockholm in 1985-87. Int J Cancer. 1990; 45:1006–11.

52. Jacobs EJ, Henion AK, Briggs PJ, Connell CJ, McCullough ML, Jonas CR, et al. Vitamin C and vitamin E supplement use and bladder cancer mortality in a large cohort of US men and women. Am J Epidemiol. 2002; 156:1002–10.

53. Zeegers MP, Goldbohm RA, Bode P, van den Brandt PA. Prediagnostic toenail selenium and risk of bladder cancer. Cancer Epidemiol Biomarkers Prev. 2002; 11:1292–7.

54. Zhou JR, Mukherjee P, Gugger ET, Tanaka T, Blackburn GL, Clinton SK. Inhibition of murine bladder tumorigenesis by soy isoflavones via alterations in the cell cycle, apoptosis, and angiogenesis. Cancer Res. 1998; 58:5231–8.

55. Sun CL, Yuan JM, Wang XL, Gao YT, Ross RK, Yu MC. Dietary soy and increased risk of bladder cancer: a prospective cohort study of men in Shanghai, China. Int J Cancer. 2004; 112:319–23.

56. Eng J, Ramsum D, Verhoef M, Guns E, Davison J, Gallagher R. A population-based survey of complementary and alternative medicine use in men recently diagnosed with prostate cancer. Integr Cancer Ther. 2003; 2:212–6.

57. Chan JM, Elkin EP, Silva SJ, Broering JM, Latini DM, Carroll PR. Total and specific complementary and alternative medicine use in a large cohort of men with prostate cancer. Urology. 2005; 66:1223–8.

58. Kirsh VA, Mayne ST, Peters U, Chatterjee N, Leitzmann MF, Dixon LB, et al. A prospective study of lycopene and tomato product intake and risk of prostate cancer. Cancer Epidemiol Biomarkers Prev. 2006; 15:92–8.

59. Heinonen OP, Albanes D, Virtamo J, Yaylor PR, Huttunen JK, Hartman AM, et al. Prostate cancer and supplementation with alpha-tocopherol and beta-carotene: incidence and mortality in a controlled trial. J Natl Cancer Inst. 1998; 90:440–6.

60. Giovannucci E. Gamma-tocopherol: a new player in prostate cancer prevention? J Natl Cancer Inst. 2000; 92:1966–7.

61. Waters DJ, Shen S, Cooley DM, Bostwick DG, Quian J, Combs GF, et al. Effects of dietary selenium supplementation on DNA damage and apoptosis in canine prostate. J Natl Cancer Inst. 2003; 95:237–41.

62. Chun JY, Nadiminty N, Lee SO, Onate SA, Lou W, Gao AC. Mechanisms of selenium down-regulation of androgen receptor signaling in prostate cancer. Mol Cancer Ther. 2006; 5:913–8.

63. Lippman SM, Goodman PJ, Klein EA, Parnes HL, Thompson IM Jr, Kristal AR, et al. Designing the Selenium and Vitamin E Cancer Prevention Trial (SELECT). J Natl Cancer Inst. 2005; 97:94–102.

64. Jatoi A, Ellison N, Burch PA, Sloan JA, Dakhil SR, Novotny P, et al. A phase II trial of green tea in the treatment of patients with androgen independent metastatic prostate carcinoma. Cancer. 2003; 97:1442–6.

65. Albrecht M, Jiang W, Kumi-Diaka J, Lansky EP, Gommersall LM, Patel A, et al. Pomegranate extracts potently suppress proliferation, xenograft growth, and invasion of human prostate cancer cells. J Med Food. 2004; 7:274–83.

66. Pantuck AJ, Leppert JT, Zomorodian N, Aronson W, Hong J, Barnard RJ, et al. Phase II study of pomegranate juice for men with rising prostate-specific antigen following surgery or radiation for prostate cancer. Clin Cancer Res. 2006; 12:4018–26.

67. Kumar NB, Cantor A, Allen K, Riccardi D, Besterman-Dahan K, Saigne J, et al. The specific role of isoflavones in reducing prostate cancer risk. Prostate. 2004; 59:141–7.

68. Leitzmann MF, Stampfer MJ, Wu K, Colditz GA, Willett WC, Giovannucci EL. Zinc supplement use and risk of prostate cancer. J Natl Cancer Inst. 2003; 95:1004–7.

69. Schoonen WM, Salinas CA, Kiemeney ALM, Stomford JL. Alcohol consumption and risk of prostate cancer in middle-aged men. Int J Cancer. 2005; 113:133–40.