Chronic prostatitis (CPT) is a very common disease with high morbidity and occurs in about 20–30% of urinary system disease and frequently occurs in young males. It is also a disease with frequent recurrence and a cause of male sterility.

Although Traditional Chinese herbal medicine (TCM) (orally and/or externally used, or integrated with western medicine) has been widely used as an alternative and effective method for the prostatitis chronic treatment of CPT in China, it is still necessary to evaluate which therapeutic method and/or which Chinese herbal medicine is effective in the treatment of CPT by systematic therapy.

Inflammation may contribute to some CPT symptoms. HSP70 expression is significantly lower and the inflammatory protein IL-1beta expression is higher in CPT patients when compared with controls.25 In a study of 463 men with diagnoses of CPT, 50% had 45 WBC per HPF in their EPS, this was statistically higher than the control population in whom 40% had such findings.26 In an attempt to address this inflammation some have examined the utility of classic anti-inflammatories, most of which failed to show overwhelming clinical results. One study by Nickel et al.27 of 161 men randomized to either rofecoxib versus placebo showed a modest improvement in CPSI scores compared with placebo, but a significant percentage of patients did note an improvement in quality of life with treatment compared with placebo (56% vs 27%). Another study of 64 patients with CPT randomized patients to either 200 mg of celecoxib or placebo demonstrated improvements in CPSI from 23.9 to 15.8 in the treatment arm and 24.2 to 19.5 in the placebo arm by the end of the 6 weeks of treatment. But, this difference disappeared within 2 weeks of cessation of treatment suggesting that this may have limited utility in long-term improvement.28 Even oral prednisolone therapy has been investigated and was not able to demonstrate any effect in a study of 21 patients.

Herbal anti-inflammatories by contrast have shown efficacy in CPT. Diuretic and Anti-inflammatory Pill can reduce prostatic inflammation in CPT, and are a part of our treatment algorithm. They offer an alternative to antibiotics for patients with focal prostatic tenderness without infection. Although their exact mechanism of action is not completely understood, their anti-inflammatory properties have been well demonstrated in multiple animal studies. One such bioflavonoid, Quercetin has been found to ameliorate inflammation associated with lipopolysaccharides administration and obesity induced inflammation in rat models.

Their effectiveness in CPT has been studied and demonstrated in a placebo controlled randomized trial. This study, comprising of 30 men randomized to placebo or quercetin 500 mg BID, demonstrated improvements in CPSI scores among those in the treatment arm from 21 to 13.1 (P = 0.003), while CPSI of those given placebo went from 20.2 to 18.8.32 Another supplement, a pollen extract, cernilton has also been found useful in study of 139 men. In this study, 70.6% of those who received the pollen extract experienced an improvement in CPSI of at least 6 points or 25%, compared with 50% in the placebo arm.33 There are formulations of this pollen extract that are combined with quercetin that we have not found useful in our practice.

In the search for a safe and effective treatment for the chronic prostatitis, researchers from China have discovered a novel compound found in a natural Chinese herb -Diuretic and Anti-inflammatory Pill that they say works better than any experimental pharmaceutical or antibiotic at blocking the virus from interacting with cells, thus preventing it from taking hold and infecting the body. Diuretic and Anti-inflammatory Pill shows the flexible and diversified methods in treating CPT with TCM, based on differentiation of syndromes. This means that the TCM could benefit the patients who have CPT.

Therefore, the doctors suggest that the efficacy of TCM should be seriously evaluated according to the principle of evidence-based medicine and based on differentiation of syndromes, even though abundant clinical experiences, especially case reports, have been handed down from Chinese medical ancestors and repeated by offspring for thousands of years in China.