Health Care Professional Information
Pygeum africanum, Prunus africana
Derived from the bark of the tree, pygeum extracts are traditionally used to manage lower urinary tract symptoms associated with benign prostatic hypertrophy (BPH).
In vitro and in vivo studies indicate that pygeum extracts antagonize androgen receptor (7), and have antiproliferative and apoptotic effects against prostate cancer cells (8) (9) (10).
Clinical studies suggest improvement in urinary symptoms associated with BPH (4) (5) (6) (11). However, additional larger studies are needed to demonstrate usefulness of pygeum compared to standard treatments in current use for BPH.
- Benign prostatic hypertrophy (BPH)
- Sexual performance
- Triterpenes (14%): Oleanolic, crataegolic, and ursolic acids
- Ferulic acid
- Phytosterols: Beta-sitosterol, beta-sitosterone and campesterol
Mechanism of Action
Phytosterols present in pygeum compete with androgen precursors and also inhibit prostaglandin biosynthesis thereby reducing inflammation. The triterpenes exhibit anti-inflammatory activity in vitro and ferulic acid esters were shown to reduce the level of cholesterol in the prostate, thereby limiting androgen synthesis. The phytosterol and triterpene components appear to work synergistically to improve the symptoms of BPH (2). Atraric acid and N-butylbenzene-sulfonamide, compounds isolated from Pygeum, have been identified as antagonists of androgen receptor, which plays an important role in development of prostate diseases (12).
Literature Summary and Critique
Dosage (Inside MSKCC Only)
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- Foster S, et al. Tyler's Honest Herbal: A Sensible Guide to the Use of Herbs and Related Remedies. New York: Haworth Herbal Press; 1999.
- Schulz V, et al. Rational Phytotherapy: A Physicians Guide to the Use of Herbs and Related Remedies, 3rd ed. Berlin (Germany): Springer; 1998.
- Fagelman E, Lowe FC. Herbal medications in the treatment of benign prostatic hyperplasia (BPH). Urol Clin N Am 2002;29:23-9.
- Ishani A, et al. Pygeum africanum for the treatment of patients with benign prostatic hyperplasia: a systematic review and quantitative meta-analysis. Am J Med 2000;109:654-64.
- Brackman F, et al. Comparison of once and twice daily dosage forms of Pygeum africanum extract in patients with benign prostatic hyperplasia: a randomized, double-blind study, with long-term open label extension. Urology 1999;54:473-8.
- Barlet A, et al. Efficacy of Pygeum africanum extract in the medical therapy of urination disorders due to benign prostatic hyperplasia: evaluation of objective and subjective parameters. A placebo-controlled double-blind multicenter study. Wien Klin Wochenshr 1990;102:667-73.
- Papaioannou M, Schleich S, Prade I, et al. The natural compound atraric acid is an antagonist of the human androgen receptor inhibiting cellular invasiveness and prostate cancer cell growth. J Cell Mol Med. 2009 Aug;13(8B):2210-23.
- Boulbès D, Soustelle L, Costa P, et al. Pygeum africanum extract inhibits proliferation of human cultured prostatic fibroblasts and myofibroblasts. BJU Int. 2006 Nov;98(5):1106-13.
- Shenouda NS, Sakla MS, Newton LG, et al. Phytosterol Pygeum africanum regulates prostate cancer in vitro and in vivo. Endocrine. 2007 Feb;31(1):72-81.
- Quiles MT, Arbós MA, Fraga A, et al. Antiproliferative and apoptotic effects of the herbal agent Pygeum africanum on cultured prostate stromal cells from patients with benign prostatic hyperplasia (BPH). Prostate. 2010 Jul 1;70(10):1044-53.
- Wilt T, Ishani A, Mac Donald R, Rutks I, Stark G. Pygeum africanum for benign prostatic hyperplasia. Cochrane Database Syst Rev. 2002;(1):CD001044.
- Roell D, Baniahmad A. The natural compounds atraric acid and N-butylbenzene-sulfonamide as antagonists of the human androgen receptor and inhibitors of prostate cancer cell growth. Mol Cell Endocrinol. 2011 Jan 30;332(1-2):1-8.
How It Works
Bottom Line: Pygeum africanum relieves the symptoms of benign prostatic hypertrophy (BPH). Its effects following long-term use are not known.
Several compounds present in Pygeum africanum reduce inflammation by stopping the production of prostaglandins, indicators of inflammation in the body. These compounds also work synergistically to reduce levels of testosterone in the prostate. This is why Pygeum is used to treat benign prostatic hypertrophy (BPH), in which growth of the prostate is enhanced by testosterone.
- To treat benign prostatic hypertrophy (BPH)
Several clinical trials show that Pygeum africanum is effective in improving urination symptoms in patients with BPH. But the long-term effectiveness and safety of this herb are not known.
- To reduce inflammation
Laboratory studies show that chemicals in pygeum have anti-inflammatory effects, but human data are lacking.
- To improve sexual performance
No scientific evidence supports this use.
Benign prostatic hypertrophy (BPH):
A meta-analysis, which is a systematic review of all of the clinical trials that have been performed with a therapy, looked at the use of Pygeum africanum to treat benign prostatic hypertrophy (BPH). In six out of the 18 randomized, controlled trials that were analyzed, Pygeum africanum was more effective at relieving urinary symptoms than a placebo pill, with no major side effects. For example, nocturia (waking up at night to urinate) was reduced by 19% and urine flow increased by 23%.
- When used for benign prostatic hypertrophy (BPH), it may take several weeks to see any beneficial effects.
Last updated: September 28, 2012