Health Care Professional Information

Scientific Name
Pygeum africanum, Prunus africana
Common Name

African plum tree

Brand Name

Tadenan®

Clinical Summary

Derived from the tree bark, 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 the androgen receptor (7), and have antiproliferative and apoptotic effects against prostate cancer cells (8) (9) (10) (13).
Clinical studies suggest effectiveness of pygeum (4) (5) (6) (11) and formulations containing pygeum and other herbs (14) in improving urinary symptoms associated with BPH. However, additional larger studies are needed to demonstrate usefulness of pygeum compared to standard treatments in current use for BPH.

Purported Uses
  • Benign prostatic hypertrophy (BPH)
  • Inflammation
  • Sexual performance
Constituents
  • Atraric acid, lauric acid, myristic acid, n-docosanol, ferulic acid, β-sitostenone, β-sitosterol, and ursolic acid
  • N-butylbenzene-sulfonamide
    (7) (15) (16)
Mechanism of Action

Pygeum antagonizes 5-lipoxygenase metabolite production, and it is thought that this ability may contribute to some of its anti-inflammatory effects (17). Atraric acid and N-butylbenzene-sulfonamide, compounds isolated from pygeum, were identified as antagonists of androgen receptor, which plays an important role in development of prostate diseases (12).
The antiproliferative and apoptotic effects of pygeum on prostate fibroblasts and myofibroblasts have been shown to be due to downregulation of transforming growth factor B1 (TGFB1) and inhibition of fibroblast growth factor 2 (FGF2) specific signaling (10).

Adverse Reactions
Literature Summary and Critique

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.
A total of 18 randomized, controlled trials involving 1,562 men were analyzed. Seventeen of the studies were double-blind. The mean study duration was 64 days. Compared with placebo in 6 studies, Pygeum africanum provided a moderately large improvement in the combined outcome of urologic symptoms and flow measures. Nocturia was reduced by 19% and residual urine volume by 24%; peak urine flow increased by 23%. Adverse effects due to Pygeum africanum were similar to placebo.

Dosage (Inside MSKCC Only)
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References
  1. 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.
  2. Schulz V, et al. Rational Phytotherapy: A Physicians Guide to the Use of Herbs and Related Remedies, 3rd ed. Berlin (Germany): Springer; 1998.
  3. Fagelman E, Lowe FC. Herbal medications in the treatment of benign prostatic hyperplasia (BPH). Urol Clin N Am 2002;29:23-9.
  4. 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.
  5. 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.
  6. 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.
  7. 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.
  8. 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.
  9. 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.
  10. 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.
  11. Wilt T, Ishani A, Mac Donald R, Rutks I, Stark G. Pygeum africanum for benign prostatic hyperplasia. Cochrane Database Syst Rev. 2002;(1):CD001044.
  12. 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.
  13. Larré S, Camparo P, Comperat E, et al. Biological effect of human serum collected before and after oral intake of Pygeum africanum on various benign prostate cell cultures. Asian J Androl. 2012 May;14(3):499-504.
  14. Coulson S, Rao A, Beck SL, et al. A phase II randomised double-blind placebo-controlled clinical trial investigating the efficacy and safety of ProstateEZE Max: a herbal medicine preparation for the management of symptoms of benign prostatic hypertrophy. Complement Ther Med. 2013 Jun;21(3):172-9.
  15. Papaioannou M, Schleich S, Roell D, et al.NBBS isolated from Pygeum africanum bark exhibits androgen antagonistic activity, inhibits AR nuclear translocation and prostate cancer cell growth. Invest New Drugs. 2010 Dec;28(6):729-43.
  16. Kadu CA, Parich A, Schueler S, Konrad H, et al. Bioactive constituents in Prunus africana: geographical variation throughout Africa and associations with environmental and genetic parameters. Phytochemistry. 2012 Nov;83:70-8.
  17. Paubert-Braquet M, Cave A, Hocquemiller R, et al. Effect of Pygeum africanum extract on A23187-stimulated production of lipoxygenase metabolites from human polymorphonuclear cells. J Lipid Mediat Cell Signal. 1994 May;9(3):285-90.

Consumer Information

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.

Purported Uses
  • 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.
Research Evidence

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%.

 

Side Effects
Special Point
  • When used for benign prostatic hypertrophy (BPH), it may take several weeks to see any beneficial effects.
E-mail your questions and comments to aboutherbs@mskcc.org.