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) (1). In vitro and in vivo studies indicate that pygeum extracts have bactericidal and fungicidal activity (2), antagonize the androgen receptor (3), and have antiproliferative and apoptotic effects against prostate cancer cells (4) (5) (6) (7). Clinical studies suggest effectiveness of pygeum (8) (9) (10) (11) and formulations containing pygeum and other herbs (12) to improve urinary symptoms associated with BPH. However, additional larger studies are needed to demonstrate usefulness of pygeum compared with 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
    (3) (13) (14)
Mechanism of Action

Pygeum antagonizes 5-lipoxygenase metabolite production, and this action may contribute to its anti-inflammatory effects (15). Antimicrobial effects have been linked to inhibition of IL-7 mRNA expression (2).

The isolated compounds atraric acid and N-butylbenzene-sulfonamide were identified as androgen receptor antagonists, which play an important role in the development of prostate diseases (16).

Antiproliferative and apoptotic effects of pygeum on prostate fibroblasts and myofibroblasts are due to downregulation of transforming growth factor B1 (TGFB1) and inhibition of fibroblast growth factor 2 (FGF2)-specific signaling (6).

Adverse Reactions
  • Nausea and gastrointestinal upset (8) (9) (10)
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)
This field is only visible to only OneMSK users.
References
  1. Abera B. Medicinal plants used in traditional medicine by Oromo people, Ghimbi District, Southwest Ethiopia. J Ethnobiol Ethnomed. 2014;10:40. doi: 10.1186/1746-4269-10-40
  2. Mwitari PG, Ayeka PA, Ondicho J, et al. Antimicrobial activity and probable mechanisms of action of medicinal plants of Kenya: Withania somnifera, Warbugia ugandensis, Prunus africana and Plectrunthus barbatus. PLoS One. 2013;8(6):e65619. doi: 10.1371/journal.pone.0065619
  3. 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. Aug 2009;13(8B):2210-2223. doi: 10.1111/j.1582-4934.2008.00426.x
  4. Boulbes D, Soustelle L, Costa P, et al. Pygeum africanum extract inhibits proliferation of human cultured prostatic fibroblasts and myofibroblasts. BJU Int. Nov 2006;98(5):1106-1113. doi: 10.1111/j.1464-410X.2006.06483.x
  5. Shenouda NS, Sakla MS, Newton LG, et al. Phytosterol Pygeum africanum regulates prostate cancer in vitro and in vivo. Endocrine. Feb 2007;31(1):72-81. 
  6. Quiles MT, Arbos 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. Jul 1 2010;70(10):1044-1053. doi: 10.1002/pros.21138
  7. Larre 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. May 2012;14(3):499-504. doi: 10.1038/aja.2011.132
  8. Ishani A, MacDonald R, Nelson D, et al. Pygeum africanum for the treatment of patients with benign prostatic hyperplasia: a systematic review and quantitative meta-analysis. Am J Med. Dec 1 2000;109(8):654-664. 
  9. 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 long-term open label extension. Urology. Sep 1999;54(3):473-478. 
  10. Barlet A, Albrecht J, Aubert 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 Wochenschr. Nov 23 1990;102(22):667-673. 
  11. Wilt T, Ishani A, Mac Donald R, et al. Pygeum africanum for benign prostatic hyperplasia. Cochrane Database Syst Rev. 2002(1):CD001044. doi: 10.1002/14651858.CD001044
  12. 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. Jun 2013;21(3):172-179. doi: 10.1016/j.ctim.2013.01.007
  13. 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. Dec 2010;28(6):729-743. doi: 10.1007/s10637-009-9304-y
  14. Kadu CA, Parich A, Schueler S, et al. Bioactive constituents in Prunus africana: geographical variation throughout Africa and associations with environmental and genetic parameters. Phytochemistry. Nov 2012;83:70-78. doi: 10.1016/j.phytochem.2012.06.001
  15. 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. May 1994;9(3):285-290. 
  16. 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. Jan 30 2011;332(1-2):1-8. doi: 10.1016/j.mce.2010.09.013

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 BPH. In 6 of 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, the need to wake 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.