Prunus africana, or African plum, was formerly classified as Pygeum africanum— a name under which it is still often known. In the Western world, an extract of Prunus africana bark is most popularly used for benign prostate hyperplasia (BPH, or prostate enlargement). Traditional uses include treatment of fever, malaria, wounds, stomach upset, kidney disease, and more.
History of Pygeum
“Pygeum africanum, a member of the Rosaceae family, is an evergreen species found across the entire continent of Africa at altitudes of 3,000 feet or higher,” reports Alternative Medicine Review. “Interest in the species began in the 1700s when European travelers learned from South African tribes how to soothe bladder discomfort and treat ‘old man’s disease’ with the bark of P. africanum … Pygeum is … [a] commonly used medicine in France for BPH, backed by many double-blind studies pointing to its efficacy for reducing its symptoms.”1
Early scientific research documented a benefit for Prunus africana in combination with a locally acting nonsteroidal anti-inflammatory drug known as benzidamine among patients suffering from prostate disorders.2 The researchers noted that good results were achieved in 90% of the cases and that there was no toxicity. Another early human study found improvements in nighttime urinary frequency, difficulty in starting urination, and incomplete emptying of the bladder in men given Pygeum extract.3
Clinical Trials with Pygeum
In 1990, the results of a multicenter, double-blind trial were published. This study included men with BPH and found improvements in urine flow, residual urine, and urination frequency at more than twice the rate in participants who received Pygeum extract for 60 days compared to a placebo group.4 The following year, a paper was published detailing the results of a trial that investigated Pygeum’s effects among men with either BPH or chronic inflammation of the prostate. In this study, Pygeum administration improved all urinary parameters investigated, including periurethral swelling.5 Another trial found an improvement in symptoms of BPH with a combination of Pygeum and Urtica dioica (nettle) root extract after 28 and 56 days.6
A multicenter trial reported in 1998 that included 85 men from the ages of 50 to 75 who received Pygeum for two months found a 40% improvement in International Prostate Symptom Scores and a 31% increase in quality of life after two months.7 Nighttime urination decreased by 32%, and improvements were observed in average maximum urinary flow, average urinary flow, and urinary volume. The changes exceeded those observed in association with a placebo in earlier studies and were still evident at an evaluation one month after the treatment was discontinued.
A meta-analysis published in December 2000 that included 18 randomized, controlled trials involving a total of 1,562 men found that subjects treated with Pygeum were more than twice as likely to report an improvement in overall symptoms than the control subjects. The investigators concluded that P. africanum significantly improves urologic symptoms and flow measures.8
Mechanisms of Action: How it Works
Pygeum, like saw palmetto, contains beta-sitosterol, which inhibits the enzyme 5 alpha-reductase that facilitates the conversion of testosterone to dihydrotestosterone (DHT), the hormone that is the cause of BPH.1,9-11 In research involving rats treated with DHT, pretreatment with Pygeum extract decreased the obstructive effects of DHT on urination and counteracted DHT-induced prostate enlargement.12 Pygeum has also shown an inhibitory effect against aromatase, an enzyme involved in the synthesis of estrogens, including the transformation of testosterone to estradiol.13
In rat prostate cells, Pygeum was shown to inhibit proliferation resulting from various growth factors. The researchers concluded that “Pygeum africanum is a potent inhibitor of rat prostatic fibroblast proliferation in response to direct activators of protein kinase C, the defined growth factors bFGF, EGF, and IGF-I, and the complex mixture of mitogens in serum depending on the concentration used. Protein kinase C activation appears to be an important growth factor¬¬–¬mediated signal transduction for this agent. These data suggest the therapeutic effect of Pygeum africanum may be due at least in part to the inhibition of growth factors responsible for the prostatic overgrowth in man.”14
Potential Anticancer Effects
In a paper published in 2007, researchers at the University of Missouri observed that extracts of Pygeum inhibited growth in two different prostate cancer cell lines, while inducing apoptosis (programmed cell death) and other changes. In the results from a mouse model of prostate cancer that was published in this same paper, animals that were fed Pygeum had a greater than 27% lower incidence of prostate cancer than a control group given casein.15
A review of Pygeum bark compounds identified ursolic acid, oleanolic acid, atraric acid, ferulic acid, N-butylbenzene-sulfonamide (NBBS), beta-sitosterol, and lauric acid as having the potential to aid in the prevention and treatment of prostate cancer. “Through synergistic interactions between different effective phytochemicals, P. Africana extracts have been shown to exhibit very strong antiandrogenic and antiangiogenic activities and have the ability to kill tumor cells via apoptotic pathways, prevent the proliferation of prostate cancer cells, and alter the signaling pathways required for the maintenance of prostate cancer cells,” write authors Richard Komakech and colleagues.16
Although Pygeum’s potential effects in prostate cancer appear worthy of investigation, it is recommended that men diagnosed with the disease follow the treatment regimen recommended by their physicians.
The Bottom Line
For men whose prostate enlargement is benign and not severe, Pygeum extract may be worth a trial. It takes a few months for symptoms to improve, so don’t give up too soon!
A double-blind trial that compared the effects of 50 milligrams of Pygeum twice per day and 100 milligrams once daily found that both treatments were associated with similar improvements in International Prostate Symptom Score, quality of life, and maximum urinary flow rate.17
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- Komakech R et al. Evid Based Complement Alternat Med. 2017;2017:3014019.
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