From the April 2001 Issue of Nutrition Science News
Richard N. Podell, M.D.
Burning prostate pain may not be a topic men often discuss, but it is a symptom of prostatitis, which affects about 5 percent of men and accounts for some 2 million medical visits in the United States every year. What's more, this inflammationknown as chronic prostatitiscan affect adult males of every age, not just older men.
Chronic prostatitis is a frustrating health problem because treatment options are poor. Most physicians prescribe multiple courses of antibiotics, which are modestly effective at best. Antibiotics fail largely because not all prostate distress is caused by bacteria. A large subgroup of men with chronic prostate symptoms has what the National Institutes of Health now calls prostatitis/category III: chronic prostatitis/chronic pelvic pain syndrome. What distinguishes this condition is an absence of bacteria found in the prostate fluidso, not surprisingly, antibiotics do not help.
A High-Priority Nutrient
But there are promising therapies on the horizon. Quercetin, a naturally occurring bioflavonoid found in apples, black tea, and onions, was tested as a treatment for chronic prostatitis in a nonblinded study by researchers at the Institute for Male Urology in Encino, Calif. In the trial, an encouraging 59 percent of the subjects improved.  In light of these results, Daniel Shoskes, M.D., and Jacob Rajfer, M.D., from the Division of Urology, HarborUCLA Medical Center in Los Angeles, decided to do a proper double-blind test of quercetin vs. placebo.
The researchers put 15 category III prostatitis patients on a twice-daily dose of 500 mg quercetin and 15 on placebo for one month. Two patients taking placebo dropped out because their symptoms worsened, whereas all those in the quercetin group remained. All 28 patients who completed the study noted decreased prostate symptoms including pain, voiding dysfunction, and impact on quality of life. In the quercetin group, symptom scores decreased significantly, by an average of about 40 percent, compared to an insignificant decrease of 6 percent for those taking placebo. 
This study appeared as a "rapid communication"meaning high priorityin Urology, the leading U.S. urology journal. What's intriguing is that this prestigious journal accepted the quercetin study despite Shoskes and Rajfer's disclosure that they owned stock in a company that sells a quercetin product. The quercetin used in this double-blind study was not the same product as theirs. However, they conducted another small trial using 500 mg of the branded product twice daily for one month, to treat chronic prostatitis in 17 patients. The open study found that 82 percent of men had at least 25 percent improvement on their symptom scores.
The branded product from the third study is a combination of quercetin with the enzymes bromelain and papain. Shoskes states, "The latter two compounds are known to increase the absorption of bioflavanoids." Hence the interesting combination.
Did the double-blind research on a product (quercetin) in which they had an indirect financial interest represent a conflict of interest for Shoskes and Rajfer? You bet! Did their conflict of interest help or hurt the public's health and the knowledge base of science? I say it helped much more than it hurtand that's what drives pharmaceutical firms to fund research. I believe that's how the system works and is supposed to work, provided that integrity is always assured.
In this case the researchers' ethics satisfied the editors of a very demanding journal, allowing them to educate urologists on this consequential work. If that kind of open-mindedness ever became the rule, who knows, we might yet find ourselves hailed as heroes by the mainstream medical communitiy.
On the other hand, prostatitis researchers were recently asked to rank their research priorities with 5 at the top and 1 at the bottom. Despite their poor track record so far, more research on antibiotics was rated 4.4. Physiotherapy such as quercetin ranked only 2.5. But, at least it beat out psychotherapy as a prostate-related treatment"it's all in your head" research scored only 2.1. 
Richard N. Podell, M.D., M.P.H., is director of the Podell Medical Center in New Providence, N.J.
1. Shoskes D. Use of bioflavonoid quercetin in patients with long-standing chronic prostatitis J Am Neutraceut Assoc 1999;2:18-21.
2. Shoskes D, et al. Quercetin in men with category III chronic prostatitis. A preliminary prospective double-blind placebo-controlled trial. Urology 1999;54:960-3.
3. Nickel, et al. For the International Prostatitis Collaborative Network, research guidelines for chronic prostatitis: consensus report from the First National Institutes of Health International Prostatitis Collaborative Network. Urology 1999;54:229-33