Novel tomato-based supplement shows potential for BPH treatment

Consumption of a newly developed whole tomato‑based food supplement* (WTFS) led to improvements in lower urinary tract symptoms** (LUTS) and quality of life (QoL) in men with benign prostatic hyperplasia (BPH), a phase II Italian study has shown.

“LUTS … can significantly affect patients’ QoL,” noted the researchers. Although BPH is not considered premalignant, evidence points to a link between BPH and increased risks of prostate cancer incidence and mortality in a study evaluating >3 million men followed for nearly 3 decades. [Eur Urol 2011;60:691-698]

A third of men are unresponsive to the available pharmacologic treatment alternatives for LUTS (eg, α-adrenergic antagonists, 5α reductase inhibitors). [N Engl J Med 2003;349:2387-2398] For those who do respond, their adherence to treatment may be countered by adverse effects. Resistance to these agents may warrant surgical intervention.

“[Our findings] demonstrated that WTFS confers a significant improvement [in LUTS] and QoL in BPH patients, thus representing a suitable alternative to pharmacologic treatment of this age-related pathology,” said the researchers.

Forty men with histologically confirmed BPH were randomized 1:1 to consume a 5-gram sachet of WTFS or placebo (ie, orange/maltodextrin) daily for 2 months. All but one placebo recipient completed the regimen. [J Transl Med 2021;doi:10.1186/s12967-020-02684-3]

Men receiving WTFS had a significant drop in mean IPSS*** (from 9.05 to 7.15; p_two-tailed<0.001) vs those on placebo (from 13.89 to 13.79; p=0.607). Specifically, WTFS significantly reduced urinary frequency (p=0.002), urgency (p<0.0001), and nicturia (p=0.005), resulting in a substantial QoL improvement among WTFS recipients (p<0.0001).

A trend towards a reduction in total prostate-specific antigen (PSA) level was observed among WTFS recipients (from 8.98 to 6.95 ng/mL; p=0.065), more so in a subset of men with baseline PSA levels of >10 ng/mL (from 18.52 vs 10.32 ng/mL; p=0.009). Conversely, the placebo arm saw a trend towards an increase in total PSA level (from 6.83 to 8.05 ng/mL; p=0.114).

These findings imply that WTFS can regulate total PSA concentrations even in men with BPH, noted the researchers. Also, these correlate with evidence showing reductions in PSA levels among men with prostate cancer consuming tomato-based interventions. [Nutr Cancer 2007;57:130-137; Clin Nutr 2017;36:672-679]

The anti-inflammatory and antioxidant effects of WTFS may be attributed to the battery of polyphenols, bioactive compounds, and micronutrients found in tomatoes and olives. [Front Pharmacol 2017;8:234; Environ Mol Mutagen 2018;59:427-437; Arch Biochemical Biophys 2004;430:127-134; Phytomedicine 2018;47:135-142]

Whole vs supplements

Despite its proven benefits, consumption of tomatoes and its derivatives is tied to gastrointestinal disturbances (eg, gastro-oesophageal reflux disease, irritable bowel syndrome), kidney stones, and urinary disorders. [Nutrition 2019;62:201-208] Also, culinary preparations involving tomatoes are usually accompanied by high carbohydrate and calorie content, thus presenting a risk factor for people with metabolic issues (eg, obesity, metabolic syndrome), the researchers pointed out.

With WTFS, the patented preparation process behind its production renders a supplement that has been rid of organic acids, significant potassium/oxalate concentrations, and tomato skin/seeds that may be responsible for the side effects of tomato consumption, the researchers explained.

Apart from generating more bioavailable cis-lycopene and increased tomato phenolic components, the resultant FruHis compounds from the WTFS production process further enhance the health-preserving properties of tomatoes. [Cancer Res 2008;68:4384-4391] “Thus, WTFS is likely to possess a spectrum of cooperative mechanisms,” they said.

Overall, the current findings imply that WTFS, either alone or in conjunction with currently available treatments, may help maintain prostate health, noted the researchers. Also, the antioxidant component of WTFS may help counter the effects of excess free radicals triggered by certain risk factors (ie, metabolic syndrome, which is associated with BPH).

“Furthermore, [WTFS] may be an ideal candidate to develop a variety of tomato-based enriched foods to delay the onset and/or to attenuate the course of age-related chronic degenerative diseases,” they added.