Effects of pumpkin on benign prostatic hyperplasia: a systematic review and meta- analysis

Abstract

Introduction: Benign prostatic hyperplasia (BPH) is a common condition affecting aging men worldwide. Pumpkin and its extracts are enriched with antioxidant, anti-androgenic and anti-inflammatory properties.Objectives: To systematically review the effect of pumpkin on the reduction of lower urinary tract symptoms (LUTS) due to bladder outflow obstruction in BPHMethods: The review (PROSPERO ID: CRD42020181395) perused PubMed, EMBASE, Cochrane Library, CINAHL and AGRICOLA databases in two rounds independently by two reviewers according to three screening questions: being a pumpkin related human study, having BPH related outcomes and including quantifiable measurements. Risk of bias assessments were done with GRADE and ROBINS-I Criteria. After assessing the clinical, methodological and statistical heterogeneity, meta-analysis was performed for one outcome with mean difference (MD) using Inverse Variance Method with Review Manager 5.4 software.Results: Out of the 242 articles with de-duplication and screening questions, 10 based on interventional studies among adult males with LUTS were selected in ??third round (8 on pumpkin seeds alone; 2 on pumpkin combined products). International Prostate Symptoms Score (IPSS) was described in nine articles. Other outcomes assessed were quality of life (QOL), prostate volume, Prostate Specific Antigen (PSA), uroflow rate, post-voidal residual volume, frequency of micturition during day and night, nocturia and erectile dysfunction. Meta-analysis of three studies (650 and 631 subjects in experimental and control groups) was performed for IPSS reduction. Pooled MD (I2=0%) was -1.41 (95% CI: -1.97, -0.85) with random effect assumption. In all relevant studies, the intervention group demonstrated significant IPSS reduction and increased QOL. One study each demonstrated significant reduction in prostate volume and residual volume; three studies in uroflow rate; and none on PSA improvement.Conclusions & Recommendations: Pumpkin seeds may be beneficial in reducing IPSS and to some extent in improving prostate and residual volume, uroflow rate and QOL in BPH. Further studies are needed to strengthen the hypothesis.