Pretreatment Factors Associated With Pain Improvement After Cernitin Pollen Extract Therapy in Men With Chronic Prostatitis/Chronic Pelvic Pain Syndrome: A Post Hoc Analysis

Objectives Cernitin pollen extract is used for chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS), but pretreatment factors associated with pain improvement remain unclear. This study explored baseline factors associated with clinically meaningful pain relief after cernitin therapy in men with CP/CPPS. Methods This exploratory post hoc analysis was based on a single‐center, open‐label, randomized prospective trial conducted between July 2017 and December 2018. Men with persistent CP/CPPS despite at least 12 weeks of α1‐blocker therapy were randomized to receive add‐on cernitin pollen extract or tadalafil for 12 weeks. The present analysis included 42 men assigned to cernitin. Good responders were defined as patients with a ≥ 50% improvement in the National Institutes of Health Chronic Prostatitis Symptom Index (NIH‐CPSI) pain subscore. Baseline variables were compared, and exploratory logistic regression analysis with a limited number of covariates was performed. Results Among 42 patients, 21 were good responders and 21 were poor responders. The NIH‐CPSI pain subscore improved by 67.0% in good responders and by 28.9% in poor responders ( p < 0.001). Baseline serum total testosterone was significantly lower in good responders than in poor responders (4.5 ± 2.9 vs. 6.3 ± 2.4 ng/mL; p = 0.006). In exploratory multivariable analysis, lower serum total testosterone remained the only factor associated with clinically meaningful pain improvement (odds ratio 0.53, 95% confidence interval 0.30–0.95; p = 0.033). Conclusions Lower pretreatment serum total testosterone was associated with clinically meaningful pain improvement after cernitin therapy. These findings are hypothesis‐generating and require validation in larger prospective cohorts.