Pumpkin seed extract

Pumpkin seed extract is an over-the-counter herbal remedy. The Bach prospective 3-year study (Urologe A 2000) in 2245 men with BPH used Prosta Fink Forte 500-1000 mg/day: IPSS dropped by 41% on average, post-void residual decreased and tolerability was good, but the design lacked placebo control. The Vahlensieck double-blind RCT (Urol Int 2015) in 1431 men compared Granu Fink Prosta forte standardised extract with placebo over 12 months: IPSS reduction was 6.8 points in the active arm vs 5.5 in placebo (statistically significant but clinically small). EMA HMPC 2012 recognises pumpkin seed as a traditional-use medicinal product for lower urinary tract symptoms in BPH based on 30 years of use, not RCTs. EAU 2024, AUA 2023 and AEU 2022 recommend alpha-blockers and 5-alpha-reductase inhibitors for moderate-severe BPH; herbal products are mentioned as an option for mild symptoms or add-on to standard therapy. If pumpkin seed extract is being considered, discuss with a urologist and have a PSA test to rule out prostate cancer.

Pumpkin seed extract is one of the few herbal remedies with an EMA-recognised indication in overactive bladder (OAB) in adults, and in women this matters because OAB is 1.5-2 times more common in women than in men. The Nishimura open-label study (J Tradit Complement Med 2014) in 39 adults with OAB used Cucurbita maxima pumpkin seed oil 10 g/day for 12 weeks: daytime voids dropped 21%, nighttime voids 36% and OAB-q balance improved. The sample is small and there is no placebo control. EMA HMPC 2012 recognises pumpkin seed as a traditional-use medicinal product for OAB symptoms based on 30 years of use, not RCTs. ICS/ICI 2023 and AUA recommend behavioural therapy as first line for OAB (fluid management, Kegel pelvic-floor exercises, timed voiding) and antimuscarinics (solifenacin, tolterodine, fesoterodine) or mirabegron as second line. Herbal products are mentioned as an option for mild symptoms. If pumpkin seed is being added to standard therapy, discuss with a urogynaecologist or urologist and rule out urinary tract infection and interstitial cystitis.