Efficacy and Safety of a Natural Supplement Containing Serenoa Repens, Solanum Lycopersicum, Lycopene, and Bromelain in Reducing Symptoms of Chronic Prostatitis/Chronic Pelvic Pain Syndrome: A Prospective Cohort Study in 250 Patients

Round 1

Reviewer 1 Report

This manuscript addresses the issue of chronic abacterial prostatitis in men, and it is highly relevant to the field of urology. The overall quality of the writing is good; however, there are some weaknesses in the study design that could be addressed to strengthen their findings. Below, I have highlighted these weaknesses:

1. Lack of control groups: The study did not include a control group for comparison, which makes it difficult to determine the specific effects of the natural supplement. To address this, the authors should consider recruiting a control group consisting of healthy patients who receive the natural supplement (PERLAPROST® soft gel) and/or prostatitis patients who are administered a placebo. This would help clarify the effects of the natural supplement in comparison to a placebo or no treatment.
2. Single-center study: The study was conducted at a single tertiary urology center, which may limit the generalizability of the findings to other settings. To enhance the external validity of the study, the authors should consider conducting multi-center trials involving diverse patient populations. This would provide more comprehensive and representative data.
3. Lack of long-term follow-up: The study assessed outcomes at one and three months, but longer-term follow-up would be valuable to evaluate the sustainability of the observed improvements. To address this limitation, the authors should consider extending the follow-up period to at least one year. This would provide a better understanding of the long-term effects of the natural supplement on chronic abacterial prostatitis.
4. Potential confounding factors: The study did not account for other interventions that may have influenced the patient outcomes. For example, lifestyle adjustments were advised, including avoiding spicy foods, alcohol, caffeine, and cycling, which could have contributed to the observed improvements. To address confounding issues, the authors could include a control group that receives only the lifestyle adjustments without the natural supplement. This would help differentiate the effects of the supplement from the lifestyle changes.

Overall, the study suggests that the natural supplement, in conjunction with lifestyle changes, could offer a safe and effective alternative treatment for patients with chronic abacterial prostatitis. The authors should consider addressing these limitations in their follow-up studies to further validate their findings. Considering the complexity of the present study, it would greatly benefit readers if the authors could provide a paragraph discussing the identified limitations and their intended approaches for addressing them in future studies. Moreover, I recommend that the graphical presentation in Figure 1 be enhanced to improve clarity and visual appeal. I am confident that with these revisions, the manuscript can be considered for publication.

Author Response

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Reviewer 2 Report

Congratulations, it is a well-written manuscript. The subject also has its merits, the use of natural supplement in conjunction with lifestyle changes 
could indeed be a safe and effective alternative treatment for patients suffering from chronic abacterial prostatitis.

The language, the figures and tables are impacable.

I only wonder if there are more recent studies regarding the references, of the 21 citations only 5 are more recent than 5 years. Only one self-citation detected.

Author Response

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Reviewer 3 Report

This study aims to evaluate the efficacy and safety of a natural supplement, composed of Serenoa Repens, Solanum Lycopersicum, Lycopene, and Bromelain, in managing symptoms of chronic abacterial prostatitis. They concluded that this natural supplement in conjunction with lifestyle changes could offer a safe and effective alternative treatment for patients with chronic abacterial prostatitis. I believe that the study has sufficient merit to be considered for publication on Uro, although major revisions are required.

 

MAJOR COMMENTS

-       Introduction. The authors should better discuss the reason of use of these products in prostatitis management and their relationship with the diet; in this regard, discuss this interesting paper (doi: 10.3390/jcm12082784; PMID 37109121).

-       Have the patients also been tested for Meares Stamey test ?

-       Discussion. The authors should add among the limitations that the self-reporting nature of questionnaires could represent another potential bias.

Moderate editing of English language required

Author Response

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Round 2

Reviewer 3 Report

The paper is worthy for publication 

Author Response

We Kindly thank the reviewer for the worthy suggestions that further improved the clinical value of the present manuscript.