Placebo-Controlled Trial of Urolithin A Supplementation in Men With Prostate Cancer Undergoing Radical Prostatectomy, URO-PRO Trial

Eligibility Criteria

• * Participants must have pathologically confirmed adenocarcinoma of the prostate with formalin-fixed paraffin embedded (FFPE) biopsy tissue available for analysis. Diagnosis can be any time in the six months prior to registration/randomization
• * Participants \>= 18 years will be enrolled. Because no dosing or adverse event (AE) data are currently available on the use of urolithin A in participants \< 18 years of age, children and adolescents are excluded from this study
• * Eastern Cooperative Oncology Group (ECOG) performance status =\< 2 (Karnofsky \>= 60%)
• * Absolute neutrophil count \>= 1,000/microliter
• * Platelets \>= 100,000/microliter
• * Total bilirubin =\< 1.5 x institutional upper limit of normal (ULN) Note: Higher total bilirubin levels (=\< 3 mg/dL) can be allowed if due to known benign liver condition, i.e. Gilbert's
• * Aspartate aminotransferase (AST) (serum glutamic-oxaloacetic transaminase \[SGOT\])/alanine aminotransferase (ALT) (serum glutamate pyruvate transaminase \[SGPT\]) =\< 3.0 x institutional upper limit of normal
• * Creatinine =\< 1.5 x institutional upper limit of normal
• * Human immunodeficiency virus (HIV)-infected participants on effective anti-retroviral therapy with undetectable viral load within 6 months are eligible for this trial
• * For participants with evidence of chronic hepatitis B virus (HBV) infection, the HBV viral load must be undetectable on suppressive therapy, if indicated
• * Participants with a history of hepatitis C virus (HCV) infection must have been treated and cured. For patients with HCV infection who are currently on treatment, they are eligible if they have an undetectable HCV viral load
• * Participants on chronic suppressive antiviral therapy for herpes simplex virus (HSV) are eligible
• * Scheduled to undergo RP in the next 3-6 weeks
• * Ability to understand and the willingness to sign a written informed consent document
• * Participants with prior primary treatment or hormonal therapy for prostate cancer (PC)
• * Participants with documented active alcohol and illegal substance dependency
• * Participants already receiving urolithin A (Mitopure, commercially available in the United States), or pomegranate supplements. Note: Other supplements are allowed but must be documented
• * Participants receiving any other investigational agents
• * History of allergic reactions attributed to compounds of similar chemical or biologic composition to urolithin A
• * Uncontrolled intercurrent illness, or psychiatric illness/social situations that would limit compliance with study requirements