Complementary and alternative medicines in management of prostate cancer

A newly published paper in the Journal of Urology has reported on the use of complementary and alternative medicines (CAMs) among a cohort of nearly 8,000 American patients with a diagnosis of prostate cancer between 1996 and 2016.

This paper by Zuniga et al. (for which the full text is freely available on line) analyzed data from a total of 7,989 men in the CaPSURE database over a 20-year time frame and included information on the use of nearly 70 different forms of complementary and alternative medicines by prostate cancer patients — i.e., things like vitamins, omega-3 fatty acid, green tea, etc.

The authors found that there had been significant changes in the popularity of specific forms of such medicines over time. Most notably:

  • Among men diagnosed between 2011 and 2016, compared to men diagnosed between 1996 and 2000, there was
    • A relative increase of 128 percent in use of all CAMs (from 24 to 54 percent)
    • A relative increase of 108 percent in use of vitamin D supplements
    • A relative decrease of 48 percent in use of vitamin E supplements
    • A very large relative increase of 259 percent in the use of acupuncture
    • A significant decrease of 65 percent in the use of selenium supplements

However, …

What this paper does not comment on is the effectiveness or the safety of use of such products, and so one has to be very careful to differentiate between whether behavior of patients has changed over time (which is what this paper shows) and actual usefulness of the CAMs discussed.

We can have a pretty clear idea why the use of vitamin E and selenium supplements dropped over these two time periods. This is — with near certainty — a consequence of the results from the 35,000-man, randomized, double-blind SELECT trial. That trial showed that taking selenium supplements led to a small but statistically insignificant increase in the risk that a man would be diagnosed with prostate cancer and that vitamin E supplements actually increased risk for diagnosis with prostate cancer significantly.

The value of most dietary modifications and CAMs in the management of prostate cancer over time remains unproven. On the other hand, there are clear benefits to overall survival from appropriate weight loss and exercise, and so dietary modifications that assist in appropriate weight loss are clearly a good idea. In saying this, we wish to emphasize that we are not denying the fact that many prostate cancer patients feel and believe that the use of CAMs and dietary modifications improve their quality of life and perhaps their overall survival. So long as there is no known harm associated with the use of such CAMs, we believe it is appropriate for patients to discuss such options with their doctors and come to a shared decision about what might work well for them.



8 Responses

  1. I was diagnosed 7+ years ago, with low-grade prostate cancer, Gleason 3 + 3. I have been on acttive surveillance during that time and have endured four biopsies, with almost no change from the first diagnosis. I have taken 2000 IU of vitamin D3 per day for 4+ years, without any noticeable consequences. But, if I may, I would like to know more about a couple of other prescriptions that I started in mid-December 2018, for an enlarged prostate: tamsulosin HCl 0.4 mg (Flomax) and Finasteride 5 mg (Proscar), each taken once daily. They have greatly reduced my prostate size, and lowered my PSA from 17.18 to 3.36 in 9 months. Are these results common?

  2. Maybe you are just being cautious because you don’t want to give medical advice, but you must know that a search of PubMed will reveal thousands of articles demonstrating the effectiveness of natural dietary supplements and repurposed drugs against prostate cancer in various stages. Yes, most of the experiments are in vitro or based on animal models, but many are also supported by small human trials. Patients can’t wait for the medical establishment, attached at the hip with big Pharma, to catch-up. That may take 20 years or it may never happen.

  3. We saw recently, that people with any cancer were 2.5 times more likely to die if they used and 2.1 times more likely to die if they used complementary medicines.

    While neither of those observational studies followed prostate cancer patients long enough to detect differences in survival, we see the damage that use of complementary and alternative medicines had on patients with more virulent cancers. Patients who get complementary medicine are more likely to refuse conventional treatments (even though they received at least one conventional treatment) and are about twice as likely to die because of that decision.

    Many patients rely on mouse and laboratory studies as “proof” that some substance is effective. Predatory web sites that sell supplements, like Life Extensions Inc., provide citations to them. Such studies are almost always disproven when tried in clinical trials. They constitute the lowest quality of evidence, and should only be used for hypothesis generation for subsequent clinical trials or to demonstrate plausibility for a cause/effect relationship found in a randomized clinical trial.

  4. Dear James:

    Tamulosin and finasteride are extremely commonly used medications that are effective and safe for the management of benign prostatic hyperplasia (enlargement of the prostate), a condition that is very common in men as the grow older. The decline in your PSA level is commonplace. The one thing that you do need to be aware of is that this decline in your PSA level does not mean that there is a decrease in your overall risk for progressive prostate cancer. The decrease in your PSA level reflects only thr decrease in the overally size of your prostate (which hopefully, from your perspective has been accompanied by an improvement in your ability to urinate normally).

  5. Dear daveofnj:

    You obviously have opinions about this issue that I don’t share. You are, of course entitled to your opinions.

    There is a complete lack of meaningful Level 1 evidence as to the effectiveness of any supplements or alternative medicines in the management of prostate cancer (with the exception of the above-mentioned SELECT trial, which had negative results). So long as they are doing themselves no harm, I have no problem with people taking supplements or applying other forms of complementary and alternative medicine. However, that doesn’t mean I necessarily think they are doing themselves any good.

    There is nothing other than will and money to stop the NIH and the NCI from conducting large, prospective, randomized trials of almost anything you might want them to study. You are correct that most of these studies would take 15 to 20 years to generate meaningful results. When we have positive data from studies like that I will be delighted to tell people about them. This has nothing whatsoever to do with the pharmaceutical industry. The supplements and alternative medicine industry is also “in it” to make money (in case you hadn’t noticed).

  6. Vitamin E and selenium

    The period during which I had a serious case of prostate cancer, now apparently cured, covered most of the time of this study (Dx 1999). Based on interesting and encouraging preliminary data, I took selenium and vitamin E from early 2000 through the discouraging study results.

    However, I’m still wondering whether a different form of vitamin E would have had better results. I moved fairly quickly to a mix of vitamin E that featured gamma-tocopherol plus some other forms of vitamin E, but not alpha-tocopherol. This was based on research suggesting that alpha-tocopherol would possibly promote prostate cancer because it would decrease gamma-tocopherol, which seemed to work against prostate cancer. In the trial, partly because earlier encouraging work had been done with the alpha form, because that form was longer lasting in the body, and other reasons, the alpha form was selected for SELECT. As many of us expected, the trial arm with vitamin E (the alpha form) did not do well.

    A similar story occurred in the form of selenium chosen for SELECT, though I am now hazy on the details. The initial trial, led by Dr. Clark, including its subgroups, was quite encouraging.

    I would really like to see a new trial with other forms of vitamin E and selenium, but due to cost, competition from other advances, and the long duration required, and the decrease in enthusiasm due to the unfavorable SELECT trial, I doubt the US will attempt that.

    Thanks for posting this study.

  7. As a point of definition, “CAM” is a mishmash of two very different concepts. “Complementary” = good (if evidence-based). It is and should be a “complement” to evidence-based medicine. “Alternative” is alternative to evidence-based medicine (= not so good). It is regrettable that the two got conjoined and have come to be accept as a package called “CAM”. I encourage folks to be attentive to what is C and what is A.

    So folks add “S” of supplements to that string of letters and. if one leads with the “S, in an informative fashion it spells SCAM.

    As for the problem with “A”, please check out <a href= Storm by Tim Minchin. The video runs about 9 minutes with the key information just after the 3-minute mark.

    Richard W.

  8. Doesn’t seem to be much useful information in this particular post.

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