Prostate Cancer

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Quick Reference

Open a 2-page quick reference summary of the therapies best supported by evidence for use with prostate cancer:

Key Points

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Less aggressive options in prostate cancer treatment have become available. in recent decades, preserving quality of life for many men without sacrificing survival.
Radical surgery and/or radiation therapy are no longer standard approaches in conventional treatment for early, low-risk prostate cancer, with a shift toward watchful waiting or active surveillance.
Integrative therapies during a period of waiting or surveillance, and also during treatment, show significant potential benefit to patients.

Prostate cancer is a prime example in which an integrative approach may be incorporated not only for reducing the risk of primary prostate cancer, but in treating and reducing risk of progression or recurrence. Following a healthy lifestyle program during active surveillance of low-risk prostate cancer may favorably change the behavior of the cancer while at the same time improving health and quality of life. Holding the cancer in this low-risk state could mean foregoing invasive treatments such as surgery or radiation therapy—treatments that can significantly reduce quality of life.

Watchful Waiting

Watchful waiting and active surveillance are treatments used for older men who do not have signs or symptoms or have other medical conditions and for men whose prostate cancer is in early stages and progressing slowly.

In the ProtecT study, for instance, men with localized prostate cancer and favorable prognoses who were followed for 10 years lived equally long whether they did active surveillance, surgery or radiation therapy. While the disease was less likely to progress in those receiving prostatectomy or radiotherapy, 44 percent of the patients who were assigned to active monitoring did not receive radical treatment and avoided side effects. Moreover, survival was as good among those who were untreated as among those who were treated—and they avoided the risks of treatment side effects.

Integrative Care in Prostate Cancer

Before investigating integrative care in prostate cancer, we recommend reviewing integrative cancer care in general.

Our goal is to help you live as well as you can for as long as you can, using the optimal combination of conventional, complementary and integrative therapies and approaches.

Cancers are composed of cells that divide without stopping and do not die as programmed. Some divide slowly, others quickly. Some are more invasive than others. Body terrain can influence the microenvironment in which the cancer exists, making it more or less likely to spread. You can sometimes improve your body terrain with integrative practices. (See Body Terrain and the Tumor Microenvironment)

Knowing how your cancer behaves will influence the type of testing and treatment used, prepare you for possible treatment side effects and guide you in steps to prevent or minimize these effects. It will help you understand and choose the complementary therapies and lifestyle approaches that may enhance your conventional treatment, manage side effects and improve your quality of your life.

You can also prepare your home team for what to expect. You can plan ahead to line up the support you may need. You can anticipate side effects and work to minimize them even before treatment starts. Finally, learning what to expect allows you to prepare mentally and spiritually to catalyze your resilience for facing the weeks and months to come.

You may read “the five-year survival for this cancer is X percent.” That means that this percentage of people survive at least five years. The five-year survival rate for most men with local or regional prostate cancer is nearly 100 percent. For men diagnosed with prostate cancer that has spread to other parts of the body (metastasized), the five-year survival rate is 30 percent.² Survival may also be expressed as median survival time—usually in years—meaning half of patients with a similar diagnosis will be alive at that time.

But median survival doesn’t show the range of survival expectancy—which can vary from months to decades. Getting healthier with cancer—and skillful use of conventional and complementary therapies—may help extend your life. It will very likely improve the quality of your life. There is nothing wrong with hope.

Clinical Practice Guidelines

National Comprehensive Cancer Network:
- Professional Guidelines (Login required)
- Guidelines for Patients:
  - Early Stage Prostate Cancer
  - Advanced Prostate Cancer
American Society of Clinical Oncology: Genitourinary Cancer

Examples: Treatment Approaches from Noted Specialists and Practices

We note examples of prostate cancer treatment approaches used by leaders in the field. Some use minimally invasive conventional procedures with some integrative approaches, while others are more fully integrative in approach.

Aaron Katz, MD, and the Active Holistic Surveillance Program

Aaron Katz, MD, is a urologist specializing in prostate cancer. Known for his program of active holistic surveillance, Dr. Katz is also known for his work with cryotherapy (using cold temperatures therapeutically).³ Cryotherapy is a minimally invasive means of treating prostate cancer. Dr. Katz has published research demonstrating that by four years post cryotherapy, men receiving this treatment report a good quality of life comparable to those who underwent active holistic surveillance.⁴

For men with low-risk, early stage prostate cancer, Dr. Katz has developed a program in which his patients engage in lifestyle practices, such as diet, exercise and mind-body approaches, as well as take specific dietary supplements to decrease the risk of cancer progressing. As Katz explains:⁵

Active surveillance is an emergent strategy for management of indolent prostate cancer. Our institution's watchful waiting protocol, active holistic surveillance (AHS), implements close monitoring for disease progression along with various chemopreventive agents and attempts to reduce unnecessary biopsies.

In research of this approach, particularly the nutritional component, Katz and colleagues looked at treatment rates of men on their AHS protocol and determined reasons for progression. They analyzed survival rate, discontinuation rates and definitive treatments for low-risk and low-intermediate-risk patients enrolled in AHS at their center. They concluded that incorporating chemopreventive agents in their AHS protocol “has allowed patients to prolong definitive treatment for many years.”⁶

In a later study, Katz and his colleagues reported results of a retrospective review comparing self-reported quality of life in men with prostate cancer who were treated with minimally invasive cryotherapy, cyberknife (CK) or active holistic surveillance (AHS). They looked at data over a four-year period and concluded that “after initially lower bowel habits and sexual function scores, CyberKnife or cryotherapy-treated patients had no significant difference in quality of life relative to AHS patients. These results highlight the benefit of CyberKnife and cryotherapy in the management of organ-confined prostate cancer.”⁷ As a group, patients who choose minimally invasive treatment may expect some initial lower function, but their quality of life will eventually improve and be comparable to quality of life reported by AHS patients.

Ornish Lifestyle Medicine

Highlighted Videos

Cardiologist, researcher and BCCT advisor Dean Ornish, MD, discusses the research regarding lifestyle medicine and prostate cancer (see the full video in the Commentary section below).

BCCT advisor Brian Bouch, MD, reviews the different therapies for prostate cancer care.

BCCT Senior Researcher Laura Pole, RN, MSN, OCNS, and integrative oncologist and BCCT advisor Donald Abrams, MD, explore integrative prostate cancer care in this webinar from the Society of Integrative Oncology.

Cardiologist Dean Ornish, MD, originally developed his Ornish Lifestyle Medicine program to reverse heart disease and has since adapted and studied the program in men with prostate cancer. The program looks at four elements of a person’s life:

What you eat
How you respond to stress
How active you are
How much love and support you have

Compared to men under active surveillance who didn’t make lifestyle changes, those who followed Ornish’s program had favorable biological markers, including lower PSAs.

Simply put, the program urges you to “Eat well, stress less, love more, move more.” (These are also four of our 7 Healing Practices.)

Most of this outpatient program happens outside the clinic in your everyday life. In response to criticism from some conventional practitioners, Dr. Ornish asks: “What’s the more radical treatment: have a heart transplant (or prostatectomy) or walk, meditate, eat vegetables and quit smoking?“⁸

Even though the program “is considered experimental and investigational as a treatment for ...prostate cancer”,⁹ the evidence shows that adopting these healthy lifestyle changes provides benefit: compared to men under active surveillance who didn’t make lifestyle changes, those who followed Ornish’s program had favorable biological markers, including lower PSAs. Benefits are directly proportional to the degree of lifestyle changes made.¹⁰

Research highlights of the Ornish program in prostate cancer:¹¹

Slower progression or stable cancer in men with early stage prostate cancer (Gleason score less than 7) or low-risk prostate cancer:
- Fewer men needing conventional treatments
- Decrease in prostate specific antigen (PSA) compared to an increase in the control group
- Inhibited prostate cancer cell growth
Favorable gene expression
Significant improvements in weight, abdominal obesity, blood pressure and lipid profiles
Increased telomerase activity in peripheral-blood mononuclear cells (PBMCs)
A rise in protective IGFBP-1

Challenges with the Ornish program:

Following the program consistently,¹² although Ornish says that hospitals and clinics using the Ornish Lifestyle Medicine Program are now reporting 85 to 90 percent of those completing the 9-week program are still following the program one year later.¹³
Increased risk for deficiencies of vitamin B₁₂, vitamin E and zinc;¹⁴ these are manageable with medical supervision and perhaps supplementation
Insurance coverage¹⁵

Charles “Snuffy” Myers, MD

Prostate Oncology Specialists

Prostate Institute of America

Block Center for Integrative Cancer Treatment

Integrative Programs, Protocols and Medical Systems

For more information about programs and protocols, see our Integrative Programs and Protocols page.

Integrative Therapies in Prostate Cancer

7 Healing Practices

7 Healing Practices: The Foundation

The 7 Healing Practices listed here all promote wellness and tend to make your body terrain less hospitable to the development and progression of cancer. Some practices address cancer symptoms and side effects.

Eating Well

Choices in diet are associated with prostate cancer outcomes.

Treating the Cancer

Limited evidence shows following a Mediterranean diet is associated with a lower risk of Gleason grade group progression, especially in non‐White men and men without diabetes.²⁶ A few individual foods are also shown to slow prostate cancer progression, reduce angiogenesis (creation of new blood vessels to supply tumor cells), induce cell death (apoptosis) and/or reduce metastasis:²⁷

Fish consumption for four to six weeks before surgery
Coffee consumption before a prostate cancer diagnosis
Cruciferous vegetables: broccoli, cauliflower, cabbage, Brussels sprouts, kale, mustard greens, and chard greens
Pomegranate juice
Soy foods (preferably organic), possibly in combination with tomato juice
Cranberry juice
Flaxseed
Turmeric
Rye bread versus wheat bread

Pomegranate juice has also been associated with longer PSA doubling times,²⁸ although possibly only in men with the MnSOD AA genotype.²⁹

A small trial of a dietary intervention showed lower PSA in patients with non-metastatic prostate cancer after three weeks consuming tomato products.³⁰

Other foods are associated with worse disease outcomes:³¹

Whole milk products (but not low-fat varieties)
Saturated fats from animal origins, including milk products and meats

Managing Side Effects and Promoting Wellness

Men with mild to moderate erectile dysfunction who drank pomegranate juice tended to report more favorable scores on the Global Assessment Questionnaire than men drinking a placebo. The result of this small pilot study was not statistically significant, nor were all the subjects cancer survivors.³²

Reducing Risk

Studies have found these associations between food choices and prostate cancer or aggressive prostate cancer at diagnosis:³³

Higher Risk	Lower Risk
Dairy and high calcium intake^a Processed red meat, such as salami, bologna, sausage, bacon and hot dogs Eggs/choline Poultry (with skin) Animal fat/saturated fat Salted or smoked fish	Fish, especially fish with high levels of omega-3 fatty acids such as salmon, sardines, mackerel and herring^b Tomatoes/lycopene Fats from vegetable sources, especially olive oil and nuts Cruciferous vegetables: broccoli, cauliflower, cabbage, Brussels sprouts, kale, mustard greens, and chard greens Coffee Soy foods or soy protein: soy isoflavones daidzein and genistein are both associated with lower risk, as is heat-treated soy grits Tea, especially green tea Low-carbohydrate diet Vitamin E^c Flavonoids found in chocolate, green and black tea, beans, cherries, strawberries, cocoa, onions and apples Onions, garlic and other alliums, particularly garlic Plant sterols

Higher Risk

Lower Risk

Dairy and high calcium intake^a
Processed red meat, such as salami, bologna, sausage, bacon and hot dogs
Eggs/choline
Poultry (with skin)
Animal fat/saturated fat
Salted or smoked fish

Fish, especially fish with high levels of omega-3 fatty acids such as salmon, sardines, mackerel and herring^b
Tomatoes/lycopene
Fats from vegetable sources, especially olive oil and nuts
Cruciferous vegetables: broccoli, cauliflower, cabbage, Brussels sprouts, kale, mustard greens, and chard greens
Coffee
Soy foods or soy protein: soy isoflavones daidzein and genistein are both associated with lower risk, as is heat-treated soy grits
Tea, especially green tea
Low-carbohydrate diet
Vitamin E^c
Flavonoids found in chocolate, green and black tea, beans, cherries, strawberries, cocoa, onions and apples
Onions, garlic and other alliums, particularly garlic
Plant sterols

Higher levels of calcium intake have been more strongly associated with increased risk of aggressive prostate cancer in men of African-American descent and individuals with a low body mass index (BMI) compared to men of European-American descent or those with higher BMIs.³⁴ Men taking in more than 2000 mg of calcium a day—combined food and supplements—have a higher risk of lethal prostate cancer, but the link may be due to phosphorus, which is found along with calcium in dairy foods as well as thousands of foods with phosphate-containing additives.³⁵
Reduced risk may be modified by genetic variation in the COX-2 gene³⁶ and by the specific fatty acids consumed.³⁷
Higher amounts of dietary vitamin E consumed by prostate cancer patients of European-American descent were associated with less aggressive forms of the disease. This was not seen in patients of African-American descent.³⁸

Dietary vitamin D intake, mostly from dairy foods, was not related to prostate cancer risk in large pooled meta-analyses.³⁹

Food Recommendations

Some of the more conservative cancer information services downplay the role of diet in prostate cancer, such as the American Society of Clinical Oncology’s statement: “There is not enough information right now to make clear recommendations about the exact role eating behaviors play in prostate cancer. Dietary changes may need to be made many years earlier in a man’s life to reduce the risk of developing prostate cancer.”⁴⁰

We disagree. Although all the mechanisms and details are not understood (they seldom are in science), enough evidence has emerged to make recommendations. The risks of following these recommendations are very low. Because benefits from these recommendations extend to heart disease and other chronic conditions in addition to many types of cancer, the potential benefits are enormous.

In general, following a plant-based, whole-foods diet such as the Mediterranean diet provides benefit:

Use cold-pressed (extra-virgin) olive oil, especially to replace butter and other animal fats
Eat fish high in omega-3 fatty acids: sardines, wild salmon and anchovies (See Dietary Sources of Omega-3 Fatty Acids for more guidance.)
Eat more cruciferous vegetables: broccoli, cabbage, kale, cauliflower, Brussels sprouts, kohlrabi
Eat food sources of lycopene: cooked tomatoes, strawberries, watermelon, pink grapefruit, guava and papaya
Eat less red meat: “Choose lean meat derived from grass-fed animals. Eat it sparingly and prepare the proteins at a low temperature.”⁴¹
Avoid eating smoked and cured meats.
Reduce saturated fats, found in these foods:
- Dairy foods: butter, cream, ghee, whole milk and cheese
- Meat: fatty cuts of beef, pork and lamb, chicken skin, and processed meats including salami and sausages
- Lard
Avoid whole-milk products (milk, cheese, butter)

In addition, these foods also show benefit:

Soy foods, such as tofu and fermented miso and tempeh
Green tea
Pomegranate juice
Flaxseed (freshly ground)

Individual studies also associate food patterns with prostate cancer risk. For instance, a 2020 study found that consumption of a lot of refined grains and sugar (pasta, white bread, cereals, cookies, muffins, donuts, cakes, pastries, pies) plus milk and carbonated beverages was associated with a higher risk of prostate cancer overall and of high-grade tumors. Conversely, the lowest risk was seen with regularly eating an abundance of fruits, vegetables, tofu, soybeans, fish, brown bread, nuts or peanut butter, yogurt, and no consumption of white bread.⁴²

See Eating Well.

Moving More

The risks from these lifestyle changes are very low, and the potential benefits are great.

Managing Stress

Sleeping Well

Creating a Healing Environment

Sharing Love and Support

Exploring What Matters Now

Obesity

Tobacco Smoking

Finding Reliable Information about Prostate Cancer

As research continues to identify best practices in prostate cancer prevention, detection and treatment, advice has changed considerably over the last couple of decades.

However, quite a lot of information that is either outdated or inaccurate is still available online and is passed along through social media.

Beyond the 7 Healing Practices: Further Integrative Therapies

Complementary therapies and lifestyle practices can be useful to enhance treatment effects, improve quality of life and possibly even extend life for those with prostate cancer.

Cells, Animals and People

Studies on human cells can be helpful in finding effects of drugs, radiation, natural compounds and other potential therapies on tumors. However, isolated cells or tissues in a highly controlled lab may behave very differently from tumors and other cells in real human beings.

Therapies are grouped according to their effects:

Treating the cancer
Managing side effects and promoting wellness
Reducing risk
Optimizing your terrain

We present natural products in six groups:

Good clinical evidence of efficacy & safety, easy access
Good clinical evidence of efficacy & safety, limited access
Limited clinical evidence of efficacy but good safety, used in leading integrative programs
Limited clinical evidence of efficacy, or significant cautions, but potential significant benefit
Especially promising preclinical or emerging clinical evidence of efficacy and safety
Evidence of no efficacy or may be dangerous

Off-label, overlooked and novel cancer approaches (ONCAs) are grouped separately:

Group A: Good clinical evidence of efficacy
Group B: Limited clinical evidence of efficacy
Group C: Promising preclinical evidence only
Group D: Evidence of no efficacy or may be dangerous

Within each section, we list only groups containing applicable therapies.

Other integrative therapies and approaches are described but not categorized. See the full summaries as linked for more information on each of these therapies.

Treating the Cancer

Predicting Treatment Outcomes

Predict Prostate is an online prognostic tool from the University of Cambridge. It uses an individualized prognostic model for men newly diagnosed with non-metastatic prostate cancer to compare the outcomes from conservative management (or monitoring) with radical treatment (surgery or radiotherapy). This tool is endorsed by the UK National Health Service (NHS) and Public Health England.

Working against cancer growth or spread, improving survival, or working with other treatments or therapies to improve their anticancer action

Effective treatment begins with an accurate diagnosis. According to a 2019 Cochrane review and meta-analysis, MRI (magnetic resonance imaging) pathway is better than systematic biopsies in making a correct diagnosis of clinically important prostate cancer and reducing redundant biopsies and the detection of unimportant cancers substantially.⁷⁰

Conventional Prostate Cancer Therapies

Comparing Approaches

A highly respected organization reviewed studies of outcomes across different approaches to treating localized prostate cancer:

Radical prostatectomy (RP)
Watchful waiting (WW)
Active monitoring (also called active surveillance) (AM)

The Ultimate Guide to Cancer: DIY Research

This guide from Ralph Moss, PhD, BCCT advisor and leading chronicler of integrative cancer treatments, shows you how to use four of the main tools that doctors use to decide on the best cancer treatments. It will help you learn why some cancer treatments that look good in clinical trials may not work for “real world” patients. It will help you answer two questions that the doctor may be hesitant to answer in the detail you need to decide about treatment:

What are my chances of actually living longer if I take your treatment?
What are the likely side effects, and how long will they last?

Not that long ago, radical surgery and/or radiation therapy were standard care after a prostate cancer diagnosis. Current approaches, even within conventional care, are much less aggressive. Mark Scholz, MD, and Ralph Blum explain that radical surgery and/or radiation therapy may or may not be the best approach for you. Whichever prostate cancer treatment specialist you see, you will most likely get a good explanation of their preferred therapy, but many will not be able to adequately tell you about other options.⁷²

More aggressive treatments have often been associated with unpleasant side effects and reduced quality of life (see Comparing Approaches at right). A study reported in 2020 compared long-term side effects of these prostate cancer treatments in men:

With favorable-risk disease: active surveillance, nerve-sparing prostatectomy, external beam radiation therapy, or low-dose-rate brachytherapy
With unfavorable-risk disease: prostatectomy or external beam radiation therapy with androgen deprivation therapy

The study found that most functional differences (including difficulties in bowel and hormonal function) reduced over time with no important differences between treatments at five years post-treatment. However, prostatectomy was associated with worse incontinence over five years for both favorable-risk and unfavorable-risk disease, and also worse sexual function at five years for unfavorable-risk disease.⁷³

These conventional prostate cancer therapies—called focal therapies— may provide alternatives to more invasive treatments. Used with localized prostate cancer, they may come with fewer side effects that affect your long-term quality of life (see Comparing Approaches at right):

Ablating the prostate gland rather than surgically removing it. Ablation involves using small needle probes placed into the prostate or high-frequency ultrasound energy to cause temperature changes that kill the cancer cells.
Radiation therapy, such as hypofractionated intensity-modulated radiation therapy (IMRT), that require fewer treatments with comparable or better outcomes to the more common Fractionated IMRT.⁷⁴
MRI-guided transurethral ultrasound ablation (TULSA) is a minimally-invasive procedure being investigated for safety and effectiveness.⁷⁵ The manufacturer provides a Treatment Locator page.
High intensity focused ultrasound ablation: Short-term results from both hemigland⁷⁶ and whole gland⁷⁷ procedures indicate safety, preservation of potency and continence, and short-term (2-7 years) prostate cancer control comparable to radical prostatectomy and radiotherapy.

Pulsed low-dose rate radiation therapy (PLDR-RT) delivers conventional radiation doses in pulses of small doses with intermittent pauses. A small study involved PLDR-RT for patients with bladder and other cancers of the pelvis. Patients had undergone radiation therapy to the pelvis previously. Twenty-three patients were treated with a curative intent and 15 were treated palliatively. At one-year, 59 percent of patients treated for curative intent had a clinical, biochemical or radiographic response, and six of the 23 patients had no evidence of disease at their last follow-up. Among the patients treated palliatively, 61 percent had a clinical or radiographic response.⁷⁸

Not all those with prostate cancer will be good candidates for these therapies. Getting the diagnosis right and considering all your options are essential to success.

With the correct diagnosis, further tests can predict if your cancer is likely to grow and spread, allowing you to hone in on the treatment options specific to you. Learn more about this testing: Gene Testing to Determine Risk of Recurrence.
In late 2020, the Food and Drug Administration approved the use of Gallium 68 PSMA-11 (Ga 68 PSMA-11) to improve detection of metastases in newly diagnosed high-risk prostate cancer and of cancer recurrence.⁷⁹ The radioactive drug carries a small amount of radiation that hones in on and accumulates in cells that have the prostate specific antigen. It is used with positron emission tomography (PET) imaging of prostate-specific membrane antigen (PSMA)-positive lesions. The PET scan detects where the Gallium is taken up.⁸⁰⁸¹
Other additional tests, both novel and standard, can provide information about your cancer cells or your terrain, which hosts the cancer cells. Read more: Other Types of Testing

See Diagnostic Approaches

A starting place for the science of conventional therapies:

National Cancer Institute:

Cancer.net: Prostate Cancer

Further guidance:

Mayo Clinic: Minimally invasive focal therapies for prostate cancer
Memorial Sloan Kettering Cancer Center: Focal Therapies for Prostate Cancer
Lebastchi AH, George AK et al. Standardized nomenclature and surveillance methodologies after focal therapy and partial gland ablation for localized prostate cancer: an international multidisciplinary consensus. European Urology. 2020;S0302-2838(20)30358-4.

Natural Products

Group 3: Limited clinical evidence of efficacy but good safety, used in leading integrative programs

Therapy	Notes
Green tea extract	Reduced serum levels of PSA, HGF, and VEGF in men with prostate cancer, with no elevation of liver enzymes in men with positive prostate biopsies and scheduled for radical prostatectomy⁸² Trend toward beneficial changes in serum prostate-specific antigen, serum insulin-like growth factor axis, and oxidative DNA damage in blood leukocytes, plus a decrease in Gleason score from biopsy to surgery in men with prostate cancer scheduled to undergo radical prostatectomy⁸³ No or minimal clinical activity against hormone refractory prostate cancer in a small study⁸⁴ Notable preclinical evidence: regulated androgen action in cell and animal studies⁸⁵ Used in these programs and protocols: Alschuler & Gazella complementary approaches⁸⁶ Block program⁸⁷ Lemole, Mehta & McKee protocols⁸⁸ McKinney protocols⁸⁹
Isoflavones, including soy supplements and red clover Benefits of consuming soy foods are discussed above in Eating Well.	Supplementation with genistein and other soy isoflavones lowers⁹⁰ or stabilizes⁹¹ PSA levels in men with prostate cancer. Red clover is associated in studies with decreased PSA levels, but with a concern that this could mask the development of prostate cancer.⁹² Anticancer effects with genistein supplementation include changes in expression of genes involved in developmental processes, stem cell markers, proliferation and transcriptional regulation.⁹³ Decreased serum sex hormone levels but not androgen receptor expression in a small pilot study⁹⁴ Notable preclinical evidence: Decreased tumor volume in animals with genistein combined with AG1024⁹⁵ Reduced metastasis in animal studies⁹⁶ In high concentrations, pure genistein induced metastasis in mouse xenograft models, although the addition of diadzein (in soybeans and various products) may prevent this response.⁹⁷ Soy and genistein are used in these programs and protocols: Block program⁹⁸ McKinney protocols⁹⁹ Ornish Lifestyle Medicine
Lycopene Benefits of consuming tomatoes and other foods high in lycopene are discussed above in Eating Well.	Reduced PSA levels and other markers of prostate cancer progression in men with prostate cancer¹⁰⁰ Stabilized serum PSA level in men with rising serum PSA following local therapy or while on hormone therapy, both alone or in combination with soy isoflavones¹⁰¹ Notable preclinical evidence: Enhanced antitumor efficacy of the chemotherapy drug docetaxel against prostate cancer in animal studies.¹⁰² Down-regulation of androgen metabolism and signaling in prostate cancer in preclinical studies¹⁰³ Used in these programs and protocols: Block program¹⁰⁴ Chang strategies for cancer risk reduction¹⁰⁵ McKinney protocols¹⁰⁶ Used in traditional Chinese medicine
Modified citrus pectin	Significantly increased prostate specific antigen doubling time in patients with recurrent prostate cancer in a small study¹⁰⁷ Stabilized disease in some patients in a pilot study¹⁰⁸ . Notable preclinical evidence: Reduced metastasis in cell studies in combination with a polybotanical compounds for prostate health, ProstaCaid™¹⁰⁹ Sensitized prostate cancer cells to radiotherapy in cell studies¹¹⁰ Used in these programs and protocols: Alschuler & Gazella complementary approaches¹¹¹ McKinney protocols¹¹²
Omega-3 fatty acid supplements containing DHA and EPA Benefits of consuming foods high in omega-3s are discussed above in Eating Well.	When combined with a low-fat diet, omega-3s led to smaller prostates (both benign and malignant components), lower proliferation index, and other anticancer effects.¹¹³¹¹⁴ Increased resistance to chemotherapy; not recommended on the days surrounding chemotherapy¹¹⁵ No effects found with EPA supplements used alone¹¹⁶ Used in these programs and protocols: Alschuler & Gazella complementary approaches¹¹⁷ Lemole, Mehta & McKee protocol¹¹⁸ McKinney protocols¹¹⁹
Pomegranate fruit and extract	Preliminary evidence that supplementation with pomegranate extract lowers PSA levels in men with prostate cancer¹²⁰ Prolonged PSA doubling time¹²¹ Pomegranate juice and extract were safe but did not significantly improve outcomes in men undergoing radical prostatectomy,¹²² in men following primary therapy¹²³ or in biochemical recurrence patients,¹²⁴ although a subset of BCR patients with the MnSOD AA genotype responded positively in these last two studies. Used in these programs and protocols: Alschuler & Gazella complementary approaches¹²⁵ McKinney protocols¹²⁶ Used in traditional Chinese medicine and Ayurveda
Sulforaphane (Healthline) Benefits of consuming cruciferous vegetables high in sulforaphane are discussed above in Eating Well.	Lowers PSA levels in men with prostate cancer,¹²⁷ with more modest reductions in recurrent cancer¹²⁸ Used in the McKinney protocols¹²⁹
Tetrathiomolybdate (TM) and other copper chelators	Slower PSA progression in a small clinical trial of TM, but with uncertain clinical significance¹³⁰ Copper depletion with TM did not delay disease progression in a small clinical trial of patients with asymptomatic metastatic hormone-refractory prostate cancer.¹³¹ Notable preclinical evidence: anticancer effects in prostate cancer cells from use of pyrrolidine dithiocarbamate (PDTC) but not TM¹³² Used in the Block program¹³³
Vitamin C	Intravenous vitamin C modulated inflammation correlated with decreases in tumor marker levels in a pilot study¹³⁴ No benefit found from intravenous vitamin C in an uncontrolled pilot study of patients with chemotherapy-naïve, metastatic, castration-resistant prostate cancer¹³⁵ Used in these programs and protocols: McKinney protocols (high-dose vitamin C)¹³⁶ Ornish Lifestyle Medicine
Zyflamend: mixture of rosemary, turmeric, ginger, holy basil, green tea, hu zhang, chinese goldthread, barberry, oregano, baikal skullcap	Significant improvements in PSA and biopsy markers, with no reported serious adverse events or toxicities in small clinical trials; considered "promising"¹³⁷ Used in the McKinney protocols¹³⁸

Group 4: Potential significant benefit, but either limited clinical evidence of efficacy or significant cautions

May be used in leading integrative oncology programs. Therapies in this group may need more medical oversight and surveillance.

Therapy	Notes
Active hemicellulose compound (AHCC) or active hexose correlated compound	One case study showed a positive PSA response to active hemicellulose compound,¹³⁹ but a study of active hexose correlated compound showed no effect.¹⁴⁰
Artemisinin	Case study of tumor remission after short-term bicalitumide treatment; seven months later, the tumor developed resistance to artemisia¹⁴¹ Used in traditional Chinese medicine
Combination therapies Benefits of consuming foods containing many of these nutrients are discussed above in Eating Well.	Curcumin and soy isoflavones Decreased PSA levels in patients with PSA of 10 or higher¹⁴² Hydroxycitrate, lipoic acid and anti-androgen Dramatic fall (90 percent) in prostate-specific antigen in a patient with advanced prostate cancer resistant to hormonotherapy¹⁴³ Supplement consisting of soy isoflavones, lycopene, silymarin (milk thistle) and antioxidants Improved measures of PSA¹⁴⁴ Milk thistle (silymarin) and selenium Reduced two markers of lipid metabolism known to be associated with prostate cancer progression in a small study¹⁴⁵ See more about selenium in Reducing Risk Group 6 below. Selenium, omega-3 fatty acids and soy isoflavones added to a dietary intervention including tomato products, grape/pomegranate juice and green/black tea Lower PSA in patients with non-metastatic prostate cancer after three weeks in a small trial¹⁴⁶ See more about selenium in Reducing Risk Group 6 below.
Cranberry juice or extract (About Herbs)	Lowered serum PSA prior to surgery¹⁴⁷
Hydroxycitrate, found in the Garcinia gummi-gutta (tamarind) fruit (About Herbs)	One case of dramatic improvement in PSA in advanced prostate cancer resistant to hormonotherapy when used in combination with lipoic acid and anti-androgen¹⁴⁸ Associated with liver toxicity,¹⁴⁹ and possibly mania¹⁵⁰ Used in McKinney protocols¹⁵¹ Used in Ayurveda
Supplement blends: Apatone® Pomi-T Prostate Health Cocktail (PHC) Block program custom blend	Apatone®: vitamin C and vitamin K₃ Decreased, PSA velocity and increased PSA doubling time in patients who had failed standard therapy.¹⁵² Pomi-T: pomegranate seed, green tea, broccoli and turmeric Reduced rise in PSA and and increase in the number of men with stable PSA at six months¹⁵³ Prostate Health Cocktail (PHC): vitamin D₃ (cholecalciferol) 400 IU, vitamin E (alpha tocopherol) 400 IU, selenium (L-selenomethionine) 200 mcg, green tea extract (epigallocatechin) 400 mg, saw palmetto berry (permixon) 320 mg, soy isoflavones (genistein, daidzein) 20 mg each, lycopene 10 mg Decrease prostate specific antigen (PSA) in one-third of patients without reducing male sex hormones (testosterone and dihydrotestosterone)¹⁵⁴ Vitamin and mineral supplementation from concentrated food or supplement sources: vitamin C, B vitamins (1, 2, 3, 5, 6, 9, 12), vitamin A, vitamin D, vitamin E, ascorbyl palmitate (absorbable vitamin C), calcium ascorbate, magnesium ascorbate, zinc ascorbate or glycinate, selenium, chromium picolinate and iodine Caution notes: Vitamin B₉ (folate/folic acid) and possibly B₁₂ may fuel prostate cancer risk or progression;¹⁵⁵ advised not to use in advanced prostate cancer Unless diagnosed with an iron or copper deficiency, do not supplement with iron or copper; iron promotes cancer growth and copper promotes angiogenesis (creation of blood vessels to supply tumors) Used in the Block program¹⁵⁶ See concerns regarding vitamin D below. See concerns regarding vitamin E in Group 6 below. See more about selenium in Reducing Risk Group 6 below.
Vitamin D₃	Serum levels: Better prognosis with medium or high serum levels compared with low levels (<50 nmol l^-1),¹⁵⁷ with a stronger effect in patients receiving hormone therapy¹⁵⁸ Higher mortality with both low and very high serum levels¹⁵⁹ Reduced tumor proliferation with higher serum 1,25 dihydroxyvitamin D levels, but not serum 25 hydroxyvitamin D levels, in a small study¹⁶⁰ Very low levels in younger men were associated with more aggressive prostate cancer¹⁶¹ Supplementation: Reduced tumor tissue inflammation and progression of low-grade prostate cancer in pilot studies¹⁶² Modestly lowered both PSA and serum PTH before radical prostatectomy¹⁶³ Decreased positive cores in some patients with low-risk prostate cancer under active surveillance¹⁶⁴ Reduced PSA levels in patients with asymptomatic, PSA-progression of prostate cancer with use of vitamin D₂ (ergocalciferol)¹⁶⁵ Anticancer effects including enhanced activity of docetaxel and improved PSA, measurable disease response rates and time to progression and survival in several small clinical studies but no improvements in others¹⁶⁶ Notable preclinical evidence: In a mouse study, both calcitriol and another form of vitamin D slowed androgen-stimulated tumor progression initially, but prolonged treatment with calcitriol resulted in development of a resistant and more aggressive disease associated with increased distant organ metastasis.¹⁶⁷ Used in these programs and protocols: Alschuler & Gazella complementary approaches¹⁶⁸ Chang strategies¹⁶⁹ McKinney protocols¹⁷⁰ See Commentary below. High levels can lead to hypercalcemia¹⁷¹

Group 5: Especially promising preclinical or emerging clinical evidence of efficacy and safety

Other therapies with preclinical evidence only for treating the cancer

African cherry (National Cancer Institute PDQ)
Alpha-lipoic acid
Anthocyanidins (delphinidin) (Science Direct)
Ashwagandha
Boron (Toxic Substances Portal)
Cannabinoids
Coenzyme Q10
Eugenol (ScienceDirect)
Garlic (About Herbs)
Ginkgo biloba (About Herbs)
Glucosinolates and isothiocyantes diindolymethane (DIM), sulforaphane
Grape seed extract
Lycopodine (ScienceDirect)
Magnolia bark (Honokiol)
ProstaCaid™
Red yeast rice (About Herbs)
Resveratrol
Scutellaria barbata (About Herbs)
Ursodiol (Urso) (Rx List)
Vitamin K
Vitex agnus-castus extract

Therapy	Notes
Astragalus	Antiproliferative effects in mice, leading to reduced tumor weight¹⁷²
Black cohosh	Inhibited tumor development, proliferation and composition in mice¹⁷³
Boswellia	Reduced proliferation and promoted cell death (apoptosis) and antitumorigenic effects in chemoresistant prostate cancer cells¹⁷⁴ Constituents inhibited the growth of docetaxel-resistant prostate cancer cells in lab and animal studies.¹⁷⁵
Curcumin Benefits of consuming turmeric are discussed above in Eating Well.	Decreased cell proliferation, increased cell death (apoptosis), and reduced angiogenesis (creation of new blood vessels to supply tumors) in mice and in human cells grafted into mice¹⁷⁶ Suppressed human prostate cancer stem cell proliferation and invasion in cell studies¹⁷⁷ for both androgen-sensitive and androgen-independent prostate cancer cells¹⁷⁸ Sensitized prostate cancer cells to chermotherapy drugs and radiation in animal and cell studies, while protecting normal cells¹⁷⁹ Inhibiting bone metastatic processes¹⁸⁰
Ginger	Cytotoxic against prostate cancer cells grafted into mice¹⁸¹
Ginseng (About Herbs)	Extracts show anticancer effects including induced cell death (apoptosis) and reduced prostate cancer cell viability in animal and lab studies¹⁸² Used in traditional Chinese medicine and Ayurveda
Indole-3-carbinol (I3C) (About Herbs) Benefits of consuming cruciferous vegetables high in I3C are discussed above in Eating Well.	Reactivated PTEN, a potent tumor suppressor gene, in mice, leading to potent suppression of tumorigenesis¹⁸³
Inositol hexaphosphate (IP-6)	Inhibited growth and angiogenesis (creation of blood vessels to supply tumors) of prostate cancer in mice¹⁸⁴
Medicinal mushrooms	Treatment with PSP extract from turkey tail mushrooms sensitized cancer cells toward γ-T3-induced cytotoxicity, and the combination of PSP and γ-T3 treatments significantly reduced the growth of prostate tumor in animals.¹⁸⁵ Reishi mushrooms inhibited the testosterone-induced growth of the ventral prostate in castrated rats,¹⁸⁶ induced growth arrest and cell death (apoptosis) in prostate cancer cell lines¹⁸⁷ and suppressed cell adhesion and migration of highly invasive prostate cancer cells¹⁸⁸ Reduced tumor growth with white button mushroom extract in mice¹⁸⁹
Melatonin	Inhibited prostate cancer tumorigenesis and markers with oral administration of melatonin in mice¹⁹⁰ Mice with human prostate cancer cell xenografts were injected with blood from human volunteers either rich or deficient in nocturnal melatonin. Melatonin-rich blood suppressed prostate cancer signal transduction, metabolic and growth activity, while blood from humans exposed to light at night markedly stimulated human prostate cancer growth, signal transduction and metabolic activity.¹⁹¹
Milk thistle	Inhibited tumor growth,¹⁹² through reduced vascularity in animals in one study¹⁹³ Inhibited growth of advanced human prostate cancer cells in animals through anti-proliferative, anti-angiogenic and other anticancer effects, especially with isosilybin B¹⁹⁴ Used in these programs and protocols: Alschuler & Gazella complementary approaches¹⁹⁵ Block program¹⁹⁶ Lemole, Mehta & McKee protocol¹⁹⁷ McKinney protocols¹⁹⁸ Used in traditional Chinese medicine and Ayurveda
Quercetin, ellagic acid and other flavanols and flavanoids including equol, luteolin, DHC, and fisetin	Inhibited prostate cancer growth in animal studies¹⁹⁹ Resensitized enzalutamide-resistant prostate cancer cells to enzalutamide treatment in mouse xenografts²⁰⁰
Saw palmetto	Lab and animal evidence of reduced proliferation of prostate cancer cells²⁰¹

Group 6: Evidence of no efficacy or may be dangerous

Therapy	Notes
Beta carotene	Evidence of no benefit but also no harm during radiation therapy²⁰²
Combination therapies Benefits of consuming green tea or tomatoes and other foods high in lycopene are discussed above in Eating Well.	Lycopene, green tea catechins and selenium Higher incidence of prostate cancer at re-biopsy and expression of microRNAs implicated in prostate cancer progression²⁰³ See more about selenium in Reducing Risk Group 6 below.
DHEA (dehydroepiandrosterone)	Can raise levels of sex hormones²⁰⁴ Recommendation against use the McKinney protocols, and against use of plant sterols and sterolines because they can raise DHEA levels²⁰⁵
Qilan capsules (consisting of astragalus, fenugreek, gynostremma, pentaphyllan and smilaz glabra)	No effects found²⁰⁶
Polyphenol E	No effects found²⁰⁷
Polysaccharide/oligosaccharide complex obtained from a shiitake mushroom extract (SME)	No effects found in clinical studies²⁰⁸
Vitamin E supplements	Serum levels: Improved prostate cancer survival in adult male smokers with higher serum alpha-tocopherol at baseline²⁰⁹ Supplements: Increased risk of prostate cancer among healthy men in a large study taking synthetic all rac-alpha-tocopheryl acetate supplements,²¹⁰ limited to those with lower baseline selenium levels, with indications of differences by genetic types²¹¹

Off-label, Overlooked or Novel Cancer Approaches (ONCAs)

These therapies have exciting potential and/or proven benefits. However, some carry higher risks of side effects, interactions with other treatments and other adverse medical events than other therapies we review. Cautions are noted with each therapy, and we strongly urge you consult your doctor before using these therapies—even over-the-counter drugs—for cancer treatment. We also note whether a prescription is needed or if a therapy is not widely available.

Group A: Good clinical evidence of efficacy

May be used in integrative protocols and programs

Therapy	Notes
Aspirin, COX-2 inhibitors and other nonsteroidal anti-inflammatory drugs (NSAIDs)	Longer overall survival but not prostate cancer-specific survival with aspirin use in some analyses²¹² but not all²¹³ Reduced incidence of lethal cancers (metastatic or fatal) with aspirin use²¹⁴ Increased disease-free survival in men of African-American descent with aspirin use²¹⁵ No benefit from post-diagnostic aspirin use in a prospective study²¹⁶ Longer PSA doubling time in a small clinical trial when used with vitamin D in men with recurrent cancer²¹⁷ Reduced metastasis²¹⁸ Noteworthy preclinical evidence: Enhanced the effect of radiation therapy on prostate cancer cells that express COX-2 in mice²¹⁹ Can have serious, even life-threatening side effects; use only under medical supervision Used in these programs and protocols: Block program²²⁰ Celebrex used in Chang strategies²²¹ Low-dose ("baby") aspirin used in Chang strategies to decrease risk of cardiovascular events and clots which can be caused by Celebrex and Chinese herbs²²²
Bisphosphonates (Canadian Cancer Society)	Improved survival with sodium clodronate but not zoledronic acid when used with docetaxel in men with metastatic disease, but no improvement with locally advanced disease²²³ Indications reduced the number of participants with disease progression²²⁴ Requires a prescription from a licensed physician
Chronomodulated therapy	Increased toxicities and biochemical failure rates seen with evening radiation treatment in prostate cancer patients (indicating that treatment is better at other times); treatment during business hours is the standard of care, but late afternoon treatments may be less optimal than treatment earlier in the day²²⁵ No response with hormone refractory metastatic prostate cancer treated with circadian-timed FUDR chemotherapy²²⁶
Cryotherapy (Medical News Today)	Rate of disease recurrence varied between 13.2 percent and 26 percent with high rates of maintained urinary continence and sexual potency following treatment; bowel habits and sexual function after four years were comparable to active holistic surveillance patients²²⁷ Inferior outcomes compared to brachytherapy in low- to intermediate-risk prostate cancer²²⁸
Gossypol (Web MD)	Extended overall survival in high-risk metastatic castration-resistant prostate cancer patients, but not other patients²²⁹ Decreased PSA levels in a small clinical trial, with adverse side effects at higher doses including fatigue, nausea/vomiting, diarrhea and ileus (a painful obstruction of the ileum or other part of the intestine)²³⁰ Failed to reduce PSA to target levels when combined with androgen deprivation therapy, and with serious adverse events in 12 of 55 participants²³¹ Notable preclinical evidence: Enhanced the antitumor activity of X-ray irradiation in mice, leading to tumor regression²³² Apogossypol, a gossypol derivative, inhibited tumor growth in a dose‑dependent manner with reduced toxicity in animals compared with gossypol.²³³ Requires a prescription from a licensed physician
Metformin	Decreased overall and prostate cancer-specific mortality among older men with both diabetes and prostate cancer. The longer the treatment with metformin, the greater the decrease in mortality.²³⁴ A systematic review and meta-analysis concluded that metformin may be a useful adjuvant (supplemental therapy in prostate cancer patients receiving radical radiotherapy.²³⁵ Significant reduction in BCR (biochemical recurrence) in prostate cancer, but not in all-cause mortality.²³⁶ Improved PSA levels without reported serious adverse events or toxicities²³⁷ Requires a prescription from a licensed physician Used in McKinney protocols, monitoring vitamin B₁₂ status²³⁸
Statins	Improved prostate cancer-specific survival, especially in advanced cancer and/or with radiation therapy²³⁹ Decreased cancer-specific and all-cause mortality with use²⁴⁰ Sensitized cancer cells to radiation and may improve prostate cancer-specific survival with radiotherapy²⁴¹ Associated with serious side effects including permanent muscle damage, increased incidence of diabetes and impaired cognitive function; their potential benefits in prostate cancer must be weighed against the risk, and they should be discontinued promptly if serious side effects occur Requires a prescription from a licensed physician Used in these programs and protocols: Block program²⁴² Chang strategies²⁴³

Group B: Limited clinical evidence of efficacy

May be used in integrative protocols and programs

Therapy	Notes
Gamma-delta T-cell immunotherapy (amino-bisphosphonates+IL-2)	Superior objective responses to current second-line therapies for advanced prostate cancer in small clinical trials²⁴⁴
Itraconazole (Web MD)	Findings from a 2018 phase 2 clinical trial:²⁴⁵ Modulated serum PSA levels modestly without lowering serum testosterone Risk of toxicities associated with mineralocorticoid excess Requires a prescription from a licensed physician
Low-dose naltrexone (LDN)	Anecdotal reports of LDN associated with remission of prostate cancer untreated by prior hormone-blocking therapy²⁴⁶ Requires a prescription from a licensed physician Used in these programs and protocols: Block program²⁴⁷ McKinney protocols²⁴⁸

Group C: Promising preclinical evidence only

Therapy	Notes
Diclofenac (Mayo Clinic)	Inhibited growth and reduced tumor weight and volume in animals²⁴⁹
Noscapine (Science Direct)	Limited tumour growth and lymphatic metastasis in mice, with stronger effects if used prophylactically²⁵⁰ Requires a prescription from a licensed physician
Propranolol and other beta blockers	Blocked the norepinephrine-induced migratory activity of cancer cells in animal studies²⁵¹ Beta blockers, including those of the non-selective type, were not associated with a decreased risk of mortality, either from prostate cancer or from all causes.²⁵² Requires a prescription from a licensed physician

Group D: Evidence of no efficacy or may be dangerous

Therapy	Notes
Dipyridamole (Persantine) (Web MD)	No meaningful improvement in response to chemotherapy in small clinical trials²⁵³

Diets and Metabolic Approaches

Therapies using Heat, Sound, Light or Cutting-edge Radiotherapy

Managing Side Effects and Promoting Wellness

Managing or relieving side effects or symptoms, reducing treatment toxicity, supporting quality of life or promoting general well-being

Conventional Therapies

After a prostatectomy, men frequently experience stress urinary incontinence (SUI) and pelvic pain. The incontinence can be from underactive, overactive or mixed-type pelvic floor dysfunction. An intervention of physical therapy targeted for each type of dysfunction found a decrease in pad usage per day, decreased pelvic pain and increased pelvic floor strength.²⁵⁶

Pulsed low-dose rate radiation therapy (PLDR-RT) delivers conventional radiation doses in pulses of small doses with intermittent pauses. A small study involved PLDR-RT for prostate and other cancers of the pelvis. Of the 50 percent of patients who reported pain at the local site before treatment, 68 percent reported an improvement in pain after PLDT-RT.²⁵⁷

Natural Products

Group 1: Good clinical evidence of efficacy & safety, easy access

These therapies may be widely used in integrative cancer protocols and traditional medical systems.

Therapy	Notes
Cranberry juice or extract (About Herbs)	Reduced incidence of urinary tract infections in men during or after radiotherapy for prostate cancer²⁵⁸ Reduced incidence of cystitis in men receiving radiation therapy for prostate cancer (limited evidence)²⁵⁹

Group 2: Good clinical evidence of efficacy & safety, limited access

Some may require a prescription, for example.

Therapy	Notes
Medical cannabis and cannabinoids	A 2018 review from the National Academy of Sciences, Engineering and Medicine drew these conclusions:²⁶⁰ Effective for treating pain in adults and chemotherapy-induced nausea and vomiting (Conclusive or substantial evidence) Improved secondary sleep disturbances (moderate evidence) Insufficient evidence of improved appetite or anxiety Access varies by country or US state, with moderately easy access in some areas and no or very limited legal access in others

Therapy

Notes

Medical cannabis and cannabinoids

A 2018 review from the National Academy of Sciences, Engineering and Medicine drew these conclusions:²⁶⁰
- Effective for treating pain in adults and chemotherapy-induced nausea and vomiting (Conclusive or substantial evidence)
- Improved secondary sleep disturbances (moderate evidence)
- Insufficient evidence of improved appetite or anxiety
Access varies by country or US state, with moderately easy access in some areas and no or very limited legal access in others

Group 3: Limited clinical evidence of efficacy but good safety, used in leading integrative programs

Therapy	Notes
Aged garlic extract (Let's Talk Nutrition)	Protected against radiation and chemical exposure, and long-term toxic damage²⁶¹ Used in the Alschuler & Gazella complementary approaches²⁶² to relieve radiation enteritis
Magnesium (About Herbs)	Conflicting evidence of reduced incidence of hot flashes, but not involving prostate cancer survivors²⁶³ Evidence of no effect on weight loss in a small randomized controlled trial of patients with testicular cancer, while also creating a "metallic taste" side effect²⁶⁴ Used in the McKinney protocols for hot flashes²⁶⁵
Melatonin and circadian activity/sleep cycle integration	Decreased pain scores and tramadol consumption, as well as enhanced sleep quality, sedation scores and subjective analgesic efficacy during the postoperative period in patients undergoing elective prostatectomy²⁶⁶ Patients with advanced lung cancer suffering greater circadian activity/sleep cycle disruption suffer greater interference with function, greater anxiety and depression, poorer nighttime sleep, greater daytime fatigue, and poorer quality of life than comparable patients who maintain good circadian integration.²⁶⁷ Melatonin is used in these programs and protocols: Alschuler & Gazella complementary approaches²⁶⁸ McKinney protocols²⁶⁹
Mistletoe (Viscum album extract)	Reviews of studies found improved quality of life among patients with unspecified cancers. One study listed benefits in coping, fatigue, sleep, exhaustion, energy, nausea, vomiting, appetite, depression, anxiety, ability to work, and emotional and functional well-being and—less consistently—in regard to pain, diarrhea, general performance, and other side effects of conventional treatments.²⁷⁰ Used in McKinney protocols²⁷¹ Used in traditional Chinese medicine
Omega-3 fatty acid supplements containing DHA and EPA	Ameliorated muscle loss and myosteatosis (the presence of intermuscular and intramuscular adipose tissue) in clinical studies²⁷² Used in the Block program to reduce radiation toxicity and relieve radiation enteritis²⁷³
Probiotics	May reduce acute radiotherapy-related diarrhea²⁷⁴ Used in the Block program to reduce radiation enteritis²⁷⁵
Pycnogenol® pine bark extract (About Herbs)	A small clinical study found these effects in cancer (but not prostate cancer) patients receiving radiotherapy or chemotherapy:²⁷⁶ Decreased incidence of nausea/vomiting, diarrhea, edema, weakness and weight loss Reduced cognitive impairment, cardiotoxicity and neutropenia Reduced need for medication to address side effects Fewer days of hospitalisation Used in the Block program to relieve radiation enteritis²⁷⁷
Three sengs decoction (ren shen yang rong tang)	Reduced moderate to severe fatigue in non-anemic cancer survivors in a small clinical study²⁷⁸ Used in the Block program to reduce radiation toxicity²⁷⁹ Used in traditional Chinese medicine
Vitamin A (retinol) (About Herbs)	Reduced oral mucositis in a small group of patients²⁸⁰ (not common in prostate cancer, but possible with some treatments) Reduced radiation proctopathy with retinol palmitate²⁸¹ Used in the Block program to relieve radiation enteritis²⁸²
Vitamin C	Intravenous vitamin C alleviated cancer- and chemotherapy-related symptoms, including fatigue, insomnia, loss of appetite, nausea, and pain, and also improved physical, role, cognitive, emotional, and social functioning, as well as overall health²⁸³ Used in the Block program to relieve radiation toxicity²⁸⁴

Group 4: Potential significant benefit, but either limited clinical evidence of efficacy or significant cautions

May be used in leading integrative oncology programs. Therapies in this group may need more medical oversight and surveillance.

Therapy	Notes
Aloe vera (About Herbs)	Improved some symptoms of acute radiation proctitis induced by radiotherapy of pelvic area: diarrhea, fecal urgency and impact on lifestyle, but no improvement in hemorrhage and abdominal/rectal pain in a small clinical trial²⁸⁵
Ashwagandha	Improved fatigue, vigor, and sexual and psychological well-being in a small study of overweight men aged 40-70 years with mild fatigue (but not cancer patients); also increased dehydroepiandrosterone (DHEA) and testosterone levels, which could be a concern with prostate cancer²⁸⁶
Curcumin	Much milder urinary symptoms in patients undergoing external beam radiotherapy²⁸⁷ Protected intestinal mucosa from radiotherapy-induced damage in rats fed curcumin²⁸⁸ No interference in radiation treatment outcomes after three months²⁸⁹
Green tea extract	Reduced lower urinary tract symptoms in men with high-grade prostate intraepithelial neoplasia²⁹⁰
Modified citrus pectin	Improved physical functioning, role functioning, social functioning, global health status, fatigue, pain, difficult or labored breathing, insomnia and appetite loss compared to the baseline in some patients in a pilot study²⁹¹
Saw palmetto	Reduced lower urinary tract symptoms during radiation therapy²⁹² Used in traditional Chinese medicine and Ayurveda
Soy isoflavones	Reduced urinary, bowel, and sexual adverse symptoms induced by radiation therapy²⁹³
Supplement blends	Vitamin and mineral supplementation from concentrated food or supplement sources: vitamin C, B vitamins (1, 2, 3, 5, 6, 9, 12), vitamin A, vitamin D, vitamin E, ascorbyl palmitate (absorbable vitamin C), calcium ascorbate, magnesium ascorbate, zinc ascorbate or glycinate, selenium, chromium picolinate and iodine Caution notes:²⁹⁴ Vitamin B₉ (folate/folic acid) and possibly B₁₂ may fuel prostate cancer progression;²⁹⁵ advised not to use in advanced prostate cancer Unless diagnosed with an iron or copper deficiency, do not supplement with iron or copper; iron promotes cancer growth and copper promotes angiogenesis See more about selenium in Reducing Risk Group 6 below. Dixentil: 10mg zinc, 500mg galacto-oligosaccharides, 10mg L acidophilus, 10mg L. casei, 1mg vitamin B₁, 1mg vitamin B₂, 1mg vitamin B₆, 10mg nicotinamide Reduced diarrhea incidence and severity including during pelvic radiation treatments²⁹⁶ Milk thistle (silymarin) and selenium Improved quality of life scores in a small study²⁹⁷ See more about selenium in Reducing Risk Group 6 below.
Vitamin D	Improved pain, muscle strength and quality of life in patients with advanced hormone-refractory prostate cancer²⁹⁸ Higher levels led to better response to influenza vaccines in prostate cancer patients.²⁹⁹ Serum 25-hydroxyvitamin D concentrations of <35 nmol/L in male and <40 nmol/L in female patient was associated with increased severity of radiation-induced acute proctitis.³⁰⁰ Improved bone health in patients with prostate cancer when used with calcium;³⁰¹ however, a 2012 review and analysis concluded that "at the doses commonly recommended, 500-1,000 mg calcium and 200-500 IU vitamin D per day, men undergoing androgen deprivation lose bone mineral density."³⁰² The authors note that "high levels of dietary calcium and calcium supplement use are associated with higher risks for cardiovascular disease and advanced prostate cancer", and so higher supplementation cannot currently be recommended for men in treatment for prostate cancer.

Group 5: Especially promising preclinical or emerging clinical evidence of efficacy and safety

Therapy	Notes
Ginkgo biloba (About Herbs)	Inhibited the formation of radiation-induced chromosome-damaging clastogenic factors and ultraviolet light-induced oxidative stress in preclinical studies³⁰³
Grape seed extract	Ameliorated some of the cytotoxic effects on normal cells/tissues induced by chemo- or radiotherapy in preclinical studies³⁰⁴ Inhibited UV radiation-induced suppression of the immune system in animals³⁰⁵
Panax ginseng (About Herbs)	Attenuated irradiation-induced myelosuppression, decreased oxidative stress and normalized increased serum liver enzymes and hepatic protein levels in liver tissue of mice exposed to x-ray radiation³⁰⁶ Protected cell lines from ultraviolet radiation³⁰⁷ No significant benefit on cancer-related fatigue compared to placebo³⁰⁸

Group 6: Evidence of no efficacy or may be dangerous

Therapy	Notes
Black cohosh	Reduced hot flashes in small studies, although not replicated in large studies, and mostly in studies of women³⁰⁹ Used in traditional Chinese medicine
L-glutamine	Supplements do not prevent radiotherapy-induced diarrhea³¹⁰

Off-label, Overlooked or Novel Cancer Approaches (ONCAs)

Group B: Limited clinical evidence of efficacy

May be used in integrative protocols and programs

Therapy	Notes
Chronomodulated therapy	Less cisplatin-induced vomiting and subacute renal toxicity in the treatment of urogenital cancer depending on timing of treatment in a small study³¹¹ (cisplatin may be used in less common types of prostate cancer such as small cell and neuroendocrine) Used in the Block program³¹²
Hyperbaric oxygen therapy (Mayo Clinic)	Improved scores for radiation injury in late radiation proctopathy³¹³ Requires a prescription from a licensed physician Mentioned by the Block program³¹⁴ to alleviate tissue damage from radiation treatment

Diets & Metabolic Therapies

Mind-Body Approaches

Manipulative and Body-based Methods

Energy Therapies

Bioelectromagnetically Based Therapies

Reducing Risk

Reducing the risk of developing cancer or the risk of recurrence

Risk Factors

Risk factors for prostate cancer include these:³²⁴

Expand list

Conventional Therapies

Group 1: Good clinical evidence of efficacy & safety, easy access

These therapies may be widely used in integrative cancer protocols and traditional medical systems.

Therapy	Notes
Grape seed extract	Reduced risk of prostate cancer³³¹
Lycopene Benefits of consuming tomatoes and other foods high in lycopene are discussed above in Eating Well.	Reduced risk of prostate cancer in large meta-analyses with both dietary intake and circulating concentrations of lycopene, but no reduced risk of advanced cancer in one analysis³³²
Quercetin Benefits of consuming onions, apples and other foods high in quercetin are discussed above in Eating Well.	Reduced incidence of prostate cancer in epidemiologic studies³³³ Notable preclinical evidence: chemopreventive properties in animal studies³³⁴

Therapy

Notes

Grape seed extract

Reduced risk of prostate cancer³³¹

Lycopene

Benefits of consuming tomatoes and other foods high in lycopene are discussed above in Eating Well.

Reduced risk of prostate cancer in large meta-analyses with both dietary intake and circulating concentrations of lycopene, but no reduced risk of advanced cancer in one analysis³³²

Quercetin

Benefits of consuming onions, apples and other foods high in quercetin are discussed above in Eating Well.

Reduced incidence of prostate cancer in epidemiologic studies³³³
Notable preclinical evidence: chemopreventive properties in animal studies³³⁴

Group 3: Limited clinical evidence of efficacy but good safety, used in leading integrative programs

Therapy	Notes
Glucosinolates and isothiocyantes: indole-3-carbinol (I3C), diindolymethane (DIM), sulforaphane Benefits of consuming cruciferous vegetables high in these nutrients are discussed above in Eating Well.	Isothiocyanates are weakly related to reduced risk of prostate cancer.³³⁵ Used in these programs and protocols: Block program³³⁶ McKinney protocols³³⁷
Green tea extract	Reduced development of prostate tumors in men with high-grade prostate intraepithelial neoplasia (HGPIN)³³⁸ Decreased incidence of prostate cancer plus atypical small acinar proliferation in men with HGPIN without atypical small acinar proliferation at baseline³³⁹
Soy isoflavones Benefits of consuming soy foods are discussed above in Eating Well.	Daidzein concentrations³⁴⁰ and genistein intake are both associated with reduced risk.³⁴¹ Genistein modulated gene changes and epigenetic modifications found in prostate cancer.³⁴² Soy isoflavones are used in the Block program.³⁴³
Vitamin E Benefits of consuming foods high in vitamin E are discussed above in Eating Well.	Serum levels: Progressively higher PSA scores with decreasing serum levels of vitamin E in a small study³⁴⁴ Decreased risk for developing prostate cancer with higher serum alpha-tocopherol levels, with a higher association of decreased risk for advanced prostate cancer and a greater association among those taking alpha-tocopherol supplements³⁴⁵ Reduced total prostate cancer risk and aggressive cancer risk in current smokers with higher alpha-tocopherol or gamma-tocopherol levels, with some evidence of differences among genotypes³⁴⁶ Supplements: Natural vitamin E contains eight tocopherols and tocotrienols, found in different combinations across sources, but vitamin E supplements typically contain only alpha-tocopherol,³⁴⁷ The specific tocopherols used in studies should be noted, for each have different properties and effects.³⁴⁸ Supplementation with higher levels of alpha-tocopherol may affect levels of gamma-tocopherol; the balance and mix of tocopherols may be very important in outcomes.³⁴⁹ Inconsistent evidence: Increased risk or no effect with synthetic all rac alpha-tocopheryl acetate³⁵⁰ Increased risk from alpha-tocopherol supplementation but decreased risk with gamma-tocopherol use³⁵¹ Reduced risk for both prostate cancer and advanced cancer with alpha-tocopherol in a pooled analysis, but no association with gamma-tocopherol³⁵² Analyses of data propose that risks associated with vitamin E may vary by genotype of patients or by the specific form of vitamin E (alpha-tocopherol versus gamma-tocopherol, for instance)³⁵³ Recommendation against use by integrative oncologist and BCCT advisor Donald Abrams, MD³⁵⁴ Used in these programs and protocols: Alschuler & Gazella complementary approaches³⁵⁵ McKinney protocols (paired with EGCG)³⁵⁶ Select tocopherols are used in these programs and protocols: Block program³⁵⁷ Lemole, Mehta & McKee protocol³⁵⁸
Vitamin K	Lower risk of prostate cancer with dietary intake of menaquinones (vitamin K₂), but not phylloquinone (vitamin K₁) in a nested case-control study³⁵⁹ Vitamin K₂ is used in these programs and protocols: Lemole, Mehta & McKee protocol³⁶⁰ McKinney protocols³⁶¹

Group 4: Potential significant benefit, but either limited clinical evidence of efficacy or significant cautions

May be used in leading integrative oncology programs. Therapies in this group may need more medical oversight and surveillance.

Therapy	Notes
Melatonin	Reduced risk of prostate cancer or advanced stage prostate cancer with high urinary melatonin, melatonin-sulfate levels or a high melatonin-sulfate/cortisol (MT/C) ratio; finding a low MT/C ratio combined with a PSA level exceeding 10 ng/ml showed the greatest potential in detecting prostate cancer and advanced stage prostate cancer.³⁶²
Zyflamend: mixture of rosemary, turmeric, ginger, holy basil, green tea, hu zhang, chinese goldthread, barberry, oregano, baikal skullcap	"Showed promise" in reducing prostate cancer risk³⁶³

Group 5: Especially promising preclinical or emerging clinical evidence of efficacy and safety

Other therapies with preclinical evidence only for reducing risk

Organosulfur compounds
Red yeast rice (About Herbs)
Resveratrol

Therapy	Notes
Curcumin	Chemopreventive effects in mice³⁶⁴
Inositol hexaphosphate (IP-6)	Lab and animal evidence of chemoprotective effects³⁶⁵
Milk thistle	Chemoprotective effects in lab and animal studies³⁶⁶
Pygeum africanum extracts	Reduced prostate cancer incidence in mice³⁶⁷
Turkey tail mushroom	Eliminated prostate cancer stem cells in animal studies³⁶⁸

Group 6: Evidence of no efficacy or may be dangerous

Therapy	Notes
Beta carotene, other carotenoids and retinol (vitamin A)	Regarding beta carotene, retinol and other carotenoids:³⁶⁹ Limited and conflicting evidence of reduced risk Increased risk of prostate cancer with higher circulating retinol concentrations in blood Increased risk of prostate cancer among smokers taking beta carotene supplements
Boron (Toxic Substances Portal)	Not associated with lower prostate cancer incidence³⁷⁰
Calcium supplements (National Cancer Institute) Risks of consuming foods high in calcium are discussed above in Eating Well.	No higher risk of prostate cancer overall, but an increased risk of fatal prostate cancer³⁷¹
Coenzyme Q10	No significant reduced risk of prostate cancer in a large cohort.³⁷²
Flavonoids, including anthocyanidins	No effect on reducing risk of prostate cancer onset³⁷³
Folic acid or folate	Increase in prostate cancer risk in a large case-control study and meta-analyses of epidemiological studies of both folic acid supplementation and blood folate levels³⁷⁴ Recommendation against use in the McKinney protocols³⁷⁵
Glucosamine (About Herbs)	No significant reduced risk of prostate cancer³⁷⁶
Omega-3 fatty acid supplements containing DHA and EPA Benefits of consuming foods high in omega-3s are discussed above in Eating Well.	2018 review conclusions:³⁷⁷ One study found an increased risk of prostate cancer and of high-grade prostate cancer with the highest blood levels of omega-3 fatty acids, but the study did not assess supplement use. Four grams of supplementation may impair clotting; patients may want to eliminate omega-3 supplements before and immediately after surgery. Conflicting evidence regarding risk: no clear relationship between omega-3s in general or fish-derived omega-3 fatty acids and risk of prostate cancer in some reviews,³⁷⁸ while another small study found higher levels of individual components of both omega-6 and omega-3 fatty acids may be associated with higher-grade prostate cancer.³⁷⁹
Saw palmetto	Evidence of no reduced risk in a large prospective cohort study³⁸⁰
Selenium	Higher blood or nail selenium levels—to a point—are associated with lower risk of prostate cancer in some studies.³⁸¹ This association may be specific to some genotypes.³⁸² However, several studies show either no effect or a trend toward increased prostate cancer risk or more advanced cancer from use of selenium supplements.³⁸³ Large studies have found that among men with high levels of selenium at baseline, those taking selenium had a greatly increased risk of high-grade prostate cancer compared to placebo. In one study, men who reported consuming 140+ μg/day of selenium after diagnosis had a 2.6-fold increased risk of prostate cancer mortality.³⁸⁴
Vitamin A (retinol) (About Herbs)	Evidence of increased risk of prostate cancer³⁸⁵
Vitamin C	No evidence of reduced risk from vitamin C supplements or dietary intake in large studies and reviews³⁸⁶
Vitamin D	Mixed results across studies and conditions: Increased risk of prostate cancer with higher vitamin D levels: With higher serum levels³⁸⁷ Of aggressive prostate cancer with very high levels of plasma vitamin D (above 70 or 80 nmol/l, depending on the study),³⁸⁸ and more strongly for high-grade disease.³⁸⁹ Especially for aggressive disease and among men with higher total vitamin D and calcium intake, greater leisure activity, higher serum alpha-tocopherol and total cholesterol, lower serum retinol or vitamin E supplementation³⁹⁰ Decreased risk with higher levels: Of developing metastatic prostate cancer with higher serum levels³⁹¹ Of aggressive prostate cancer with high vitamin D intake in men of African-American descent and individuals with a low body mass index (BMI) compared to men of European-American descent or those with higher BMIs³⁹² Severe vitamin D deficiency (<12 ng /mL) was associated with increased risk of a prostate cancer diagnosis on biopsy among men of African American descent, and associated with higher Gleason grade and tumor stage in men of both African American and European American descent³⁹³ Both low (<50 nmol/L) and high (≥75 nmol/L) vitamin D concentrations were associated with increased risk of prostate cancer, and more strongly for high-grade disease. Authors of this study do not advise supplementation in men with adequate levels.³⁹⁴ High levels can lead to hypercalcemia³⁹⁵ See the Commentary section below.
Zinc (About Herbs)	Decreased zinc levels found in prostate cancer cells is considered an essential early event in prostate oncogenesis.³⁹⁶ However, a 2016 meta-analysis found no evidence for an association between zinc intake and prostate cancer incidence among men of African-American descent.³⁹⁷

Off-label, Overlooked or Novel Cancer Approaches (ONCAs)

Group A: Good clinical evidence of efficacy

May be used in integrative protocols and programs

Therapy	Notes
Aspirin, COX-2 inhibitors and other nonsteroidal anti-inflammatory drugs (NSAIDs)	Reduced risk of developing prostate cancer³⁹⁸ Decreased risk of advanced stage prostate cancer in men of African-American descent³⁹⁹ Can have serious, even life-threatening side effects; use only under medical supervision See Commentary below.
Finasteride (brand names Proscar, Propecia, and Propecia Pro-Pak) and other 5-alpha reductase inhibitors (Web MD)	A placebo-controlled, randomized clinical trial found these associations:⁴⁰⁰ Reduced prostate cancer risk, with finasteride concentrations affected by variations in genes responsible for altering its metabolism pathway Greater inflammation in benign prostate tissue in those receiving finasteride, but the risk of total and higher-grade cancer was not increased compared to those receiving placebo. Most significant reduction has been seen in low-grade prostate cancer, with a concern that 5-ARIs could potentially increase high-risk prostate cancer and mortality. Although higher mortality has not been seen in follow-up data, 5-ARIs continue to have a black box warning and are not approved for prostate cancer prevention.⁴⁰¹ Requires a prescription from a licensed physician Used in Chang strategies⁴⁰²
Metformin	Significant reduction in BCR (biochemical recurrence) in prostate cancer, but not in all-cause mortality.⁴⁰³ Requires a prescription from a licensed physician
Propranolol	Reduced risk of prostate cancer⁴⁰⁴ Requires a prescription from a licensed physician
Statins	Decreased risk of advanced or aggressive prostate cancer⁴⁰⁵ Decreased risk of recurrence after radiation therapy⁴⁰⁶ Decreased risk of biochemical recurrence among patients who received radiation therapy but not radical prostatectomy, and only among men undergoing androgen deprivation therapy⁴⁰⁷ Increased prostate cancer risk with extended use in obese men Some evidence of reduced risk with statin use,⁴⁰⁸ but insufficient evidence of benefit to support the use of statins for the primary prevention of prostate cancer⁴⁰⁹ Associated with serious side effects including permanent muscle damage and impaired cognitive function; their potential benefits in prostate cancer must be weighed against the risk, and they should be discontinued promptly if serious side effects occur Require a prescription from a licensed physician
Vitamin K antagonists, drugs that reduce blood clotting by reducing the action of vitamin K; the most common are coumarins such as warfarin (brand names Coumadin and Jantoven) (Web MD)	Decreased risk of prostate cancer, especially in long-term users, in a meta-analysis⁴¹⁰ and large population studies⁴¹¹ Requires a prescription from a licensed physician High risk of bleeding if levels are not monitored closely

Optimizing Your Terrain

Creating an environment within your body that does not support cancer development, growth or spread

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Omega-3 fatty acids show some evidence of decreased inflammatory markers in clinical trials.⁴¹²
Intravenous vitamin C modulated inflammation correlated with decreases in tumor marker levels in a pilot study⁴¹³
Milk thistle (silymarin) and selenium reduced two markers of lipid metabolism known to be associated with prostate cancer progression in a small study.⁴¹⁴

Integrative Approaches and Surgery

Surgery may be part of the recommended treatment for this cancer type. We provide helpful information about how integrative approaches can coordinate with surgery on our Integrative Approaches and Surgery page.

In addition, information specific to prostate cancer surgery is offered here:

Delaying surgery for as long as six months in high-risk patients with clinically localized prostate cancer does not increase adverse pathological outcomes, nor does it impact survival, a large analysis found in 2020.⁴¹⁵ This is an important consideration both for making a thoughtful—as opposed to a rushed—decision about surgery and for avoiding unnecessary hospital time during the current pandemic.

While anesthesia reduces a patient’s experience of pain during surgery, it may also impair numerous immune functions.⁴¹⁶ On the other hand, pain itself can promote stress hormones and cascade into negative effects.⁴¹⁷

Finding the best approaches to pain management is important for outcomes related to both the surgery and the cancer. A 2008 study found that patients who received general anesthesia combined with epidural analgesia had a 57 percent lower risk of cancer recurrence than patients who had general anesthesia and postoperative opioids.⁴¹⁸

Commentary

Highlighted Video

Dean Ornish, MD: Symington 2017

In his Grand Rounds Urology lecture, Aaron Katz, MD, cites the literature supporting vitamin D’s positive effect in reducing disease risk, including prostate cancer. Dr. Katz’s practice is to “obtain [baseline] vitamin D levels on all of my [prostate cancer] patients that are on active surveillance, whether it be in the recurrent cases or in primary [cases]. Then. . . restore about 1,000 international units (IUs) of vitamin D, [to] give you just a bump [in blood levels] up of around 10 ng/mL. Most people in the field believe that the therapeutic range is somewhere between 40 and 50 ng/mL. ”⁴¹⁹

BCCT senior researcher Laura Pole, RN, MSN, OCNS: In dosing vitamin D to bring up to therapeutic levels, keep in mind that many clinicians, including BCCT advisor Donald Abrams, MD, feel that doses greater than 4000 IU daily lead to increased risk of calcification of blood vessels. Dr. Katz reports that he has not seen any problems dosing with 5000 IU vitamin D per day for 3 months, then re-checking the vitamin D level. BCCT advises not to take high doses of vitamin D without medical advice and supervision.

BCCT advisor Keith Block, MD, says that off-label use of calcitriol, which is the most active form of vitamin D, is of particular interest in prostate cancer.⁴²⁰ Preclinical evidence shows clear benefit and early clinical evidence to date is promising but not yet conclusive.⁴²¹ See descriptions of vitamin D in Treating the Cancer, Group 4 and in Reducing Risk, Group 6.

Dr. Block cautions against giving alpha-tocopherol alone, as this may deplete the body of other important components of vitamin E.⁴²²

Dr. Block prefers to get at the root of inflammation using diet and other non-drug approaches, but in certain situations, he uses Celebrex to block the COX-2 enzyme, “since the inflammatory chemicals the enzyme spawns play a major role in blocking the effectiveness of chemotherapy and radiation.”⁴²³ Note that NSAIDs can have serious, even life-threatening side effects; use them only under medical supervision.

Nutrition Advisor Karen Collins, MS, RDN, CDN, FAND, American Institute for Cancer Research, July 26, 2019: There are multiple reasons to be cautious about alpha-tocopherol supplements much beyond RDA level. I cannot find evidence of an effect on absorption of tocotrienols and other tocopherols, but it has been known for many years that high levels of alpha-tocopherol intake tend to decrease blood and tissue levels of gamma-tocopherol. (I'm not sure of the reason—perhaps through effects on absorption from the gut, but perhaps on saturation of metabolic enzymes, preferential saturation of carriers within the body, or other mechanisms.)

While there is great interest in the potential of tocopherols and tocotrienols beyond alpha-tocopherol for anticancer effects, these ideas are largely based on in vitro and animal studies. There is a big leap from these kinds of studies to human application, which need to consider dose, bioavailability, potential differences among human populations.

However, it's important to think more broadly about your question, too. Our antioxidant defense network (from exogenous sources and endogenous elements within our body) interact in many ways. So setting any single element high may have ramifications on others. Selenium is one example, which is noted in the references I share below and is still coming up in studies as recently as May.

Perhaps this summary of research and recommendations written for health professionals will be helpful to you: National Institutes of Health Vitamin E: Fact Sheet for Health Professionals. It focuses on alpha-tocopherol, since that is the only form for which we have established recommended intake at this time. The reason I recommend it for your review is that it provides important perspective on potential for excess. Although the Tolerable Upper Intake Levels (set to accompany the RDAs) were developed based on avoidance of hemorrhagic effects, evidence from studies like the SELECT trial show that problems such as increased risk of prostate cancer can occur at levels above the RDA but well below that upper limit. (Remember back in the day when cardiologists were excited to recommend 400 IU to all their heart patients??)

There is also a version written for the public, in case you'd like to link to it in what you're creating: Vitamin E:
Fact Sheet for Consumers.

Another reference that may help explain the strong findings about the dangers of antioxidant supplements during cancer treatment: Avoiding Antioxidant-Drug Interactions During Cancer Treatment.

My bottom line: Concern about interactions of alpha-tocopherol supplements with tocotrienols and other tocopherols is only one of several reasons to be concerned about supplementation beyond the RDA, especially well beyond it.

Written by Laura Pole, RN, MSN, OCNS, and Nancy Hepp, MS; most recent update on January 20, 2021. BCCT is grateful for review and feedback on this summary from integrative oncologist and BCCT advisor Donald Abrams, MD, and for the KNOW Oncology resource used in creating this summary.

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