Prostate Cancer
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Authors
Laura Pole, RN, MSN, OCNS, BCCT Senior Researcher Ms. Pole is an oncology clinical nurse specialist who has been providing integrative oncology clinical care, navigation, consultation and education services for more than 30 years. View profile.
Ms. Hepp is a science researcher and communicator who has been writing and editing educational content on varied health topics for more than 20 years. View profile. Reviewer
Donald Abrams, MD, BCCT Advisor Dr. Abrams is past chief of the Hematology-Oncology Division at Zuckerberg San Francisco General Hospital, an integrative oncologist at the UCSF Osher Center for Integrative Medicine and professor emeritus of clinical medicine at the University of California San Francisco. View profile. BCCT is grateful for the KNOW Oncology resource used in creating this summary. Last updated August 2, 2021. |
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 WaitingWatchful 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. Watchful waiting is closely monitoring a patient’s condition without giving any treatment until signs or symptoms appear or change. Treatment is given to relieve symptoms and improve quality of life. Active surveillance is closely following a patient's condition without giving any treatment unless test results change. It is used to find early signs that the condition is getting worse. In active surveillance, patients are given specific exams and tests to check if the cancer is growing: digital rectal exam, prostate-specific antigen (PSA) test, transrectal ultrasound and transrectal needle biopsy. Treatment is given when the cancer progresses. Other terms describing no active treatment to manage prostate cancer right after diagnosis:
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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.
Men with newly diagnosed, localized prostate cancer need to consider the critical trade-off between the short-term and long-term effects of radical treatments on urinary, bowel and sexual function and the higher risks of disease progression with active monitoring, as well as the effects of each of these options on quality of life.”1
Whatever conventional treatment option turns out to be right for you, there is a role for wisely integrating complementary therapies. We give you information on those therapies that have evidence for benefit: lifestyle practices, natural products and off-label, overlooked or novel cancer approaches (ONCAs). We will focus on two lifestyle programs for men in active surveillance, Ornish Lifestyle Medicine created by Dean Ornish, MD, and the Active Holistic Surveillance program of Aaron Katz, MD. We hope in your exploration you find that you have choices in living more healthfully and fully with prostate cancer.
Michael Lerner
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:
- 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 VideosCardiologist, 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 for 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
Dr. Charles “Snuffy” Myers is a noted medical oncologist and prostate cancer survivor who specializes in treating prostate cancer. He practices conventional oncology and also considers lifestyle practices, particularly diet, important for men with prostate cancer. He thinks deeply and innovatively about conventional prostate cancer treatment, such as targeted therapies, as well as the problem of prostate cancers becoming resistant to chemotherapy. He is now editor-in-chief of an information and resource website for those with prostate cancer, Prostapedia. He has also written a cookbook specifically for prostate cancer: The New Prostate Cancer Nutrition Book.
In his compelling presentation on Grand Rounds Urology, he discusses these topics and presents information on his group’s study using a drug that inhibits the enzyme poly ADP ribose polymerase (PARP) in advanced prostate cancer patients who were no longer responding to the chemotherapy drug taxotere. Dr. Myers states:16
So 20 percent to 30 percent of post-taxotere patients may be candidates for PARP therapy, an oral drug associated with close to 90 percent response rate. So it’s hard for me to believe this won’t be an important advance in the management of those patients. In addition to being very well tolerated, this drug does not depend on testosterone presence or absence to work.
Prostate Oncology Specialists
Medical oncologists Mark Scholz, MD; Richard Lam, MD; and Jeffrey Turner, MD, run an integrative oncology practice in Marina del Ray, California. One of BCCT’s advisors, a medical advocate, is impressed with their integrative, individualized approach. Doctors Scholz, Lam and Turner state:
As medical oncologists rather than surgeons, we do not have a preset agenda toward a specific treatment. All treatments, including active surveillance, hormone therapy, immunotherapy, surgery, radiation, brachytherapy, cryotherapy, focal therapy, proton therapy, nutritional and alternative therapies, HIFU and chemotherapy are given equal consideration depending on the unique needs of each individual patient.
Their Prostate Oncology Specialists website, books and publications provide a wealth of information on making decisions about prostate cancer treatment, and shedding light on innovative, integrative approaches to prostate cancer care. Find more information about their resources and publications below.
Prostate Institute of America
Dr. Duke Buhn with the Prostate Institute of America provides “options that include minimally invasive therapies, including cryotherapy, as a means of treatment that increase survivability and may reduce side effects and complications.” According to one of BCCT's medical advocacy advisors, Dr. Buhn has been performing cryotherapy for prostate cancer for many years. He is also a master at noninvasive methods to gather information, such as Harmonic Doppler Ultrasound.
Block Center for Integrative Cancer Treatment
Keith Block, MD, integrates lifestyle, nutrition, natural products and other complementary approaches into conventional cancer care. At the 2003 conference of the American Society of Clinical Oncology, he presented a case series of 27 prostate cancer patients who began treatment with combined androgen blockade after diagnosis of distant metastases. All patients received conventional treatment along with counseling in therapeutic nutrition and supplementation, fitness and physical therapy, and mind-spirit care. Both survival after severe disease and survival after development of androgen-resistant disease exceeded observations of similar groups in the literature.17
Integrative Programs, Protocols and Medical Systems
For more information about programs and protocols, see our Integrative Programs and Protocols page. |
Programs and protocols related to prostate cancer:
- Alschuler & Gazella complementary approaches18
- Block program19
- Chang strategies20
- Cohen & Jefferies Mix of Six anticancer practices: risk reduction21
- Elsegood LDN guidelines22
- Geffen Seven Levels of Healing23
- Lemole, Mehta & McKee prostate cancer protocol24
- McKinney prostate cancer protocol25
- Ornish Lifestyle Medicine
Integrative Therapies in Prostate Cancer
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 |
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- 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
- See recommendations about eggs in the Commentary section below.
- 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
Treating the Cancer
In men with prostate cancer, three or more hours per week of vigorous activity is associated with a substantially lower risk of dying from prostate cancer compared with men with less than one hour of vigorous activity per week.43
Managing Side Effects and Promoting Wellness
Men with prostate cancer managed with androgen deprivation therapy who engaged in long-term soccer (European football) training showed increased mineral density in their right femoral neck bones compared to men not training. However, over five years, muscle mass, knee-extensor muscle strength, VO2 max, and postural balance decreased in both groups.44
Reducing Risk
Strong evidence shows that vigorous activity (activities that cause sweating and increased heart and respiratory rates) is associated with a reduced risk of lethal prostate cancer. Activity such as brisk walking (three or more miles per hour) three times a week or regular bicycling is associated with a substantially lower risk of recurrence compared to lower frequency or more leisurely activity.45
A Norwegian study following almost 2000 men for 30 years found that men in the highest third of fitness had an increased risk of prostate cancer compared to those in the lowest third.46 However, a much larger study following almost 50,000 men for 26 years found an opposite association with advanced and lethal prostate cancers: Men who engaged most frequently in vigorous activity over the length of the study had a 30 percent lower risk of developing advanced prostate cancer and 25 percent lower risk of developing lethal prostate cancer when compared with men who exercised the least.47 A 2020 review found moderate evidence of reduced risk of prostate cancer with higher levels of occupational physical activity.48
See Moving More.
The risks from these lifestyle changes are very low, and the potential benefits are great.
Managing Stress
Treating the Cancer
In a large study in Sweden, men with the highest levels of perceived stress had a statistically significantly increased rate of prostate cancer-specific mortality.49
Managing Side Effects and Promoting Wellness
A small study found that participation in a mindfulness-based stress reduction program was associated with "enhanced quality of life and decreased stress symptoms, altered cortisol and immune patterns consistent with less stress and mood disturbance, and decreased blood pressure."50
Optimizing Your Terrain
Chronic inflammation, which can be provoked by chronic stress, is involved in prostate carcinogenesis.51
See Managing Stress.
Sleeping Well
Reducing Risk
Large studies52 have found no association between sleep duration and risk of prostate cancer overall, or for advanced or more lethal disease. Sleep does not seem to be an important factor in prostate cancer risk.
See Sleeping Well.
Creating a Healing Environment
Reducing Risk
A large study of twins concluded that inherited genetic profile can influence your risk of prostate cancer, but "the environment has the principal role in causing sporadic cancer."53
Several chemical exposures are associated with increased risk of prostate cancer:54
- Agent Orange
- Aromatic amines
- Dioxins
- Methyl bromide
- Organochlorine and other pesticides
- PAHs
- Solvents
A few exposures are associated with lower risk:
Sharing Love and Support
Managing Side Effects and Promoting Wellness
Studies have found that social support is associated with prostate cancer patients' reports of quality of life.57
Exploring What Matters Now
Managing Side Effects and Promoting Wellness
Study results among men with newly diagnosed clinically localized prostate cancer:
- Men who were more active in making decisions about treatment and who had greater knowledge reported lower decisional conflict and higher decision-making satisfaction. They also reported greater decision-making difficulty.58
- Greater spirituality was associated with greater decision-making satisfaction, less decisional conflict, and less decision-making difficulty.59
- Receiving informational support (to couples) facilitated treatment decision making and was associated with lower levels of psychological distress.60
Other Lifestyle Associations: Creating Healthy Habits
Obesity
High body mass index (BMI) "is strongly associated with increased risk of developing lethal prostate cancer, and increasing evidence suggests that obesity (either before or at the time of diagnosis) is associated with prostate cancer progression and prostate cancer-specific mortality."61 Obesity (body mass index ≥30 kg/m2) may also predispose patients to higher rates of adverse outcomes following radical prostatectomy.62
Weight gain of five pounds or more from five years prior to one year after surgery is associated with a much higher risk of recurrence and prostate cancer-specific mortality. Another study found a 5 kg/m2 increase in body mass index (BMI) was associated with a 20 percent higher risk of death from prostate cancer.63
However, a large, 30-year Norwegian study found that lower BMI (under 25) was associated with a higher risk of prostate cancer compared to BMI at or greater than 25,64 contrary to most other evidence. We look forward to further research and analysis to explain this apparent contradiction.
The World Cancer Research Fund/American Institute for Cancer Research includes recommendations to "keep your weight within the healthy range and avoid weight gain in adult life" to reduce the risk of all cancers.65
Tobacco Smoking
Of the risk factors that you can change, “smoking within the previous 10 years is one of the big ones,” according to Meir Stampfer at Harvard.66 A 2018 study found that “current smokers at the time of primary curative treatment for localized prostate cancer are at higher risk of experiencing biochemical recurrence, metastasis, and cancer-specific mortality.”67 Studies have consistently found worse outcomes among smokers compared to nonsmokers in prostate cancer patients treated by radiation, androgen-deprivation therapy (ADT), and radical prostatectomy.68
Finding Reliable Information about Prostate CancerAs 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. A 2018 study evaluated the accuracy of 150 videos on prostate cancer screening and treatment posted on YouTube. Study findings:69
We encourage our readers to check the dates on information, cross-check claims with reliable and authoritative science-based sources, and validate claims as far as possible before investing much time or money in miracle cures. |
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.
Several therapeutic approaches show potential. The therapies presented here are not necessarily singly or in combination the right supplements for you to use. This list is not a recommendation from BCCT. Refer to our summaries of each of these therapies to see uses in prostate cancer, where to find dosing guidelines, cautions, and their use in integrative protocols, programs and systems. A licensed health professional experienced in integrative prostate cancer care can provide valuable guidance in selecting therapies.
Cells, Animals and PeopleStudies 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. Drawing conclusions from cell studies is fraught with the potential for errors, a little bit like predicting children's final career successes from their performance in kindergarten. Yes, some differences hold all throughout the many levels and experiences on the way to the final goal, but many other intervening variables can change the outcome. Animal studies are a step up from cell studies, but differences between humans and lab animals make animal evidence unreliable in predicting how cancer patients will respond to therapies that work well with animals. While cell and animal studies are good markers for therapies to explore further, these results alone are not good evidence of a therapy's ultimate effects. In our therapy summaries, we list clinical evidence first, and then we include lab and animal evidence for further insights. When no clinical evidence is available, lab and animal evidence is offered, but we do not consider it strong evidence. This handbook focuses on therapies with clinical evidence of effects in prostate cancer. However, we also include therapies with particularly promising animal evidence. These are the Group 5 therapies in each category. |
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 OutcomesPredict 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 ApproachesA highly respected organization reviewed studies of outcomes across different approaches to treating localized prostate cancer:
Conclusions:71
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The Ultimate Guide to Cancer: DIY ResearchThis 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:
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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
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 |
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Green tea extract |
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Isoflavones, including soy supplements and red clover Benefits of consuming soy foods are discussed above in Eating Well. |
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Benefits of consuming tomatoes and other foods high in lycopene are discussed above in Eating Well. |
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Modified citrus pectin | |
Omega-3 fatty acid supplements containing DHA and EPA Benefits of consuming foods high in omega-3s are discussed above in Eating Well. |
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Pomegranate fruit and extract |
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Sulforaphane (Healthline) Benefits of consuming cruciferous vegetables high in sulforaphane are discussed above in Eating Well. |
|
Tetrathiomolybdate (TM) and other copper chelators |
|
Vitamin C |
|
Zyflamend: mixture of rosemary, turmeric, ginger, holy basil, green tea, hu zhang, chinese goldthread, barberry, oregano, baikal skullcap |
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 | |
Artemisinin |
|
Combination therapies Benefits of consuming foods containing many of these nutrients are discussed above in Eating Well.
|
|
Cranberry juice or extract (About Herbs) |
|
Hydroxycitrate, found in the Garcinia gummi-gutta (tamarind) fruit (About Herbs) |
|
Supplement blends:
|
|
Vitamin D3 |
|
Group 5: Especially promising preclinical or emerging clinical evidence of efficacy and safety
Other therapies with preclinical evidence only for treating the cancer
|
Therapy | Notes |
---|---|
Astragalus |
|
Black cohosh |
|
Boswellia | |
Benefits of consuming turmeric are discussed above in Eating Well. |
|
Ginger |
|
Ginseng (About Herbs) |
|
Indole-3-carbinol (I3C) (About Herbs) Benefits of consuming cruciferous vegetables high in I3C are discussed above in Eating Well. |
|
Inositol hexaphosphate (IP-6) |
|
Medicinal mushrooms |
|
Melatonin |
|
Milk thistle |
|
Quercetin, ellagic acid and other flavanols and flavanoids including equol, luteolin, DHC, and fisetin | |
Saw palmetto |
|
Group 6: Evidence of no efficacy or may be dangerous
Therapy | Notes |
---|---|
Beta carotene |
|
Combination therapies Benefits of consuming green tea or tomatoes and other foods high in lycopene are discussed above in Eating Well.
|
|
DHEA (dehydroepiandrosterone) | |
Qilan capsules (consisting of astragalus, fenugreek, gynostremma, pentaphyllan and smilaz glabra) |
|
Polyphenol E |
|
Polysaccharide/oligosaccharide complex obtained from a shiitake mushroom extract (SME) |
|
Vitamin E supplements |
|
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) |
|
Bisphosphonates (Canadian Cancer Society) | |
Chronomodulated therapy |
|
Cryotherapy (Medical News Today) |
|
Gossypol (Web MD) |
|
Metformin |
|
Statins |
|
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) |
|
Itraconazole (Web MD) |
|
Low-dose naltrexone (LDN) |
Group C: Promising preclinical evidence only
Therapy | Notes |
---|---|
Diclofenac (Mayo Clinic) |
|
Noscapine (Science Direct) |
|
Propranolol and other beta blockers |
|
Group D: Evidence of no efficacy or may be dangerous
Therapy | Notes |
---|---|
Dipyridamole (Persantine) (Web MD) |
|
Diets and Metabolic Approaches
- Ketogenic diet
- Animal studies show a positive effect slowing tumor growth in prostate cancer, but not improving survival, with the ketogenic diet compared to western diet.254 Clinical trials are currently in progress.
- Macrobiotic diet
- Anthony Sattilaro, MD, diagnosed with metastatic prostate cancer, experienced complete resolution of his bone lesions at one and four years after diagnosis. Reviews have not found sufficient evidence of cancer-treating effects to recommend this diet.255
See Alternative and Popular Cancer Diets.
- Anthony Sattilaro, MD, diagnosed with metastatic prostate cancer, experienced complete resolution of his bone lesions at one and four years after diagnosis. Reviews have not found sufficient evidence of cancer-treating effects to recommend this diet.255
Therapies using Heat, Sound, Light or Cutting-edge Radiotherapy
- Hyperthermia
- Local and regional hyperthermia is being used in Europe and the US; it may be combined with radiation therapy in treating prostate cancer. No evidence of effects has been published to date.
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) |
Group 2: Good clinical evidence of efficacy & safety, limited access
Some may require a prescription, for example.
Therapy | Notes |
---|---|
Medical cannabis and cannabinoids |
|
Group 3: Limited clinical evidence of efficacy but good safety, used in leading integrative programs
Therapy | Notes |
---|---|
Aged garlic extract (Let's Talk Nutrition) | |
Magnesium (About Herbs) |
|
Melatonin and circadian activity/sleep cycle integration |
|
Mistletoe (Viscum album extract) |
|
Omega-3 fatty acid supplements containing DHA and EPA | |
Probiotics | |
Pycnogenol® pine bark extract (About Herbs) |
|
Three sengs decoction (ren shen yang rong tang) |
|
Vitamin A (retinol) (About Herbs) | |
Vitamin C |
|
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) | |
Ashwagandha | |
Curcumin | |
Green tea extract |
|
Modified citrus pectin |
|
Saw palmetto |
|
Soy isoflavones |
|
Supplement blends |
|
Vitamin D |
|
Group 5: Especially promising preclinical or emerging clinical evidence of efficacy and safety
Therapy | Notes |
---|---|
Ginkgo biloba (About Herbs) |
|
Grape seed extract | |
Panax ginseng (About Herbs) |
|
Group 6: Evidence of no efficacy or may be dangerous
Therapy | Notes |
---|---|
Black cohosh |
|
L-glutamine |
|
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 B: Limited clinical evidence of efficacy
May be used in integrative protocols and programs
Therapy | Notes |
---|---|
Chronomodulated therapy | |
Hyperbaric oxygen therapy (Mayo Clinic) |
Diets & Metabolic Therapies
Fasting reduced chemotherapy side effects (vomiting, diarrhea, fatigue and weakness) in two patients with prostate cancer.316
Mind-Body Approaches
These therapies show benefit for many typical cancer side effects and symptoms:
- Mind-body approaches317
- Tai Chi and qigong
- Yoga
- "Salutogenic (health-promoting) effect in both prostate cancer patients and their caregivers"320
- Reduced pre-existing and radiation therapy-related fatigue and urinary and sexual dysfunction in prostate cancer patients321
Manipulative and Body-based Methods
- Acupuncture:322
- Reduced chemotherapy-induced nausea and vomiting
- Reduced hot flashes
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:325
- Age (increasing risk with aging)
- Race and ethnicity, with men of African-American descent, West African ancestry from the Caribbean and men from South America showing higher incidence and mortality of prostate cancer than white men; Asian men have lower incidence
- Family history of prostate cancer in father or brother
- High serum levels of insulin-like growth factor (IGF-I)
- Sexually transmitted infections
- Obesity
- Smoking
- Alcohol consumption
- Diet (as described above in Eating Well)
- Vasectomy (slightly increased relative risk in some studies)
- Diabetes (conflicting results across studies)
- Environmental exposures as described above in Creating a Healing Environment
An extensive meta-analysis did not find an overall association between ever-exposure to night-shift work and the risk of prostate cancer.326 Separate studies of the association between artificial light at night (LAN) and incidence of several cancers "found a significant positive association between population exposure to LAN and incidence rates of prostate cancer."327
A small study found an association between use of the beta blocker metoprolol and higher risk of metastatic prostate cancer.328 Until that association is confirmed in a larger study, BCCT does not consider it a concern.
Conventional Therapies
In a large study of associations between testosterone replacement therapy (TRT) and risk of prostate cancer, use was significantly associated with more favorable-risk prostate cancer and lower risk of aggressive prostate cancer.329 This is considered a surprising find by many oncologists, for conventional treatment is to reduce testosterone.
A 2019 retrospective study from Japan suggests that patients with localized prostate cancer treated with carbon ion radiotherapy appear to have a lower risk of subsequent primary cancers than those treated with photon radiotherapy.330 Access to carbon ion radiotherapy in the United States has been limited to clinical trials, although the National Cancer Institute has announced a goal to create a carbon therapy instrument and treatment center in the US.331
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 |
---|---|
Grape seed extract |
|
Benefits of consuming tomatoes and other foods high in lycopene are discussed above in Eating Well. |
|
Benefits of consuming onions, apples and other foods high in quercetin are discussed above in Eating Well. |
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. |
|
Benefits of consuming soy foods are discussed above in Eating Well. |
|
Benefits of consuming foods high in vitamin E are discussed above in Eating Well. |
|
Vitamin K |
|
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 |
|
Zyflamend: mixture of rosemary, turmeric, ginger, holy basil, green tea, hu zhang, chinese goldthread, barberry, oregano, baikal skullcap |
|
Group 5: Especially promising preclinical or emerging clinical evidence of efficacy and safety
Other therapies with preclinical evidence only for reducing risk
|
Therapy | Notes |
---|---|
Curcumin |
|
Inositol hexaphosphate (IP-6) |
|
Milk thistle |
|
Pygeum africanum extracts |
|
Turkey tail mushroom |
|
Group 6: Evidence of no efficacy or may be dangerous
Therapy | Notes |
---|---|
Beta carotene, other carotenoids and retinol (vitamin A) |
|
Boron (Toxic Substances Portal) |
|
Calcium supplements (National Cancer Institute) Risks of consuming foods high in calcium are discussed above in Eating Well. |
|
Coenzyme Q10 |
|
Flavonoids, including anthocyanidins |
|
Folic acid or folate | |
Glucosamine (About Herbs) |
|
Omega-3 fatty acid supplements containing DHA and EPA Benefits of consuming foods high in omega-3s are discussed above in Eating Well. |
|
Saw palmetto |
|
Selenium |
|
Vitamin A (retinol) (About Herbs) |
|
Vitamin C |
|
Vitamin D |
|
Zinc (About Herbs) |
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) | |
Finasteride (brand names Proscar, Propecia, and Propecia Pro-Pak) and other 5-alpha reductase inhibitors (Web MD) |
|
Metformin |
|
Propranolol |
|
Statins |
|
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) |
Optimizing Your Terrain
Creating an environment within your body that does not support cancer development, growth or spread
Natural Products
- Omega-3 fatty acids show some evidence of decreased inflammatory markers in clinical trials.413
- Intravenous vitamin C modulated inflammation correlated with decreases in tumor marker levels in a pilot study414
- Milk thistle (silymarin) and selenium reduced two markers of lipid metabolism known to be associated with prostate cancer progression in a small study.415
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 2020.416 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.417 On the other hand, pain itself can promote stress hormones and cascade into negative effects.418
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.419
Commentary
Highlighted VideoDean Ornish, MD: Symington 2017 The Transformative Power of LifeStyle Medicine 00:27 Introduction |
Vitamin D
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. ”420
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.421 Preclinical evidence shows clear benefit and early clinical evidence to date is promising but not yet conclusive.422 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.423
Celecoxib for Inflammation
Dr. Block prefers to get at the root of inflammation using diet and other non-drug approaches, but in certain situations, he uses celecoxib (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.”424 Note that NSAIDs can have serious, even life-threatening side effects; use them only under medical supervision.
Vitamin E
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 2019.
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.
Eggs
Cancer researcher and BCCT advisor Ralph Moss, PhD, comments on a series of observational studies that suggest a correlation between egg consumption and prostate cancer in men in North America. A follow-up study in 2015 “found a 47 percent increased risk of life-threatening prostate cancer . . . A 2016 study from the same group similarly found that high intake of eggs was associated with a doubled risk of advanced prostate cancer.”425
Moss emphasizes that observational studies are not proof. Interestingly, in China, egg consumption is the highest in the world, yet the prostate cancer rates are low. The studies did not take into account the quality of the eggs consumed, and Moss wonders if commercial egg factories produce eggs that are more unhealthy. Moss concludes his commentary: “Could the increased diagnosis of fatal prostate cancers be limited to factory farm-produced eggs in the United States and Canada? Definitely. But, in the meantime, I recommend erring on the side of caution: I would suggest that all PC [prostate cancer] patients, or others at high risk, cut back or eliminate their consumption of all eggs, especially the yolks. It is the prudent thing to do.”426
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- Cancer.net. Prostate Cancer: Statistics. American Society of Clinical Oncology (ASCO). January 2019. Viewed July 2, 2019.
- American Cancer Society. Cryotherapy for Prostate Cancer. March 11, 2016. Viewed on September 17, 2018.
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- Werneburg GT, Kongnyuy M et al. Patient-reported quality of life progression in men with prostate cancer following primary cryotherapy, cyberknife, or active holistic surveillance. prostate cancer and prostatic diseases. 2018;21(3):355–363.
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- Aetna. Ornish Cardiac Rehabilitation Program. February 28, 2018. Viewed September 20, 2018.
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- Myers C. Path to Durable Complete Remission in Prostate Cancer: What Do We Know and What Do We Need to Learn? April 2016. Viewed September 27, 2018.
- Block KI, Gyllenhaal C, Shoham J. Survival impact of integrative cancer care in advanced metastatic prostate cancer. Presentation at the 2003 conference of the American Society of Clinical Oncology.
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- Gregg JR, Zhang X et al. Adherence to the Mediterranean diet and grade group progression in localized prostate cancer: an active surveillance cohort. Cancer. 2021 Jan 7.
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- Pantuck AJ, Leppert JT et al. Phase II study of pomegranate juice for men with rising prostate-specific antigen following surgery or radiation for prostate cancer. Clinical Cancer Research. 2006 Jul 1;12(13):4018-26.
- Pantuck AJ, Pettaway CA et al. A randomized, double-blind, placebo-controlled study of the effects of pomegranate extract on rising PSA levels in men following primary therapy for prostate cancer. Prostate Cancer and Prostatic Diseases. 2015 Sep;18(3):242-8.
- Paur I, Lilleby W et al. Tomato-based randomized controlled trial in prostate cancer patients: effect on PSA. Clinical Nutrition. 2017 Jun;36(3):672-679.
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More Information
Integrative Approaches to Prostate Cancer Care
- World Cancer Research Fund/American Institute for Cancer Research Continuous Update Project Expert Report 2018: Diet, Nutrition, Physical Activity and Cancer: A Global Perspective
- Anticancer Lifestyle Program: Prostate Cancer Prevention and Treatment: An Integrative Approach (webinar recording)
- Katz's Corner with Dr. Aaron Katz
- What is Holistic Urology? Interview with Dr. Aaron Katz in “Ask the Doctor” series of Winthrop-University Hospital
- Katz A. Diet and Supplements for Men with Rising PSA. Grand Rounds Urology. January 2015.
- Abrams D. An integrative approach to prostate cancer. The Journal of Alternative and Complementary Medicine. 2018 Sep/Oct;24(9-10):872-880.
- Berg CJ, Habibian DJ et al. Active holistic surveillance: the nutritional aspect of delayed intervention in prostate cancer. Journal of Nutrition and Metabolism, 2016;2016:2917065.
- Charles “Snuffy” Myers:
- Scholz M. The Key to Prostate Cancer: 30 Experts Explain 15 Stages of Prostate Cancer. Prostate Oncology Specialists. 2018.
- Dr. Geovanni Espinosa:
- National Cancer Institute Prostate Cancer, Nutrition, and Dietary Supplements (PDQ®)
- Prostapedia Journal (requires paid subscription. However, access to blog and weekly email updates is free.)
- Scambia J, Darves A, Katz A. Chapter 22: Prostate cancer: an integrative approach. In Abrams DI, Weil AT. Integrative Oncology, 2nd Edition. New York, NY: Oxford University Press. 2014.
- Werneburg GT, Kongnyuy M et al. Patient-reported quality of life progression in men with prostate cancer following primary cryotherapy, cyberknife, or active holistic surveillance. prostate cancer and prostatic diseases. 2018;21(3):355–363.
- Scholz M, Blum R. Invasion of the Prostate Snatchers: No More Unnecessary Biopsies, Radical Treatment or Loss of Sexual Potency. 2010.
- Foundation for Alternative and Integrative Medicine: Fatty Acids and Prostate Cancer Risk
- Prostate.net: Can medical marijuana treat prostate cancer? 2013.
- European Association on Urology Nurses: Using cannabis in prostate cancer patients
- Ting H, Deep G, Agarwal C, Agarwal R. The strategies to control prostate cancer by chemoprevention approaches. Mutation Research. 2014 Feb;760:1-15.
- McKee D. Off Label Pharmaceutical ‘Cocktails’ For Cancer Treatment (excerpts relevant to prostate cancer). A4M Integrative Cancer Therapies Module 6. June 6-8, 2013.
- Philippou Y, Hadjipavlou M, Khan S, Rane A. Complementary and alternative medicine (CAM) in prostate and bladder cancer. BJU International. 2013 Dec;112(8):1073-9.
- Ting H, Deep G, Agarwal C, Agarwal R. The strategies to control prostate cancer by chemoprevention approaches. Mutation Research. 2014 Feb;760:1-15.
- Beth Israel Medical Center and the Balm Foundation: Preparing for Surgery
Conventional Approaches
- Tyson MD, Penson DF, Resnick MJ. The comparative oncologic effectiveness of available management strategies for clinically localized prostate cancer. Urologic Oncology, 2017 Feb;35(2), 51–58.
- Myers CE, Basu G, Wright B, Mahanes J, Spinelli A. Successful treatment of advanced metastatic prostate cancer following chemotherapy based on molecular profiling. Case Reports in Oncology. 2012 Jan-Apr;5(1):154–158.
- National Cancer Institute: Contact Us for Help
Information specialists at the NCI Contact Center are available to help answer your cancer-related questions in English and Spanish whether you are a patient, family member or friend, health care provider, or researcher. We also respond to questions and requests for information about NCI and its programs and provide support in quitting smoking. - 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.
- Dr. Patrick Walsh's Guide to Surviving Prostate Cancer
- Saad F, Pouliot F, Danielson B, Catton C, Kapoor A. Symptom assessment to guide treatment selection and determine progression in metastatic castration-resistant prostate cancer: expert opinion and review of the evidence. Canadian Urological Association Journal. 2018 Sep;12(9):E415-E420.
Advocacy and Support Groups
- National Comprehensive Cancer Network: Advocacy and Support Groups; select prostate cancer or another topic of interest from the dropdown menu.
More from Our Resources Database
- Society for Integrative Oncology: Navigating Integrative Prostate Cancer Care
- Gurdev Parmar and Tina Kaczor: Textbook of Naturopathic Oncology
- University of Cambridge: Predict Prostate
- Danial E. Baker: Application of chronotherapy to the treatment of cancer: can changing the timing of drug administration influence efficacy and toxicity?
- September 2018 Issue of the Journal of Alternative and Complementary Medicine
- The Lord Symington Foundation with Healing Circles and The New School at Commonweal: Dean Ornish, MD: Symington 2017
- Ralph Moss, PhD: The Moss Reports
- National Cancer Institute: Complementary and Alternative Medicine for Health Professionals
Related Pages
Personal Stories
In the News
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- Depression, anxiety rates high with androgen deprivation therapy for prostate cancer
- A randomized trial of the effects of exercise on anxiety, fear of cancer progression and quality of life in prostate cancer patients on active surveillance
- Novel radioligand therapy improves progression-free and overall survival in patients with metastatic prostate cancer
- Vegetarians have a 14% lower risk of cancer, compared to meat-eaters, study finds
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