Prostate Cancer

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Quick Reference

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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.

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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.

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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.

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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.

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Clinical Practice Guidelines

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

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Ornish Lifestyle Medicine

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Charles “Snuffy” Myers, MD

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Prostate Oncology Specialists

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Prostate Institute of America

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Block Center for Integrative Cancer Treatment

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Integrative Programs, Protocols and Medical Systems

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

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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

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7 Healing Practices

Moving More

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

Managing Stress

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Sleeping Well

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Creating a Healing Environment

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Sharing Love and Support

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Exploring What Matters Now

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Other Lifestyle Associations: Healthy Living

Obesity

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Tobacco Smoking

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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.

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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.

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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.

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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 and off-label, overlooked and novel cancer approaches (ONCAs) in six groups:

  1. Good clinical evidence of efficacy & safety, easy access
  2. Good clinical evidence of efficacy & safety, limited access
  3. Limited clinical evidence of efficacy but good safety, used in leading integrative programs
  4. Limited clinical evidence of efficacy, or significant cautions, but potential significant benefit
  5. Especially promising preclinical or emerging clinical evidence of efficacy and safety
  6. 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.68

Conventional Prostate Cancer Therapies

In the ProtecT study, men with localized prostate cancer and favorable prognoses who were followed for 10 years lived just as long whether they did active surveillance, surgery or radiation therapy.

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Natural Products

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

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Group 4: Limited clinical evidence of efficacy, or significant cautions, but potential significant benefit

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

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

Other therapies with preclinical evidence only for treating the cancer

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Group 6: Evidence of no efficacy or may be dangerous

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

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

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

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

Some may require a prescription, for example.

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

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Group 4: Limited clinical evidence of efficacy, or significant cautions, but potential significant benefit

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

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

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Group 6: Evidence of no efficacy or may be dangerous

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Diets and Metabolic Approaches

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

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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

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.

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

Some may require a prescription, for example.

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

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Group 4: Limited clinical evidence of efficacy, or significant cautions, but potential significant benefit

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

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

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Group 6: Evidence of no efficacy or may be dangerous

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

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

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Mind-Body Approaches

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Manipulative and Body-based Methods

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Energy Therapies

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Bioelectromagnetically Based Therapies

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Reducing Risk

Reducing the risk of developing cancer or the risk of recurrence

Risk Factors

Risk factors for prostate cancer include these:310

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Conventional Therapies

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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.

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

Read more

Group 4: Limited clinical evidence of efficacy, or significant cautions, but potential significant benefit

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

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

Other therapies with preclinical evidence only for reducing risk

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Group 6: Evidence of no efficacy or may be dangerous

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

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

Some may require a prescription, for example.

Read more

Group 4: Limited clinical evidence of efficacy, or significant cautions, but potential significant benefit

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

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Optimizing Your Terrain

Natural Products

  • Omega-3 fatty acids show some evidence of decreased inflammatory markers in clinical trials.400
  • Intravenous vitamin C modulated inflammation correlated with decreases in tumor marker levels in a pilot study401
  • Milk thistle (silymarin) and selenium reduced two markers of lipid metabolism known to be associated with prostate cancer progression in a small study.402

Commentary

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. ”403

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.404 Preclinical evidence shows clear benefit and early clinical evidence to date is promising but not yet conclusive.405 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.406

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.”407 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 October 8, 2019. 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.

Highlighted Video

Dean Ornish, MD: Symington 2017

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View All References

More Information

Integrative Approaches to Prostate Cancer Care

Conventional Approaches

Advocacy and Support Groups

  • National Comprehensive Cancer Network: Advocacy and Support Groups; select prostate cancer or another topic of interest from the dropdown menu.

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