Originally published 11/26/2015
We thought it was especially important to refresh the information in the original blog below because the study it described was only specific for prostate cancer (PCa) patients who had IMRT radiation as their treatment. A more recent paper addresses the general population of PCa patients as well as men at risk for PCa.
Can supplements offer any protection against developing PCa, or protection against current disease becoming worse? The authors of a 2020 paper surveyed extensive published evidence on the impact of the supplements most used by men to reduce PCa risks.[i]
For their purposes, the authors used the PSA blood test as an indicator of risk, even while acknowledging it’s imperfect because a rising PSA does not necessarily indicate cancer. The authors examined data on lycopene, selenium, curcumin, phytoestrogens (including isoflavones and flavonoids), green tea catechins, fruit and fruit extracts (saw palmetto, cranberries, pomegranate), Vitamin D, ascorbic acid and A-tocopherol, combined antioxidant therapy, and a number of dietary interventions.
The authors concluded that natural “chemoprevention” of PCa is not supported by the literature, that “…the role of nutrition in down-regulating PSA concentrations appears to be minimal.” Sorry, guys, it seems that supplements have little to no value for reducing PCa risk, but that’s not to suggest that natural products are worthless for any other condition. As we urged in the earlier blog, talk to your doctor or nutritionist for professional advice.
A recent study out of Fox Chase Cancer Center (Philadelphia) on men’s health supplements and prostate cancer gained publicity. Unfortunately, some of the press articles distorted the purpose and outcome of the study with statements like, “Men’s health supplements (MHSs) offer no benefit for patients with localized prostate cancer…”[ii] Men who take saw palmetto, the most prevalent ingredient (91%) identified by the research team, would probably be crushed at the notion that the money they were spending to prevent prostate problems was all for nothing.
Not to worry. A careful reading of the abstract by Zaorsky et al.[iii] (available online at http://www.redjournal.org/article/S0360-3016(15)01775-7/fulltext) should put your mind at ease. It was not the authors’ intent to conduct a sweeping research study on the benefits of saw palmetto and other ingredients found in natural products marketed as promoting prostate health. Their purpose was very specific, and limited only to 2301 prostate cancer patients who were treated during a 10 year period at their center with IMRT (intensity modulate radiation therapy) for localized PCa. They designed their research to evaluate “the impact of MHSs on patient outcomes and toxicities” on the 232 men who said they were taking men’s health supplements at the time of their treatment or during follow up. In other words, this is a study only on men’s health supplements and IMRT. Period.
The authors set out to compare the effects of treatment between these patients and the other 2269 men who were not using supplements. They adjusted the comparison to take into account each patient’s baseline (at the start of IMRT) factors, including age, PSA, Gleason score, T stage, hormone use, other medical conditions and smoking. The two groups were then compared for the incidence of side effects as well as acute and late gastrointestinal and genitourinary toxicities. In addition, they were tracked for rates of freedom from biochemical recurrence (rising PSA after nadir, that is, the lowest post-treatment point), freedom from distant cancer spread, cancer-specific survival and overall survival.
The authors report their findings at a median follow-up of almost four years (46 months) as follows:
| Acute and late treatment related toxicities | No difference |
| Freedom from biochemical recurrence | No difference |
| Freedom from distant PCa spread | No difference |
| Cancer-specific survival | No difference |
| Overall survival | No difference (after adjusting for risk factors) |
Interestingly, the men taking supplements were “less likely to have heart disease or diabetes,” according to the study—so that alone should be encouraging! They concluded that men’s health supplement use “is not associated with a change in cancer-related outcomes or toxicities in men receiving IRMT for prostate cancer.”
Here are my takeaway points:
- Radiation therapy is designed to destroy prostate cancer, and a related consequence is that it destroys healthy tissue as well. I’m not sure that any men’s health supplement on the market would confer an advantage during radiation treatment. Common sense suggests that the injury effect from radiation would outweigh any advantage saw palmetto or other supplement would confer on normal, healthy tissue.
- Saw palmetto, the primary ingredient in the supplements reported identified by the 232 men in this study, is known to be beneficial for men with benign prostatic hyperplasia (BPH).[iv] This is a normal, noncancerous growth of prostate tissue resulting in a gland enlargement that can cause disruptions in urinary function. Saw palmetto, a natural ingredient, does not “cure” BPH, but it has helped countless men minimize urinary symptoms.
- Are there any supplements that are proven to prevent prostate cancer or its recurrence after treatment? Most authorities agree on the principle that if it’s heart-healthy, it’s prostate healthy! Their guidelines include: a diet low in red meat and animal fats (with fish and chicken in moderation) but high in fruits, vegetables, nuts and whole grains; regular exercise; stress management; and antioxidants.
- Read books and do your research. Don’t be surprised if names like Snuffy Myers or Mark Moyad consistently pop up. Many PCa patients rely on their well-informed counsel.
Returning to the IMRT/supplements study, lead author Nicholas Zaorsky was quoted in the news story cited earlier about men’s health supplements in general: “Many men believe the supplements will help their cancer, or at worst, do nothing, so what’s the harm…There have been thousands of cases in the United States where supplements have harmed patients, so we urge men to take caution when they walk down grocery store aisles and see bottles of pills labeled ‘men’s health’ or ‘prostate health.”
I agree with this statement. Be careful, as not all supplements contain what they claim, nor are manufactured by reputable formularies. Talk to your general practitioner, internist or a specialist in complementary and alternative medicine before you embark on “prostate health” supplements. To be your best self, put only the best in your body.
NOTE: This content is solely for purposes of information and does not substitute for diagnostic or medical advice. Talk to your doctor if you are experiencing pelvic pain, or have any other health concerns or questions of a personal medical nature.
References
[i] Grammatikopoulou MG, Gkiouras K, Papageorgiou S?, Myrogiannis I et al. Dietary Factors and Supplements Influencing Prostate Specific-Antigen (PSA) Concentrations in Men with Prostate Cancer and Increased Cancer Risk: An Evidence Analysis Review Based on Randomized Controlled Trials. Nutrients. 2020 Sep 29;12(10):2985.
[ii] http://www.practiceupdate.com/news/9495/32/1?elsca1=emc_conf_ASTRO2015During1&elsca2=email&elsca3=practiceupdate_onc&elsca4=201592_ASTRO2015During-1&elsca5=conference&rid=OTMxMDY4MTg5MTgS1&lid=10332481
[iii] Zaorsky NG, Churilla TM, Ruth K, Slifker M et al. Men’s Health Supplement Use and Outcomes Among Men Receiving Definitive IMRT for Localized Prostate Cancer. Int J Rad Onc. 2015 Nov 1;93(3):E194-5. Men’s Health Supplement.
[iv] Aliaev luG, vinarov AS, Demidko Iul, Spivak LG. The results of the 10-year study of efficacy and safety of Serenoa repens extract in patients at risk of progression of benign prostatic hyperplasia].Urologiia. 2013 Jul-Aug;(4):32-6.
About Dr. Dan Sperling
Dan Sperling, MD, DABR, is a board certified radiologist who is globally recognized as a leader in multiparametric MRI for the detection and diagnosis of a range of disease conditions. As Medical Director of the Sperling Prostate Center, Sperling Medical Group and Sperling Neurosurgery Associates, he and his team are on the leading edge of significant change in medical practice. He is the co-author of the new patient book Redefining Prostate Cancer, and is a contributing author on over 25 published studies. For more information, contact the Sperling Prostate Center.
