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Prostate Cancer (Holistic)

Prostate Cancer (Holistic)

About This Condition

Gain added protection against prostate cancer by living a healthy lifestyle and by learning more about the causes of this common disease. According to research or other evidence, the following self-care steps may be helpful.
  • Eat risk-reducing foods

    Add plenty of tomato, soy, cruciferous vegetables (such as broccoli, kale, cauliflower, and Brussels sprouts), and fish to your meals

  • Try vitamin E as mixed tocopherols

    50 IU a day of this supplement may help lower prostate cancer risks

  • Take time for a checkup

    See your doctor once a year for a prostate exam that can help detect disease before it becomes advanced

  • Try lycopene

    4 mg twice per day for a year has been has been shown to improve precancerous conditions in at-risk people

About

About This Condition

Prostate cancer is a malignancy of the prostate. It is characterized by unregulated replication of cells creating tumors, with the possibility of some of the cells spreading to other sites (metastasis).

This article includes a discussion of studies that have assessed whether certain vitamins, minerals, herbs, or other dietary ingredients offered in dietary or herbal supplements may be beneficial in connection with the reduction of risk of developing prostate cancer, or of signs and symptoms in people who have this condition.

This information is provided solely to aid consumers in discussing supplements with their healthcare providers. It is not advised, nor is this information intended to advocate, promote, or encourage self use of these supplements for cancer risk reduction or treatment. Furthermore, none of this information should be misconstrued to suggest that dietary or herbal supplements can or should be used in place of conventional anticancer approaches or treatments.

It should be noted that certain studies referenced below, indicating the potential usefulness of a particular dietary ingredient or dietary or herbal supplement in connection with the reduction of risk of prostate cancer, are preliminary evidence only. Some studies suggest an association between high blood or dietary levels of a particular dietary ingredient with a reduced risk of developing prostate cancer. Even if such an association were established, this does not mean that dietary supplements containing large amounts of the dietary ingredient will necessarily have a cancer risk reduction effect.

Prostate cancer is the most common cancer among men in the United States. Although the cause is not known, most researchers believe that alterations in testosterone metabolism and/or bodily responses to testosterone are involved.

Throughout the world, autopsy reports show that evidence of microscopic prostate cancer is extremely common in older men. However, most men who have such microscopic disease are never diagnosed with, nor do they die from, prostate cancer. Unlike this dormant form of the disease, the incidence of potentially life-threatening prostate cancer varies greatly in different parts of the world. Researchers believe that some factors, possibly involving diet or lifestyle issues, determine the risk of having potentially life-threatening prostate cancer.

American men are at high risk of being diagnosed with such prostate cancer, and African-American men are at particularly high risk, for reasons that are not completely clear. A family history of prostate cancer increases the risk to a limited extent. Farmers, mechanics, workers in tire and rubber manufacturing, sheet metal workers, and workers exposed to cadmium have also been reported to be at increased risk.

Symptoms

Prostate cancer usually grows slowly, initially producing no symptoms. Later in the course of the disease, symptoms that overlap with symptoms of prostatic hyperplasia, a very common benign condition, may appear. Some of these symptoms include frequent urination (including having to urinate more frequently at night), pain on urination, a weak urinary stream, dribbling after urination, and a sensation of incomplete emptying. In addition, blood may appear in urine. None of these symptoms is specific to prostate cancer; the diagnosis of this disease requires the help of a doctor.

If prostate cancer spreads to a distant part of the body, it most often is found in bone, a condition that may cause bone pain. Late stages of the disease are associated with severe weight loss, untreatable fatigue-inducing anemia, and finally death.

Healthy Lifestyle Tips

Several studies have reported that the risk of prostate cancer increases with increasing body weight .1 , 2

Eating Right

The right diet is the key to managing many diseases and to improving general quality of life. For this condition, scientific research has found benefit in the following healthy eating tips.

Recommendation Why
Go fish
Fish eaters have been reported to have a low risk of prostate cancer, possibly due to fish’s high omega-3 fatty acid content.

Fish eaters have been reported to have low risk for prostate cancer.3 The omega-3 fatty acids found in fish are thought by some researchers to be the components of fish responsible for protection against cancer.4

Go for cruciferous veggies
Cruciferous vegetables, such as cabbage, Brussels sprouts, broccoli, and cauliflower, may protect against prostate cancer.

Cabbage, Brussels sprouts, broccoli, and cauliflower belong to the Brassica family of vegetables, also known as “cruciferous” vegetables. In test tube and animal studies, these foods have shown to have anticancer activity,5 possibly due to several substances found in them, such as indole-3-carbinol ,6 glucaric acid ( calcium D-glucarate ),7 and sulforaphane .8 A recent preliminary study of men newly diagnosed with prostate cancer showed a 41% decreased risk of prostate cancer among men eating three or more servings of cruciferous vegetables per week, compared with those eating less than one serving per week.9 Protective effects of cruciferous vegetables were thought to be due to their high concentration of the carotenoids lutein and zeaxanthin, as well as their stimulatory effects on the breakdown of environmental carcinogens associated with prostate cancer.10

Sample some soy
Genistein, found in soy foods, has been shown to inhibit growth of prostate cancer cells, help kill these cells, and exhibit other anticancer actions in test-tube studies, more research is needed to confirm these findings

Genistein is an isoflavone found in soybeans and many soy foods, such as tofu, soy milk, and some soy protein powders. Except for soy sauce and soy protein concentrates processed with alcohol, most soy-based foods contain significant amounts of isoflavones, such as genistein. Genistein inhibits growth of prostate cancer cells, helps kill these cells,11 and has other known anticancer actions, according to test tube research findings.12

In preliminary research, men who consumed soy milk more than once per day were reported to have a significantly lower risk of prostate cancer compared with other men.13 Some researchers are now saying that genistein may eventually be shown to have the potential to treat prostate cancer,14 while others say only that enough evidence exists to recommend that future genistein research be devoted to the subject of prostate cancer prevention.15

Team up with tomatoes
Tomatoes may protect against a variety of cancers, and their protective effect seems to be stronger for prostate cancer than for most other cancers.

Tomatoes contain lycopene —an antioxidant similar in structure to beta-carotene . Most lycopene in our diet comes from tomatoes, though traces of lycopene exist in other foods. Lycopene has been reported to inhibit the proliferation of cancer cells in test tube research.16

A review of published research found that higher intake of tomatoes or higher blood levels of lycopene correlated with a reduced risk of cancer in 57 of 72 studies. Findings in 35 of these studies were statistically significant.17 Evidence of a protective effect for tomato consumption was stronger for prostate cancer than for most other cancers.
Try a low-fat diet
Men who ate a high-fat, low-fiber diet were reported to have higher levels of testosterone, which might increase prostate cancer risk.

When combined with a low-fiber diet, men consuming a high-fat diet have been reported to have higher levels of testosterone,18 which might increase their risk of prostate cancer. The risk of prostate cancer correlates with dietary fat from country to country,19 a finding supported in some,20 , 21 but not all,22 preliminary trials. In one study, prostate cancer patients consuming the most saturated fat (from meat and dairy), and followed for over five years, had over three times the risk of dying from prostate cancer compared with men consuming the least amount of saturated fat.23

Avoid beer
Although the effect of drinking alcohol on prostate cancer risk appears weak, some association between beer drinking and an increased risk may exist.

Although the effect of drinking alcohol on prostate cancer risk appears weak, some association between beer drinking and an increased risk may exist, according to an analysis of most published reports.24

Watch the meat
Research suggests that frequently eating meat, well-done steak, or cured meats may increase prostate cancer risk, though the association between prostate cancer and other meats has not been confirmed.

Meat contains high amounts of arachidonic acid. Some by-products of arachidonic acid have promoted prostate cancer in animals.25 Preliminary reports have suggested that frequently eating well-done steak26 or cured meats27 may also increase the risk of prostate cancer in men, though the association between prostate cancer and other meats has not been consistently reported.

Supplements

What Are Star Ratings?

Our proprietary “Star-Rating” system was developed to help you easily understand the amount of scientific support behind each supplement in relation to a specific health condition. While there is no way to predict whether a vitamin, mineral, or herb will successfully treat or prevent associated health conditions, our unique ratings tell you how well these supplements are understood by the medical community, and whether studies have found them to be effective for other people.

For over a decade, our team has combed through thousands of research articles published in reputable journals. To help you make educated decisions, and to better understand controversial or confusing supplements, our medical experts have digested the science into these three easy-to-follow ratings. We hope this provides you with a helpful resource to make informed decisions towards your health and well-being.

3 Stars Reliable and relatively consistent scientific data showing a substantial health benefit.

2 Stars Contradictory, insufficient, or preliminary studies suggesting a health benefit or minimal health benefit.

1 Star For an herb, supported by traditional use but minimal or no scientific evidence. For a supplement, little scientific support.

Supplement Why
2 Stars
Green Tea
Several cups per day (enough to provide 600 mg of catechins daily)
Drinking green tea or taking green tea catechins may help prevent prostate cancer in men at high risk of developing the disease.

In a double-blind trial, men with precancerous changes in the prostate received a green tea extract providing 600 mg of catechins per day or a placebo for one year. After one year, prostate cancer had developed in 3.3% of the men receiving the green tea extract and in 30% of those given the placebo, a statistically significant difference.28 These results suggest that drinking green tea or taking green tea catechins may help prevent prostate cancer in men at high risk of developing the disease.

2 Stars
Lycopene
For symptoms: 15 mg twice per day; for prevention: 4 mg twice per day
Supplementing with lycopene may help slow down aggressive growth of prostate cancer.

In a preliminary trial, 26 men with prostate cancer were randomly assigned to receive lycopene (15 mg twice a day) or no lycopene for three weeks before undergoing prostate surgery. Prostate tissue was then obtained during surgery and examined. Compared with the unsupplemented men, those receiving lycopene were found to have significantly less aggressive growth of cancer cells.29 In addition, a case report has been published of a 62-year-old man with advanced prostate cancer who experienced a regression of his tumor after starting 10 mg of lycopene per day and 300 mg of saw palmetto three times per day. As saw palmetto has not been previously associated with improvements in prostate cancer, the authors of the report attributed the response to the lycopene.30 In a preliminary trial, supplementation with 4 mg of lycopene twice a day for one year reduced the incidence of prostate cancer in men with precancerous changes in their prostate glands.31 Long-term controlled studies are needed to confirm these promising initial reports.
2 Stars
PC-SPES
Take only under medical supervision
In several trials, PC-SPES has been shown to reduce blood levels of a marker for prostate cancer progression in men with prostate cancer. PC-SPES should never be taken without the close supervision of a doctor.

Warning: PC-SPES has been reported to cause serious side effects, including potentially life-threatening blood clots. PC-SPES should never be taken without the close supervision of a doctor. PC-SPES is not for sale is certain parts of the world.

“PC” in this formula’s name stands for prostate cancer, while “SPES” is the Latin word for hope. The complete formula consists of isatis (Isatis indigotica), licorice  (Glycyrrhiza glabra) and/or Gan cao (G. uralensis), Chinese scullcap  (Scutellaria baicalensis), reishi  (Ganoderma lucidum), saw palmetto  (Serenoa repens), Asian ginseng  (Panax ginseng) or sanqi ginseng (P. pseudoginseng), denodrantherm (Denodrantherma morifolium), and rabdosia (Rabdosia rubescens).

In several preliminary trials, this formula has been shown to reduce blood levels of prostate specific antigen (PSA, a marker for prostate cancer progression) in men with prostate cancer.32 , 33 , 34 , 35 , 36 While such a reduction suggests a therapeutic effect, trials have yet to explore whether PC-SPES increases survival in people with prostate cancer.

One trial distinguished prostate cancer patients with androgen-dependent (an earlier, milder form of the cancer) and androgen-independent (a later, more severe form of the cancer) disease.37 PSA scores began to decline in most people within two to six weeks after first receiving PC-SPES. Scores reached their lowest point in an average of 23 weeks in men with androgen-dependent prostate cancer and 16 weeks in men with androgen-independent prostate cancer. PSA scores declined an average of 80% and became undetectable in four out of every five men with androgen-dependent disease. In contrast, 54% of androgen-independent prostate cancer patients had a PSA decline of 50% or more. After an average of about one year, 31 of 32 androgen-dependent prostate cancer patients continued to have normal PSA scores. However, 28 of the 35 patients with androgen-independent prostate cancer ultimately developed PSA increases consistent with progression of their cancer, despite continued use of PC-SPES. Improvement or disappearance of cancer was seen in four patients who had previously had cancer spread to the bone, as well as in one patient who had previously had cancer spread to the bladder. Rarely, PSA levels have risen slightly (less than 20%) during PC-SPES use, according to other studies.38 Testosterone levels are almost always decreased by PC-SPES therapy, according to most studies, which presumably accounts, in part, for the therapeutic effect.39 , 40

Many men who take the formula have been reported to develop symptoms of estrogen excess, including breast tenderness, enlargement of the breasts, loss of libido, and the more serious problem of blood clots in the veins (venous thrombosis).41 , 42 , 43 At least one person who took PC-SPES developed a potentially life-threatening blood clot in the lung. For this reason, some doctors recommend that people taking PC-SPES also take blood-thinning medication, such as heparin or warfarin (Coumadin®).44 , 45 However, each of these drugs can cause excessive bleeding. Because of the potential side effects of PC-SPES and the complex medical issues involved with the use of blood-thinning drugs, people should never take PC-SPES without the close supervision of a doctor. The amount of PC-SPES used in most studies was 320 to 960 mg three times per day.46 , 47 , 48

In February 2002, the sole supplier of PC-SPES in the United States (BotanicLab) issued a recall of the product after the California Health Department reported it contained warfarin, a prescription drug that can cause severe bleeding. However, PC-SPES is known to contain compounds that, though distinct from warfarin, could potentially be mistakenly identified as warfarin using currently available laboratory methods.49 There has been one case report of excessive bleeding occurring in a man who was taking PC-SPES. 50 However, the warfarin concentration in this patient’s blood was not high enough to explain his abnormal bleeding. In addition, allegations have been made that PC-SPES contains small amounts of a synthetic estrogen (diethylstilbestrol; DES). That claim has been disputed by BotanicLab.

Although additional information is needed to determine whether PC-SPES has been adulterated with one or more prescription drugs, at the time of this writing (February 2003) the product is not available in the United States.
2 Stars
Selenium
200 mcg daily
Selenium has been reported to have diverse anticancer actions. Supplementing with this mineral may decrease your prostate cancer risk.

Selenium has been reported to have diverse anticancer actions.51 , 52 Selenium inhibits cancer in animals.53 Low soil levels of selenium (probably associated with low dietary intake), have been associated with increased cancer incidence in humans.54 Blood levels of selenium have been reported to be low in patients with prostate cancer.55 In preliminary reports, people with the lowest blood levels of selenium had between 3.8 and 5.8 times the risk of dying from cancer compared with those who had the highest selenium levels.56 , 57

The strongest evidence supporting the anticancer effects of selenium supplementation comes from a double-blind trial of 1,312 Americans with a history of skin cancer who were treated with 200 mcg of yeast-based selenium per day or placebo for 4.5 years and then followed for an additional two years.58 Although no decrease in skin cancers occurred, a dramatic 50% reduction in overall cancer deaths and a 37% reduction in total cancer incidence were observed. A statistically significant 63% decrease in prostate cancer incidence was reported.59 However, in a follow-up double-blind trial that included 35,533 healthy men, supplementing with 200 mcg per day of selenium for an average of 5.5 years had no effect on the incidence of prostate cancer.60 In another trial, 5,141 men were randomly assigned to receive a placebo or a daily supplement containing 100 mcg of selenium, 120 mg of vitamin C , 30 IU of vitamin E , 6 mg of beta-carotene , and 20 mg of zinc 20 for eight years. Among men with a normal PSA level at the start of the study, there was a statistically significant 48% reduction in the incidence of prostate cancer. Among men with an initially elevated PSA level, the supplemented group had an increased incidence of prostate cancer that was not statistically significant.61 In a double-blind study of men who already had non-metastatic prostate cancer, supplementation with selenium 200 or 800 mcg per day for up to 5 years had no significant effect on the progression rate of the cancer.62

2 Stars
Vitamin D
2,000 IU daily
Taken under a doctor's supervision, vitamin D might help reduce pain and slow down disease progression.

Where sun exposure is low, the rate of prostate cancer has been reported to be high.63 , 64 In the body, vitamin D is changed into a hormone with great activity. This activated vitamin D causes “cellular differentiation”—essentially the opposite of cancer.

In a preliminary trial, 7 of 16 men who had prostate cancer that had spread to bone and who had been unresponsive to conventional treatment were found to have evidence of vitamin D deficiency.65 All 16 were given 2,000 IU of vitamin D per day for 12 weeks, and levels of pain were recorded for 14 of these men. Vitamin D supplementation led to reduced pain in 4 of the 14 men, and 6 showed evidence of increased strength.66 Those with vitamin D deficiency were more likely to respond, compared with those who were not deficient.67 People taking 2,000 IU per day of Vitamin D should be supervised by a doctor.

In another preliminary study, men with prostate cancer that had relapsed after surgery or radiation therapy were treated with 2,000 IU of vitamin D per day for nine months. In approximately half of the men, the prostate-specific antigen (PSA) level decreased, suggesting that the progression of the disease had been halted or reversed; this decrease was sustained for 5 to 17 months.68 In addition, the study was done in Toronto, Canada, where the amount of sunlight is limited and vitamin D status tends to be low. It is not known whether vitamin D supplementation would be as effective in geographical regions such as the Southern United States, where the amount of sunlight is greater.
2 Stars
Vitamin E
50 IU daily
Supplementing with vitamin E as mixed tocopherols may help lower prostate cancer risk, especially in smokers.

Relatively high blood levels of vitamin E have been associated with relatively low levels of hormones linked to prostate cancer.69 In a double-blind trial studying smokers, vitamin E supplementation (50 IU per day for an average of six years) led to a 32% decrease in prostate cancer incidence and a 41% decrease in prostate cancer deaths.70 Both findings were statistically significant.71 However, in a double-blind study of 35,533 healthy men, supplementing with 400 IU per day of vitamin E for an average of 5.5 years (with a total follow-up period of 7 years) significantly increased the incidence of prostate cancer by 17%.72 The effects of vitamin E have yet to be studied in men already diagnosed with prostate cancer.

The conflicting results in these studies may be due to the fact that all of the studies used pure alpha-tocopherol, which is only one of the four different forms of vitamin E that occur naturally in food (alpha-, beta-, gamma-, and delta-tocopherol). Treatment with large doses of alpha-tocopherol by itself (such as 400 IU per day or more) has been shown to deplete gamma-tocopherol, potentially upsetting the natural balance of the different forms of vitamin E in the body. "Mixed tocopherols," on the other hand, a supplement that contains all four types of vitamin E, would not be expected to cause such an imbalance.

Both alpha-tocopherol and gamma-tocopherol have been found to inhibit the growth of human prostate cancer cells in a test tube, but gamma-tocopherol was the more potent of the two.73 In another study, higher blood levels of alpha-tocopherol and gamma-tocopherol were each associated a lower risk of developing prostate cancer, but the protective effect of gamma-tocopherol was greater than that of alpha-tocopherol.74 These observations raise the possibility that both alpha- and gamma-tocopherol have a protective effect against prostate cancer. However, when alpha-tocopherol is given by itself in large doses (such as 400 IU per day or more), it depletes gamma-tocopherol, which could more than negate any beneficial effect that alpha-tocopherol might have. If that is the case, then taking vitamin E as mixed tocopherols would not be expected to increase prostate cancer risk, and might even help prevent prostate cancer. Further research is needed to examine that possibility.

 The effects of vitamin E have yet to be studied in men already diagnosed with prostate cancer.

1 Star
Coenzyme Q10
600 mg daily
Supplementing with CoQ10 may reduce levels of PSA—a marker of cancer activity.

In an unpublished report, after one year, 10 of 15 prostate cancer patients experienced a 78% decrease in the level of PSA—a marker of cancer activity.75 The amount of   coenzyme Q10 given to these men was 600 mg per day; after four months, PSA scores began to decline.76 Such undocumented case reports require confirmation from published research trials.
1 Star
Conjugated Linoleic Acid
Refer to label instructions
Preliminary research suggests that CLA might reduce the risk of cancers at several sites, including breast, prostate, colorectal, lung, skin, and stomach.

Preliminary animal and test tube research suggests that conjugated linoleic acid might reduce the risk of cancers at several sites, including breast , prostate , colorectal , lung , skin, and stomach.77 , 78 , 79 , 80

1 Star
Melatonin
Refer to label instructions
Melatonin may help stabilize the condition of some people with advanced cancers.

Years ago, a preliminary study suggested that melatonin may help stabilize the condition of some people with advanced cancers.81 Since then, Italian researchers have been investigating the effects of melatonin in cancer patients, often with partial success.82 , 83 , 84 , 85 , 86 , 87 , 88 , 89 , 90 , 91 , 92 , 93

Patients with advanced prostate cancer who had previously not responded to drug therapy (triptorelin) were given melatonin plus triptorelin in a preliminary trial.94 PSA scores, a marker of disease progression, fell (i.e., improved) more than 50% in 8 of 14 patients.

Patients with advanced cancer have been reported to have improved survival and fewer side effects from taking chemotherapy when given melatonin plus chemotherapy vs. chemotherapy alone.95

1 Star
Shiitake
Refer to label instructions
Lentinan, a carbohydrate in shiitake mushrooms, has been found to have beneficial effects on cancer patients’ immune systems, including improved longevity and survival rates.

Several trials studying cancer patients have investigated the effects of lentinan, a carbohydrate found in shiitake  (Lentinus edodes) mushrooms.96 , 97 , 98 , 99 Injection of lentinan repeatedly has been found to have beneficial effects on the immune systems of cancer patients.100 , 101 Two trials reported that lentinan injections prolonged life in people with a variety of advanced cancers.102 , 103 Another trial found that intravenous lentinan increased five-year survival rates in prostate cancer patients compared with those not given lentinan.104 It is unknown whether consumption of shiitake mushrooms or lentinan supplements would have the same effects reported in studies using injectable lentinan.

References

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2. Andersson S-O, Wolk A, Bergstrom R, et al. Body size and prostate cancer: a 20-year follow-up study among 135,006 Swedish construction workers. J Natl Cancer Inst 1997;89:385–9.

3. Kune GA. Eating fish protects against some cancers: epidemiological and experimental evidence for a hypothesis. J Nutr Med 1990;1:139–44 [review].

4. Rose DP, Connolley JM. Omega-3 fatty acids as cancer chemopreventive agents. Pharmacol Ther 1999;83:217–44.

5. Beecher CW. Cancer preventive properties of varieties of Brassica oleracea: a review. Am J Clin Nutr 1994;59(suppl):1166–70S.

6. Cover CM, Hsieh SJ, Cram EJ, et al. Indole-3-carbinol and tamoxifen cooperate to arrest the cell cycle of MCF-7 human breast cancer cells. Cancer Res 1999;59:1244–51.

7. Walaszek Z, Hanausek-Walaszek M, Minton JP, Webb TE. Dietary glucarate as anti-promoter of 7,12-demethylbenz [a]anthracene-induced mammary tumorigenesis. Carcinogenesis 1986;7:1463–6.

8. Zhang Y, Kensler TW, Cho CG, et al. Anticarcinogenic activities of sulforaphane and structurally related synthetic norbornyl isothiocyanates. Proc Natl Acad Sci USA 1994;91:3147–50.

9. Cohen JH, Kristal AR, Stanford JL. Fruit and vegetable intakes and prostate cancer risk. J Natl Cancer Inst 2000;92(1):61–8.

10. Cohen JH, Kristal AR, Stanford JL. Fruit and vegetable intakes and prostate cancer risk. J Natl Cancer Inst 2000;92(1):61–8.

11. Davis JN, Singh B, Bhuiyan M, Sarkar FH. Genistein-induced upregulation of p21WAF1, downregulation of cyclin B, and induction of apoptosis in prostate cancer cells. Nutr Cancer 1998;32:123–31.

12. Barnes S, Peterson TG, Coward L. Rationale for the use of genistein-containing soy matrices in chemoprevention trials for breast and prostate cancer. J Cell Biochem Suppl 1995;22:181–7.

13. Jacobsen BK, Knutsen SF, Fraser GE. Does high soy milk intake reduce prostate cancer incidence? The Adventist Health Study (United States). Cancer Causes Control 1998;9:553–7.

14. Geller J, Sionit L, Partido C, et al. Genistein inhibits the growth of human-patient BPH and prostate cancer in histoculture. Prostate 1998;34:75–9.

15. Moyad MA. Soy, disease prevention, and prostate cancer. Semin Urol Oncol 1999;17:97–102.

16. Levy J, Bosin E, Feldman B, et al. Lycopene is a more potent inhibitor of human cancer cell proliferation than either a-carotene or ß-carotene. Nutr Cancer 1995;24:257–66.

17. Giovannucci E. Tomatoes, tomato-based products, lycopene, and cancer: review of the epidemiologic literature. J Natl Cancer Inst 1999;91:317–31.

18. Dorgan JF, Judd JT, Longcope C, et al. Effects of dietary fat and fiber on plasma and urine androgens and estrogens in men: a controlled feeding study. Am J Clin Nutr 1996;64:850–5.

19. Peinta KJ, Esper PS. Is dietary fat a risk factor for prostate cancer? J Natl Cancer Inst 1993;85:1538–9 [editorial/review].

20. Giovannucci E, Rimm EB, Colditz GA, et al. A prospective study of dietary fat and risk of prostate cancer. J Natl Cancer Inst 1993;85:15571–9.

21. Le Marchand L, Kolonel LN, Wilkens LR, et al. Animal fat consumption and prostate cancer: a prospective study in Hawaii. Epidemiology 1994;5:276–82.

22. Schuurman AG, van den Brandt PA, Dorant E, et al. Association of energy and fat intake with prostate carcinoma risk: results from the Netherlands Cohort Study. Cancer 1999;86:1019–27.

23. Meyer F, Bairati I, Shadmani R, et al. Dietary fat and prostate cancer survival. Cancer Causes Control 1999;10:245–51.

24. Dennis LK. Meta-analysis for combining relative risks of alcohol consumption and prostate cancer. Prostate 2000;42:56–66.

25. Ghosh J, Myers C Jr. Arachidonic acid metabolism and cancer of the prostate. Nutrition 1998;14:48–57 [editorial].

26. Norrish AE, Ferguson LR, Knize MG, et al. Heterocyclic amine content of cooked meat and risk of prostate cancer. J Natl Cancer Inst 1999;91:2038–44.

27. Schuurman AG, van den Brandt PA, Dorant E, Goldohm RA. Animal products, calcium and protein and prostate cancer risk in the Netherlands Cohort Study. Br J Cancer 1999;80:1107–13.

28. Bettuzzi S, Brausi M, Rizzi F, et al. Chemoprevention of human prostate cancer by oral administration of green tea catechins in volunteers with high-grade prostate intraepithelial neoplasia: a preliminary report from a one-year proof-of-principle study. Cancer Res 2006;66:1234–40.

29. Kucuk O, Sarkar FH, Sakr W, et al. Phase II randomized clinical trial of lycopene supplementation before radical prostatectomy. Cancer Epidemiol Biomarkers Prev 2001;10:861–8.

30. Matlaga BR, Hall MC, Stindt D, Torti FM. Response of hormone refractory prostate cancer to lycopene. J Urol 2001;166:613.

31. Mohanty NK, Saxena S, Singh UP, et al. Lycopene as a chemopreventive agent in the treatment of high-grade prostate intraepithelial neoplasia. Urol Oncol 2005;23:383–5.

32. DiPaola RS, Zhang H, Lambert GH, et al. Clinical and biologic activity of an estrogenic herbal combination (PC-SPES) in prostate cancer. New Engl J Med 1998;339:785–91.

33. Kameda H, Small EJ, Reese DM. A phase II study of PC-SPES, an herbal compound, for the treatment of advanced prostate cancer (PCa). Proc Am Soc Clin Oncol 1999;18:320a [abstract].

34. De la Taille A, Hayek OR, Buttyan R, et al. Effects of a phytotherapeutic agent, PC-SPES, on prostate cancer: a preliminary investigation on human cell lines and patients. BJU Int 1999;84:845–50.

35. Small EJ, Frohlich MW, Bok R, et al. Prospective trial of the herbal supplement PC-SPES in patients with progressive prostate cancer. J Clin Oncol 2000;18:3595–603.

36. De la Taille A, Buttyan R, Hayek O, et al. Herbal therapy PC-SPES: in vitro effects and evaluation of its efficacy in 69 patients with prostate cancer. J Urology 2000;164:1229–34.

37. Small EJ, Frohlich MW, Bok R, et al. Prospective trial of the herbal supplement PC-SPES in patients with progressive prostate cancer. J Clin Oncol 2000;18:3595–603.

38. De la Taille A, Hayek OR, Buttyan R, et al. Effects of a phytotherapeutic agent, PC-SPES, on prostate cancer: a preliminary investigation on human cell lines and patients. BJU Int 1999;84:845–50.

39. Small EJ, Frohlich MW, Bok R, et al. Prospective trial of the herbal supplement PC-SPES in patients with progressive prostate cancer. J Clin Oncol 2000;18:3595–603.

40. DiPaola RS, Zhang H, Lambert GH, et al. Clinical and biologic activity of an estrogenic herbal combination (PC-SPES) in prostate cancer. New Engl J Med 1998;339:785–91.

41. DiPaola RS, Zhang H, Lambert GH, et al. Clinical and biologic activity of an estrogenic herbal combination (PC-SPES) in prostate cancer. New Engl J Med 1998;339:785–91.

42. Small EJ, Frohlich MW, Bok R, et al. Prospective trial of the herbal supplement PC-SPES in patients with progressive prostate cancer. J Clin Oncol 2000;18:3595–603.

43. De la Taille A, Buttyan R, Hayek O, et al. Herbal therapy PC-SPES: in vitro effects and evaluation of its efficacy in 69 patients with prostate cancer. J Urology 2000;164:1229–34.

44. Strum SB. High risk prostate cancer. Prostate Cancer Research Institute Annual Conference, July 31–August 1, 1999, Los Angeles, CA.

45. Kameda H, Small EJ, Reese DM. A phase II study of PC-SPES, an herbal compound, for the treatment of advanced prostate cancer (PCa). Proc Am Soc Clin Oncol 1999;18:320a [abstract].

46. DiPaola RS, Zhang H, Lambert GH, et al. Clinical and biologic activity of an estrogenic herbal combination (PC-SPES) in prostate cancer. New Engl J Med 1998;339:785–91.

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