Related Terms

• Adrenal, androgen, antiandrogen, apoptosis, BPH, benign prostatic brachytherapy, benign prostatic hyperplasia (BPH), hyperplasia, biologic therapy, biopsy, catheter, chemotherapy, cryosurgery, digital rectal exam, erectile dysfunction, estrogen, hormone, hormonal, hyperplasia, hypogonadism, impotence, incontinence, metastasis, metastasize, obesity, oncologist, PAP, PSA, pelvic lympadenectomy, perineum, perineal prostatectomy, prostatitis, prostate gland, prostate-specific antigen, prostatic acid phosphatase, radical prostatectomy, receptor, resectoscope, retropubic prostatectomy, seminal fluid, testosterone, transrectal, transrectal ultrasound, transperineal, transurethral, ultrasound, vaccine, vasectomy.

Background

• Prostate cancer is the uncontrollable growth of cells in the prostate gland.

• The prostate is part of a man's reproductive system, and is located in front of the rectum and under the bladder. It surrounds the urethra, the tube through which urine flows. A healthy prostate is about the size of a walnut. The prostate makes part of the seminal fluid. During ejaculation, seminal fluid helps carry sperm out of the man's body as part of semen. Male hormones (androgens) make the prostate grow. The testicles are the main source of male hormones, including testosterone. The adrenal gland, located above the kidneys, also makes testosterone, but in small amounts. If the prostate grows too large, it squeezes the urethra. This may slow or stop the flow of urine from the bladder to the penis.

• Prostate tumors are masses of prostate cells. Prostate tumors can be benign (non-cancerous) or malignant (cancerous). Benign tumors in the prostate are rarely life-threatening. Benign prostatic hyperplasia (BPH) is the abnormal growth of benign prostate cells. The prostate grows larger and squeezes the urethra, preventing the normal flow of urine. BPH is a very common problem worldwide. Malignant or cancerous tumors of the prostate are generally more serious than benign tumors and may be life threatening. Malignant tumors can spread, or metastasize, to other parts of the body such as the lymph nodes, liver, bones, colon, and other organs.

• When caught and treated early, prostate cancer has a cure rate of over 90%. It is extremely important to be diagnosed early, and healthcare professionals recommend men 50 years of age and older get screened for prostate cancer.

• Prostate cancer is the most common non-skin cancer in America, affecting one in six men. More than 218,000 men in the United States will be diagnosed with prostate cancer in 2007.

• Although only one in 10,000 men under the age of 40 will be diagnosed, the rate increases up to one in 39 for men between the ages of 40 to 59, and one in 14 for ages 60 to 69. More than 65% of all prostate cancers are diagnosed in men over the age of 65.

Risk Factors and Causes

• Age: As men get older, (after age 50) their risk of prostate cancer increases. Individuals with risk factors for developing prostate cancer, or men above 50 years of age, should be checked for prostate cancer routinely.

• Race or ethnicity: Prostate cancer exhibits tremendous differences in incidence among populations worldwide. Asian men typically have a very low incidence of prostate cancer, with age-adjusted incidence rates ranging from 2-10 per 100,000 men. Higher incidence rates are generally observed in northern European countries. African American men, however, have the highest incidence of prostate cancer in the world. In the United States, African American men have a 60% higher incidence rate compared with Caucasian men.

• Family history: If an immediate family member such as a father or brother has prostate cancer, the risk of developing the disease is greater than that of the average American man. From 5-10% of prostate cancer cases are believed to be due primarily to high-risk inherited genetic factors or prostate cancer susceptibility genes.

• Obesity: A high-fat diet and obesity may increase the risk of prostate cancer. Researchers theorize that fat increases production of the hormone testosterone, which may promote the development of prostate cancer cells. Obese men who are diagnosed with prostate cancer have more than two-and-a-half times the risk of dying from the disease as compared to men of normal weight at the time of diagnosis. Scientists believe that obesity increases the risk of prostate cancer by increasing inflammation and steroid hormones, such as testosterone.

• High levels of testosterone: Because testosterone naturally stimulates the growth of the prostate gland, men who have high levels of testosterone, such as those with hypogonadism and men who use testosterone (steroid) therapy, are more likely to develop prostate cancer than are men who have lower levels of testosterone. Long-term testosterone treatment could cause prostate gland enlargement (benign prostatic hyperplasia or BPH). Also, doctors are concerned that testosterone therapy might fuel the growth of prostate cancer that is already present.

Signs and Symptoms

• If the cancer is identified at its earliest stages, most men will not experience any symptoms. Some men, however, will experience symptoms that might indicate the presence of prostate cancer, including a need to urinate frequently, especially at night, difficulty starting urination or holding back urine, weak or interrupted flow of urine, painful or burning urination, difficulty in having an erection, painful ejaculation, blood in urine or semen, or frequent pain or stiffness in the lower back, hips, or upper thighs. Because these symptoms can also indicate the presence of other conditions, such as urinary tract infections or bladder problems, men who experience any of these symptoms will undergo a thorough work-up to determine the underlying cause of the symptoms.

Diagnosis

• Exams and tests:

• Digital rectal exam (DRE): The digital rectal exam is a procedure commonly performed during routine physical examinations. During a DRE, a doctor feels the prostategland by passing a gloved finger into the patient's rectum tofind hard or lumpy areas of the gland, which may represent anabnormality.

• Prostate-specific antigen (PSA) test: Prostate specific antigen (PSA) is an enzyme that participates in breaking down proteins in seminal fluid and plays an important role in fertility. A blood sample is drawn from a vein and analyzed for PSA, a protein that is naturally produced by the prostate gland. The highest amounts of PSA are found in the seminal fluid. It is normal for the blood stream to contain a small amount of PSA. However, if a higher than normal level is found, it may be an indication of prostate infection, inflammation, enlargement or cancer. Normal levels of PSA are less than 4.0 nanograms per milliliter (ng/ml), meaning that anything above 4.0 ng/ml is abnormal. If the PSA is elevated, or if the individual has an abnormal digital rectal exam, then further tests may be needed.If the PSA is elevated, further tests may be needed to investigate the cause of the discrepancy. However, these findings do not necessarily mean that a patient has prostate cancer. A DRE will also be performed.

• Using the PSA test to screen men for prostate cancer is controversial because it is not yet known if this test actually saves lives. Moreover, it is not clear if the benefits of PSA screening outweigh the risks of follow-up diagnostic tests and cancer treatments. For example, the PSA test may detect small cancers that would never become life threatening. This situation, called overdiagnosis, puts men at risk for complications from unnecessary treatment such as surgery or radiation.

• Prostate biopsy: If DRE and PSA test results suggest prostate cancer, a doctor may recommend a prostate biopsy. The patient will be prescribed antibiotics, usually a three day course, before the surgery. Most individuals receive local anesthesia, such as lidocaine (Xylocaine®). To do a biopsy, a doctor inserts a small, lubricated probe about the size and shape of a cigar into the rectum (called transrectal ultrasound). The probe uses sound waves that are converted to visual data in order to see a picture of the prostate gland, which is then analyzed for changes. If an abnormal area is seen on the transrectal ultrasound, the doctor will likely biopsy that area. Then a fine, hollow needle is aimed at these areas of the prostate. A spring propels the needle into the prostate gland and retrieves a very thin section of tissue. Biopsies in general take 15-45 minutes to complete, depending upon the procedure. The procedure used to diagnose prostate cancer (prostate biopsy) may cause side effects, including bleeding and infection. Fifty-five percent of men report discomfort during the biopsy. The same procedure can be performed through the perineum area (between the anus and the scrotum, called transperineal biopsy), or through the urethra (canal that the urine travels through for elimination, called transurethral biopsy).

• If a doctor thinks the cancer may have spread to other parts of the body, other tests may be used. These include procedures such as a bone scan, ultrasound, computerized tomography (CT) scan, magnetic resonance imaging (MRI), and lymph node biopsies.

• Grading:

• Once the presence of cancer is confirmed by a biopsy, the doctor determines how aggressive the cancer is and assigns it a corresponding grade. This is done by examining and comparing tissue samples of cancerous cells and healthy prostate cells. Cancer cells may vary in shape and size. Some cells may be aggressive, while others are not. More aggressive cancers generally receive more aggressive treatments. Prognosis is also poorer if the cancer is aggressive.

• The Gleason score is a tumor grading procedure used to judge how aggressive a tumor might be. During the Gleason scoring process, the pathologist takes the numbers for the two most representative types of cells seen in the prostate biopsy and adds them together. Two representative cell types seen in the tumor are rated with a number from 1=normal to 5=very abnormal. Then each of the numbers are added together to give a Gleason score.

• Gleason scores will range from two to ten, with two being completely normal, and ten very aggressive cancer. Generally Gleason scores of seven or above indicate a more serious prognosis with the chance that the tumors will be quite aggressive and spread quickly unless brought under control.

• Staging:

• Two systems are commonly used for the staging of prostate cancer: the Jewett system (stages A through D) and the American Joint Committee on Cancer (AJCC) tumor, nodes, and metastasis (TNM) system. Both systems take into account the size of the tumor, whether the lymph glands (also called lymph nodes) are affected, and whether the tumor has metastasized (spread to other areas of the body). In general, prostate cancer has four basic stages:

• Stage A: In stage A, the cancer is very small and completely inside the prostate gland which feels normal when a rectal examination is performed.

• Stage B: Stage B cancer is still inside the prostate gland, but is larger and a lump or hard area can be felt when a rectal examination is done.

• Stage C: Stage C cancer has broken through the covering of the prostate and may have grown into the seminal vesicles.

• Stage D: Stage D cancer has grown into the neck of the bladder, rectum or pelvic wall, or has spread to the lymph nodes or another part of the body.

Complications

• Prostate cancer can metastasize (spread to nearby areas in the body) and can be life-threatening. Metastasis can take months to years, depending on the individual. Although early-stage prostate cancer typically is not painful, once it has spread to bones, it may produce pain, which can be intense. Urinary incontinence (leakage) may occur, erectile dysfunction (impotence), or depression may also occur.

Treatment

• Prostate cancer is generally slow growing and occurs in older men (over the age of 65). If the individual is not experiencing symptoms, healthcare professionals can use watchful waiting. Watchful waiting is the close monitoring an individual's condition without giving any treatment until symptoms appear or change. When a patient does need treatment, there are several conventional options available, which include surgeries, radiation, or hormone therapies. Patients with prostate cancer have a choice about their treatment.

• Surgery:

• Radical prostatectomy: Radical prostatectomy is a surgical procedure to remove the prostate, surrounding tissue, and seminal vesicles. There are two types of radical prostatectomy, including retropubic prostatectomy, during which the prostate and nearby lymph nodes are removed through an incision (cut) in the abdominal wall, and perineal prostatectomy, a surgical procedure to remove the prostate and nearby lymph nodes through an incision made in the perineum (area between the scrotum and anus).

• Transurethral resection of the prostate (TURP): This is a surgical procedure to remove tissue from the prostate that may be blocking urine flow using a resectoscope (a thin, lighted tube with a cutting tool) inserted through the urethra. This surgery is sometimes performed to relieve symptoms caused by benign (non-cancerous) tumors. Transurethral resection of the prostate may also be done in men who cannot have a radical prostatectomy because of age or illness.

• Surgery complications: Surgery for prostate cancer can cause problems such as impotence (erectile dysfunction) and leakage of urine from the bladder or stool from the rectum. In some cases, doctors can use a technique known as nerve-sparing surgery. This type of surgery may save the nerves that control erection. These surgeries are performed under general anesthesia, which may also cause complications.

• Radiation therapy:

• Radiation therapy is a cancer treatment that uses high-energy radiation to kill cancer cells and shrink tumors. Radiation targets rapidly growing cancer cells and helps decrease metastasis, or the spreading to other areas of the body. There are two types of radiation therapy. External radiation therapy (XRT) uses a machine outside the body to send radiation toward the cancer. Internal radiation therapy (or brachytherapy) involves surgically implanting tiny, radioactive capsules (called "seeds") into the cancerous prostate gland. The seeds emit radiation that kills the malignant tumor. The type of radiation therapy used depends on the type and stage of the cancer being treated. Side effects can include diarrhea, skin burns, sexual dysfunction, and urinary discomfort or urgency. Normal tissue can be damaged by radiation. However, new developments in radiation delivery may decrease the chances of damage.

• Hormone therapy:

• Hormone therapy is utilized in cancer treatment to remove hormones or block their action, ultimately inhibiting the growth of cancer cells. Hormones are substances produced by glands in the body that circulate within the bloodstream and exert specific effects on the body. Some hormones can contribute to the growth of certain cancers. If laboratory tests show that the cancer cells have receptors (places of attachment) for hormones, then drugs, surgery, or radiation therapy are used to reduce the production of hormones or block them from working. Side effects may include nausea, vomiting, hot flashes, impaired sexual function, loss of desire for sex, and breast tenderness may occur in men treated with hormone therapies. Patients who begin hormone therapy may experience an increase in prostate cancer symptoms for approximately two weeks, due to a temporary increase in testosterone levels.

• Luteinizing hormone-releasing hormone agonists: These drugs can prevent the testicles from producing testosterone (the male hormone). Examples are leuprolide (Eligard®, Lupron®, Lupron Depot®, Viadur®), goserelin (Zoladex®), and buserelin (Suprefact®).

• Antiandrogens: Antiandrogens can block the action of androgens (hormones that promote male sex characteristics). Two examples are flutamide (Eulexin®) and nilutamide (Anandron®). Healthcare professionals recommend that patients who are taking antiandrogens get periodic liver function tests and should report symptoms such as nausea and vomiting, stomach pain, fatigue (extreme tiredness), appetite loss, dark urine, and yellowing of the eyes to their physician immediately.

• Adrenal agents: Drugs that can prevent the adrenal glands from making androgens (male sex hormones) include aminoglutethimide (Cytadren®). Side effects include drowsiness, dizziness, headache, weakness, nausea, or loss of appetite during the first few weeks of treatment. As the body adjusts to the medication, the symptoms should disappear. If symptoms persist after two weeks, healthcare professionals recommend contacting a doctor.

• Estrogens: Estrogens (hormones that promote female sex characteristics) can prevent the testicles from producing testosterone or the male hormone. However, estrogens are seldom used today in the treatment of prostate cancer because of the risk of serious side effects, including breast cancer development and an increase in stroke (neurological damage caused by lack of oxygen to the brain), or heart attack. Estrogens include conjugated estrogen (Premarin®) or estradiol (Ogen®).

• Other therapies:

• Cryosurgery: Cryosurgery is a treatment that uses an instrument to freeze and destroy prostate cancer cells. This type of treatment is also called cryotherapy. Cryotherapy alone rarely causes side effects. However, when used after the individual has undergone radiation therapy for the prostate cancer, it increases the risks of side effects. The rates of incontinence, or the involuntary excretion of urine from the body, in patients undergoing cryosurgery after radiation (either seeds or external beam) are 60-70%, compared to less than 1% of patients undergoing cryosurgery who have not had any prior radiation. Other risks of side effects, such as sexual dysfunction and pain, are increased when using cryosurgery after treatment with radiation. The severity of the side effects in the previously radiated group is directly related to the extent of freezing and the total amount of ice that is generated during the procedure.

• Chemotherapy: Chemotherapy is a cancer treatment that uses drugs to stop the growth of cancer cells, either by killing the cells or by stopping them from dividing. Chemotherapy is often used to treat prostate cancers that are resistant to hormonal treatments. An oncology (cancer) specialist will usually recommend a single drug or a combination of drugs. Chemotherapy medications that may be used to treat prostate cancer include mitoxantrone (Novantrone®), paclitaxel (Taxol®), docetaxel (Taxotere®), estramustine (Emcyt®), and doxorubicin (Adriamycin®). Common side effects of chemotherapy depend on the type of drug used, dosage, and length of treatment. The most common side effects are fatigue, nausea and vomiting, diarrhea, hair loss, and increased susceptibility to infection.

• Biologic therapy: Biologic therapy is a treatment that uses the patient's immune system to fight cancer. Substances made by the body or made in a laboratory are used to boost, direct, or restore the body's natural defenses against cancer. This type of cancer treatment is also called biotherapy or immunotherapy. Side effects include fever, chills, nausea, and vomiting.

• High-intensity focused ultrasound: High-intensity focused ultrasound is a treatment that uses ultrasound (high-energy sound waves) to destroy cancer cells. To treat prostate cancer, an endorectal (inside the rectum) probe is used to make the sound waves.

• When the individual has not responded to treatment methods, the cancer has metastasized (spread to other areas of the body), and the prognosis is not good, palliative care (provides symptomatic relief but not a cure) may be chosen over aggressive therapies and the side effects associated with them.

Integrative Therapies

• Good scientific evidence:

• Greater celandine: Ukrain™, a semisynthetic drug derived from greater celandine (Chelidonium majus), has been studied in clinical trials of various types of cancer with consistently positive outcomes. However, the quality of the research performed to date is inadequate, and higher quality studies are needed.

• Use cautiously in patients taking amphetamines, morphine, hexobarbital, MAOIs, or dopaminergic or serotonergic drugs, or in patients undergoing radiation therapy.

• Guided imagery: Early research suggests that guided imagery may help reduce cancer pain. Further research is needed to confirm these results.

• Guided imagery is usually intended to supplement medical care, not to replace it, and guided imagery should not be relied on as the sole therapy for a medical problem. Contact a qualified health care provider if mental or physical health is unstable or fragile. Never use guided imagery techniques while driving or doing any other activity that requires strict attention. Use cautiously with physical symptoms that can be brought about by stress, anxiety or emotional upset because imagery may trigger these symptoms. If feeling unusually anxious while practicing guided imagery, or with a history of trauma or abuse, speak with a qualified health care provider before practicing guided imagery.

• Meditation: There is good evidence that various types of meditation may help improve quality of life in cancer patients. Studies have shown benefits for mood, sleep quality, and the stresses of treatment. The specific effects of meditation are not fully understood. Additional research is needed in this area.

• Use cautiously with underlying mental illnesses. People with psychiatric disorders should consult with their primary mental healthcare professional(s) before starting a program of meditation, and should explore how meditation may or may not fit in with their current treatment plan. Avoid with risk of seizures. The practice of meditation should not delay the time to diagnosis or treatment with more proven techniques or therapies, and should not be used as the sole approach to illnesses.

• Psychotherapy: Psychotherapy is an interactive process between a person and a qualified mental health care professional (psychiatrist, psychologist, clinical social worker, licensed counselor, or other trained practitioner). There is good evidence that psychotherapy may enhance quality of life in cancer patients by reducing emotional distress and aiding in coping with the stresses and challenges of cancer. Therapy may be supportive-expressive therapy, cognitive therapy or group therapy. While some patients seek psychotherapy in hopes of extending survival, there conclusive evidence of effects on medical prognosis is currently lacking. Psychotherapy may help people come to terms with the fact that they may die of cancer, which is the 4th stage of dealing with a terminal illness, including denial, anger, bargaining, and acceptance.

• Psychotherapy is not always sufficient to resolve mental or emotional conditions. Psychiatric medication is sometimes needed. The reluctance to seek and use appropriate medication may contribute to worsening of symptoms or increased risk for poor outcomes. In order to be successful, psychotherapy requires considerable personal motivation and investment in the process. This includes consistent attendance and attention to treatment recommendations provided by the practitioner. Not all therapists are sufficiently qualified to work with all problems. The client or patient should seek referrals from trusted sources and should also inquire of the practitioner's training and background before committing to work with a particular therapist. Some forms of psychotherapy evoke strong emotional feelings and expression. This can be disturbing for people with serious mental illness or some medical conditions. Psychotherapy may help with post-partum depression, but is not a substitute for medication, which may be needed in severe cases.

• Selenium: Selenium is a trace mineral found in soil, water, and some foods. It is an essential element in several metabolic pathways. There is some evidence that low selenium levels are associated with an increased risk of prostate cancer. In human studies, initial evidence has suggested that selenium supplementation reduces the risk of developing prostate cancer in men with normal baseline PSA (prostate specific antigen) levels, and low selenium blood levels. Selenium deficiency may be diagnosed by measuring the selenium in the blood where the normal level is 70 nanograms per milliliter or ng/ml in blood plasma (liquid component) or 90 ng/ml in red blood cells, where the normal values are indicated. Laboratory studies have reported several potential mechanisms for selenium's beneficial effects in prostate cancer prevention, including a decrease in androgen receptors and PSA production, angiogenesis (growth of new blood vessels in tumors) inhibition, and increased antioxidant effects including cancer cell apoptosis (cell death).

• Avoid if allergic or sensitive to products containing selenium. Avoid with a history of nonmelanoma skin cancer.

• Yoga: Yoga is an ancient system of relaxation, exercise, and healing with origins in Indian philosophy. Several studies report enhanced quality of life in cancer, lower sleep disturbance, decreased stress symptoms and changes in cancer-related immune cells after patients received relaxation, meditation and gentle yoga therapy. Yoga is not recommended as a sole treatment for cancer but may be helpful as an adjunct therapy.

• Yoga is generally considered to be safe in healthy individuals when practiced appropriately. Avoid some inverted poses with disc disease of the spine, fragile or atherosclerotic neck arteries, risk for blood clots, extremely high or low blood pressure, glaucoma, detachment of the retina, ear problems, severe osteoporosis, or cervical spondylitis. Certain yoga breathing techniques should be avoided in people with heart or lung disease. Use cautiously with a history of psychotic disorders.

• Unclear or conflicting scientific evidence:

• Acupuncture: Acupuncture, or the use of needles to manipulate the "chi" or body energy, originated in China over 5,000 years ago. There has been limited research on acupuncture for cancer pain, and the research that was done was shown to have mixed results. More studies are needed to determine potential benefits. Evidence from several small studies supports use of acupuncture at a specific point on the wrist (P6) to help chemotherapy patients reduce nausea and vomiting. Acupuncture may also reduce the pain associated with cancer.

• Needles must be sterile in order to avoid disease transmission. Avoid with valvular heart disease, infections, bleeding disorders or with drugs that increase the risk of bleeding (anticoagulants), medical conditions of unknown origin, or neurological disorders. Use cautiously with pulmonary disease (like asthma or emphysema). Use cautiously in elderly or medically compromised patients, diabetics or with history of seizures. Avoid electroacupuncture with arrhythmia (irregular heartbeat) or in patients with pacemakers.

• Aloe: Transparent gel from the pulp of the meaty leaves of Aloe vera has been used on the skin for thousands of years to treat wounds, skin infections, burns, and numerous other skin conditions. Dried latex from the inner lining of the leaf has traditionally been used as an oral laxative. Preliminary research suggests that aloe may help in the area of cancer prevention or may aid in the regression of cancerous tumors. Additional research is needed in this area.

• Caution is advised when taking aloe supplements as numerous adverse effects including a laxative effect, cramping, dehydration, and drug interactions are possible.

• American pawpaw: Evidence supporting the use of the American pawpaw (Asimina triloba) tree for cancer treatment in humans is largely anecdotal and subjective. However, use in humans has reported minimal side effects, and evidence from animal and test tube studies suggest that American pawpaw extract does have some anticancer activity. Pawpaw standardized extract has been used for 18 months in patients with various forms of cancer. Well-designed studies on the long-term effects of pawpaw extracts are currently lacking.

• Antineoplastons: Antineoplastons are a group of naturally occurring peptide fractions, which were observed by Stanislaw Burzynski, MD, PhD in the late 1970s to be absent in the urine of cancer patients. There is inconclusive scientific evidence regarding the effectiveness of antineoplastons in the treatment of cancer. Several preliminary human studies (case series, phase I/II trials) have examined antineoplaston types A2, A5, A10, AS2-1, and AS2-5 for a variety of cancer types. It remains unclear if antineoplastons are effective, or what doses may be safe. Until better research is available, no clear conclusion can be drawn.

• Avoid if allergic or hypersensitive to antineoplastons. Use cautiously with high medical or psychiatric risk, an active infection due to a possible decrease in white blood cells, high blood pressure, heart conditions, chronic obstructive pulmonary disease, liver disease or damage, or kidney disease or damage.

• Arabinoxylan: Arabinoxylan is made by altering the outer shell of rice bran using enzymes from Hyphomycetes mycelia mushroom extract. Arabinoxylan has been found to improve immune reactions in patients with diabetes and cancer of various types. Arabinoxylan products may contain high calcium and phosphorus levels, which may be harmful for patients with compromised renal (kidney) function. Caution is advised when taking arabinoxylan supplements, as numerous adverse effects including drug interactions are possible.

• Aromatherapy: Healing with fragrant oils has been used for thousands of years. Aromatherapy is often used in people with chronic illnesses (frequently in combination with massage), with the intention to improve quality of life or well-being. There is currently not enough scientific evidence to form a firm conclusion about the effectiveness of aromatherapy for quality of life in cancer.

• Essential oils should only be used on the skin in areas without irritation. Essential oils should be administered in a carrier oil to avoid toxicity. Avoid with a history of allergic dermatitis. Use cautiously if driving or operating heavy machinery. Avoid consuming essential oils. Avoid direct contact of undiluted oils with mucous membranes.

• Art therapy: Art therapy involves the application of a variety of art modalities including drawing, painting, clay and sculpture. Art therapy enables the expression of inner thoughts or feelings when verbalization is difficult or not possible. Limited evidence suggests that art therapy may be of benefit in cancer caregiving for families of cancer patients. Possible benefits include reduced stress, lowered anxiety, increased positive emotions and increased positive communication with cancer patients and health care professionals. Art therapy may also reduce pain and other symptoms in cancer patients. More studies are needed to determine how best to use this form of intervention with this population. Art therapy may also benefit children hospitalized with leukemia during and after painful procedures. Limited available study suggests that art therapy improves cooperation with treatment. Children requested art therapy again when procedures were repeated, and parents reported that children were more manageable after art therapy.

• Art therapy may evoke distressing thoughts or feelings. Use under the guidance of a qualified art therapist or other mental health professional. Some forms of art therapy use potentially harmful materials. Only materials known to be safe should be used. Related clean-up materials (like turpentine or mineral spirits) that release potentially toxic fumes should only be used with good ventilation.

• Astragalus: Astragalus (Astragalus membranaceus) has been used in Chinese medicine for centuries for its immune enhancing properties. Although early laboratory and animal studies report immune stimulation and reduced cancer cell growth associated with the use of astragalus, reliable human evidence in these areas is currently lacking. In Chinese medicine, astragalus-containing herbal mixtures are also sometimes used with the intention to reduce side effects of chemotherapy and other cancer treatments. Astragalus-containing herbal combination formulas may also have beneficial effects in aplastic anemia. Due to a lack of well-designed research, a firm conclusion cannot be drawn.

• Caution is advised when taking astragalus supplements, as numerous adverse effects including drug interactions are possible.

• Baikal skullcap: Although the outcomes of early studies using baikal skullcap for cancer are promising, high-quality clinical studies are needed in this area before a conclusion can be made. Avoid if allergic or hypersensitive to Baikal skullcap (Scutellaria barbata), its constituents, or members of the Lamiaceae family. Use cautiously if taking sedatives and/or operating heavy machinery. Use cautiously if taking antineoplastic (anticancer) agents or agents metabolized by cytochrome P450 enzymes. Baikal skullcap is an ingredient in PC-SPES, a product that has been recalled from the U.S. market and should not be used.

• Bee pollen: Bee pollen is considered a highly nutritious food because it contains a balance of vitamins, minerals, proteins, carbohydrates, fats, enzymes, and essential amino acids. Research has found that bee pollen may reduce some adverse effects of cancer treatment side effects. Additional study is needed before a firm recommendation can be made. Caution is advised when taking bee pollen supplements as allergic reactions may occur in sensitive individuals.

• Beta-glucan: Treatment with a beta-glucan, called lentinan, plus chemotherapy (S-1) may help prolong the lives of patients with cancer that has returned or cannot be operated on. More research is needed in this area. Avoid if allergic or hypersensitive to beta-glucan. When taken by mouth, beta-glucan is generally considered safe. Use cautiously with AIDS or AIDS-related complex (ARC). Avoid using particulate beta-glucan.

• Bitter melon: Bitter melon (Momordica charantia) is used in Avurvedic medicine from India to lower blood sugar levels. Research has also found that bitter melon extracts may be beneficial in cancer therapies. MAP30, a protein isolated from bitter melon extract, is reported to possess anti-cancer effects in laboratory studies. Potential anti-cancer effects have not been studied appropriately in humans. Caution is advised when taking bitter melon supplements, as numerous adverse effects including blood sugar lowering and drug interactions are possible.

• Black tea: Black tea (Camellia sinensis) is from the same plant as green tea, but the leaves are processed differently. Black tea usually contains more caffeine than green tea. Several studies have explored a possible association between regular consumption of black tea and rates of cancer in several populations. This research has yielded conflicting results, with some studies suggesting benefits, and others reporting no effects. Laboratory and animal studies report that components of tea, such as polyphenols, have antioxidant properties and effects against tumors. However, effects in humans remain unclear, and these components may be more common in green tea rather than in black tea. Some animal and laboratory research suggests that components of black tea may actually be carcinogenic, or cancer causing, although effects in humans are not clear. Overall, the relationship of black tea consumption and human cancer prevention remains undetermined.

• Avoid if allergic or hypersensitive to caffeine or tannins. Skin rash and hives have been reported with caffeine ingestion. Use caution with diabetes.

• Bovine cartilage: In early study, bovine tracheal cartilage (preparations such as Catrix® and VitaCarte®) has been studied for the treatment of cancer with encouraging results. High quality clinical research is needed to better determine the effectiveness of bovine tracheal cartilage preparations for cancer treatment.

• Avoid if allergic or hypersensitive to bovine cartilage or any of its constituents. Use cautiously with cancer, renal (kidney) failure, or hepatic (liver) failure.

• Bromelain: Bromelain is a sulfur-containing digestive enzyme (proteins which help with digestion) that is extracted from the stem and the fruit of the pineapple plant (Ananas comosus). There is not enough information to recommend for or against the use of bromelain in the treatment of cancer, either alone or in addition to other therapies. One small study found that a bromelain supplement decreased tumor size in 12 breast cancer patients. Patients took the supplements for different periods of time, lasting from months to years. Caution is advised when taking bromelain supplements, as numerous adverse effects including blood thinning and drug interactions are possible.

• Calcium: Calcium is the most abundant mineral in the human body. There is currently a lack of agreement among studies on the relationship between calcium and prostate cancer risk. Until this is clarified, it is reasonable for men to consume recommended intakes as per the Food and Nutrition Board of the Institute of Medicine. Treatment of prostate cancer should only be done under the supervision of a qualified healthcare professional.

• Avoid if allergic or hypersensitive to calcium or lactose. High doses taken by mouth may cause kidney stones. Avoid with high levels of calcium in the blood, high levels of calcium in urine, hyperparathyroidism (overgrowth of the parathyroid glands), bone tumors, digitalis toxicity, ventricular fibrillation (rapid, irregular twitching of heart muscle), kidney stones, kidney disease, or sarcoidosis (inflammatory disease). Calcium supplements made from dolomite, oyster shells, or bone meal may contain unacceptable levels of lead. Use cautiously with achlorhydria or irregular heartbeat.

• Cat's claw: Originally found in Peru, the use of cat's claw (Uncaria tomentosa) has been said to date back to the Inca civilization, possibly as far back as 2,000 years. Cat's claw has anti-inflammatory properties, and several low-quality studies suggest that cat's claw may slow tumor growth. However, this research is early and has not identified specific types of cancer that may benefit; thus, the results are not clear. A few studies suggest that cat's claw may also boost the immune system. Caution is advised when taking cat's claw supplements, as numerous adverse effects including blood thinning and drug interactions are possible.

• Chaparral: Chaparral was used by the Native Americans for various health conditions. The chaparral component nordihydroguaiaretic acid (NDGA) has been evaluated as a treatment for cancer but due to risk of toxicity is considered unsafe and not recommended for use. Chaparral and NDGA have been associated with cases of kidney and liver failure, liver cirrhosis, kidney cysts, and kidney cancer in humans. In response to these reports, the U.S. Food and Drug Administration (FDA) removed chaparral from its "generally recognized as safe" (GRAS) list in 1970. Chaparral and NDGA are generally considered unsafe and are not recommended for use.

• Avoid if allergic to chaparral or any of its components, including nordihydroguaiaretic acid. Use cautiously if taking blood thinners (anticoagulants), blood sugar medication, or drugs that are broken down by the liver (like amiodarone, phenobarbital, valproic acid). Stop use two weeks before surgery/dental/diagnostic procedures with bleeding risk, and do not use immediately after these procedures. Use cautiously if driving or operating heavy machinery.

• Chlorophyll: Preliminary evidence in suggest that chlorophyll may aid in the reduction of side effects associated with photodynamic therapies, such as those used in management of malignant tumors. Further research is required to support the use of chlorophyll as a laser therapy adjunct for cancer treatment.

• Avoid if allergic or hypersensitive to chlorophyll or any of its metabolites. Use cautiously with photosensitivity, compromised liver function, diabetes or gastrointestinal conditions or obstructions. Use cautiously if taking immunosuppressant agents or antidiabetes agents.

• Chrysanthemum: Early study indicates that hua-sheng-ping (includes Chrysanthemum morifolium, Glycyrrhiza uralensis, and Panax notoginseng) may be beneficial for patients with precancerous lesions. However, more research is needed.

• Avoid if allergic or hypersensitive to Chrysanthemum, its constituents, or members of the Asteraceae/Compositae family, such as dandelion, goldenrod, ragweed, sunflower, and daisies. Use cautiously if taking medication for gout, cancer, or HIV. Use cautiously with compromised immune systems or if taking immunomodulators. Avoid with photosensitivity or if taking photosensitizers. Avoid large acute or chronic doses of ingested pyrethrin. Avoid pyrethrin with compromised liver function, epilepsy, or asthma. Avoid ocular exposure to pyrethrin.

• Coenzyme Q10: Further research is needed to determine if coenzyme Q10 (CoQ10) may be of benefit for cancer when used with other therapies. Limited available study using a combination that included CoQ10 did not find a significant effect on PSA levels in patients with prostate cancer. Although PSA levels may be an indicator of cancer, it is unclear whether CoQ10 would have any effect on cancer treatment of prevention. More study is needed in this area.

• Allergy associated with Coenzyme Q10 supplements has not been reported, although rash and itching have been reported rarely. Stop use two weeks before surgery/dental/diagnostic procedures with bleeding risk and do not use immediately after these procedures. Use caution with a history of blood clots, diabetes, high blood pressure, heart attack, or stroke, or with anticoagulants (blood thinners) or antiplatelet drugs (like aspirin, warfarin, clopidogrel (like Plavix®), or blood pressure, blood sugar, cholesterol or thyroid drugs.

• Copper: Copper is a mineral that occurs naturally in many foods, including vegetables, legumes, nuts, grains and fruits, as well as shellfish, avocado, and beef (organs such as liver). Preliminary research reports that lowering copper levels theoretically may arrest the progression of cancer by inhibiting blood vessel growth (angiogenesis). Copper intake has not been identified as a risk factor for the development or progression of cancer. Copper is potentially unsafe when used orally in higher doses than the RDA.

• Cranberry: Several laboratory studies have reported positive effects of proanthocyanidins, flavonoid components of cranberry (Vaccinium macrocarpon) and other fruits such as blueberries, grape seed, and pomegranate, on health. Based on early laboratory research, cranberry has been proposed for cancer prevention. Additional study is needed in humans before a conclusion can be made.

• Avoid if allergic to cranberries, blueberries or other plants of the Vaccinium species. Sweetened cranberry juice may effect blood sugar levels. Use cautiously with a history of kidney stones.

• Dandelion: Limited animal research does not provide a clear assessment of the effects of dandelion on tumor growth. Well-conducted human studies are needed to better determine dandelion's effects on cancer.

• Avoid if allergic to chamomile, feverfew, honey, yarrow, or any related plants such as aster, daisies, sunflower, chrysanthemum, mugwort, ragweed, or ragwort. Use cautiously with diabetes or bleeding disorders, gastroesophageal reflux disease (GERD), kidney or liver diseases, or a history of stroke or electrolyte disorders. Monitor potassium blood levels. Stop use two weeks before surgery/dental/diagnostic procedures with bleeding risk and do not use immediately after these procedures.

• Echinacea: There is currently a lack of clear human evidence that echinacea affects any type of cancer. The evidence from a small number of clinical trials evaluating efficacy of echinacea in the treatment of radiation-induced leukopenia (decrease in white blood cells) is equivocal. Studies have used the combination product Esberitox®, which includes extracts of echinacea (Echinacea purpurea and pallida) root, white cedar (Thuja occidentalis) leaf, and wild indigo (Baptisia tinctoria)root. Additional clinical studies are needed to make a conclusion.

• Caution is advised when taking echinacea supplements, as numerous adverse effects including drug interactions are possible.

• Essiac®: Essiac® contains a combination of herbs, including burdock root (Arctium lappa), sheep sorrel (Rumex acetosella), slippery elm inner bark (Ulmus fulva), and Turkish rhubarb (Rheum palmatum). The original formula was developed by the Canadian nurse Rene Caisse (1888-1978) and is thought to be effective in cancer therapies, although currently there is not enough evidence to recommend for or against the use of this herbal mixture as a therapy for any type of cancer. Different brands may contain variable ingredients, and the comparative effectiveness of these formulas is not known. None of the individual herbs used in Essiac® has been tested in rigorous human cancer trials, although some components have anti-tumor activity in laboratory studies. Numerous individual patient testimonials and reports from manufacturers are available on the Internet, although these cannot be considered scientifically viable as evidence. Individuals with cancer are advised not to delay treatment with more proven therapies. Caution is advised when taking Essiac® supplements, as numerous adverse effects including drug interactions are possible.

• Flaxseed and flaxseed oil: Flaxseed (Linum usitatissimum) and its derivative flaxseed oil/linseed oil are rich sources of the essential fatty acid alpha-linolenic acid, which is a biologic precursor to omega-3 fatty acids such as eicosapentaenoic acid. There is limited high quality research of the effects of flaxseed or alpha-linolenic acid (which is in flaxseed) on prostate cancer risk. This area remains controversial as there is some data reporting possible increased risk of prostate cancer with alpha linolenic acid. Prostate cancer should be treated by a medical oncologist.

• Flaxseed has been well-tolerated in studies for up to four months. Avoid if allergic to flaxseed, flaxseed oil or other plants of the Linaceae family. Avoid large amounts of flaxseed by mouth and mix with plenty of water or liquid. Avoid flaxseed (not flaxseed oil) with history of esophageal stricture, ileus, gastrointestinal stricture or bowel obstruction. Avoid with history of acute or chronic diarrhea, irritable bowel syndrome, diverticulitis, or inflammatory bowel disease. Avoid topical flaxseed with open wounds or abraded skin surfaces. Use cautiously with history of a bleeding disorder or with drugs that cause bleeding (like anticoagulants and non-steroidal anti-inflammatories (like aspirin, warfarin, Advil®)), high triglyceride levels, diabetes, mania, seizures or asthma. Avoid ingestion of immature flaxseed pods.

• Focusing: Focusing (experiential therapy) is a method of psychotherapy that involves being aware of one's feelings surrounding a particular issue and understanding the meaning behind words or images conveyed by those feelings. Early evidence suggests focusing may improve mood and attitude in cancer patients. Firm recommendations cannot be made until well-designed clinical trials are available.

• Side effect reporting is rare, but patients should consult with a qualified healthcare practitioner before making decisions about medical conditions and practices. Individuals with severe emotional difficulties should not abandon proven medical and psychological therapies but rather choose focusing as a possible adjunct.

• Folic acid: Folic acid or folate is a form of a water-soluble B vitamin needed for human health. Preliminary evidence suggests that folate may decrease the risk of several types of cancer. Additional research is needed to make a conclusion. Folic acid supplementation may mask the symptoms of pernicious, aplastic, or normocytic anemias caused by vitamin B12 deficiency and may lead to neurological damage.

• Avoid if allergic or hypersensitive to folate or any folate product ingredients. Use cautiously if receiving coronary stents and with anemia and seizure disorders.

• Gamma linolenic acid (GLA): GLA is an omega-6 essential fatty acid. Some laboratory and human studies indicate that GLA may have anti-tumor activity and may be used as a cancer treatment adjunct. Additional research is needed in this area.

• Caution is advised when taking GLA supplements, as numerous adverse effects including an increased risk of bleeding and drug interactions are possible.

• Garlic: Preliminary human studies suggest that regular consumption of garlic (Allium sativum) supplements may reduce the risk of developing several types of cancer. Some studies use multi-ingredient products so it is difficult to determine if garlic alone may play a beneficial role in cancer prevention. Further well-designed human clinical trials are needed to conclude whether eating garlic or taking garlic supplements may prevent or treat cancer.

• Caution is advised when taking garlic supplements, as numerous adverse effects including an increased risk of bleeding and drug interactions are possible.

• Ginseng: Early studies report that ginseng taken by mouth may be of benefit in cancer prevention, especially if ginseng powder or extract is used. Weak studies suggest that ginseng in combination with other herbs may improve cell activity, immune function, and red and white blood cell counts in patients with aplastic anemia; however, other studies have found decreases in blood cell counts. Early studies suggest that ginseng may decrease radiation therapy side effects and may be used as a chemotherapy adjunct to improve body weight, quality of life, and the immune response. There is currently not enough evidence to recommend the use of Panax ginseng or American ginseng for these indications. Study results are unclear, and more research is needed before a clear conclusion can be reached.

• Caution is advised when taking ginseng supplements, as numerous adverse effects including an increased risk of drug interactions are possible.

• Goji: Polysaccharide constituents, such as alpha- and beta-glucans from a variety of plants, are reported to have immune system enhancing properties. In clinical study, Lycium barbarum polysaccharides (LBP) demonstrated a synergistic effect in various cancer treatments, when administered in conjunction with powerful immune stimulating drugs.

• Use cautiously in patients who are taking blood-thinning medications, such as warfarin. Use cautiously in asthma patients and in patients with sulfite sensitivities. The New York Department of Agriculture has detected the presence of undeclared sulfites, a food additive, in two dried goji berry products from China. Avoid in patients who are allergic to goji, any of its constituents, or to members of the Solanaceae family.

• Grape seed: There is currently little information available on the use of grape seed extract in the treatment of human cancer. Further research is needed before a recommendation can be made.

• Avoid if allergic or hypersensitive to grapes or other grape compounds. Use cautiously with bleeding disorders or if taking blood thinners such as warfarin, aspirin, non-steroidal anti-inflammatory drugs (NSAIDS), or anti-platelet agents. Use cautiously with drugs processed using the liver's cytochrome P450 enzyme system. Use cautiously with blood pressure disorders or if taking ACE inhibitors.

• Green tea: Green tea is made from the dried leaves of Camellia sinensis, a perennial evergreen shrub. Green tea has a long history of use in health and longevity, dating back to China approximately 5,000 years ago. Although used for centuries to help prevent diseases, the relationship of green tea consumption and human cancer in general remains inconclusive. Evidence from well-designed clinical trials is needed before a firm conclusion can be made in this area.

• Caution is advised when taking green tea supplements, as numerous adverse effects including an increased risk of drug interactions are possible.

• Healing touch: Preliminary data suggests that healing touch (HT) may increase quality of life in cancer. However, due to weaknesses in design and the small number of studies, data are insufficient to make definitive recommendations. Studies with stronger designs are needed. HT should not be regarded as a substitute for established medical treatments.

• Hoxsey formula: "Hoxsey formula" is a misleading name, because it is not a single formula, but rather is a therapeutic regimen consisting of an oral tonic, topical (on the skin) preparations, and supportive therapy. The tonic is individualized for cancer patients based on general condition, location of cancer, and previous history of treatment. An ingredient that usually remains constant for every patient is potassium iodide. Other ingredients are then added and may include licorice, red clover, burdock, stillingia root, berberis root, pokeroot, cascara, Aromatic USP 14, prickly ash bark, and buckthorn bark. A red paste may be used, which tends to be caustic (irritating), and contains antimony trisulfide, zinc chloride, and bloodroot. A topical yellow powder may be used, and contains arsenic sulfide, talc, sulfur, and a "yellow precipitate." A clear solution may also be administered, and contains trichloroacetic acid.

• Well-designed human studies available evaluating the safety or effectiveness of Hoxsey formula are currently lacking. Caution is advised when taking the Hoxsey formula supplements, as numerous adverse effects including an increased risk of drug interactions are possible.

• Hydrazine sulfate: Hydrazine is an industrial chemical marketed as having the potential to repress weight loss and cachexia (muscle wasting) associated with cancer, and to improve general appetite status. However, in large randomized controlled trials, hydrazine has not been proven effective for improving appetite, reducing weight loss, or improving survival in adults. The National Cancer Institute (NCI) sponsored studies of hydrazine sulfate that claimed efficacy in improving survival for some patients with advanced cancer. Trial results found that hydrazine sulfate did not prolong survival for cancer patients. The U.S. Food and Drug Administration (FDA) has received requests from individual physicians for approval to use hydrazine sulfate on a case-by-case "compassionate use" basis on the chance that patients with no other available effective cancer treatment options might benefit from this therapy. The overall controversy in the use of hydrazine sulfate is ongoing, and relevance to clinical practice is unknown. The use of hydrazine sulfate needs to be evaluated further before any recommendations can be made.

• Hydrazine sulfate may cause cancer. Avoid if allergic or hypersensitive to hydrazine sulfate or any of its constituents. Use cautiously with liver or kidney problems, psychosis, diabetes or seizure disorders. Side effects have been reported, including dizziness, nausea, and vomiting.

• Iodine: Iodine is an element (atomic number 53), which is required by humans for the synthesis of thyroid hormones (triiodothyronine/T3 and thyroxine/T4). The potential role of non-radioactive iodine in cancer care remains unknown. Antioxidant and anti-tumor effects have been proposed based on laboratory research. In contrast, some scientists have asserted that tumors may uptake more iodine than normal tissues. It has been suggested that high rates of gastric (stomach) cancer or low rates of breast cancer in coastal Japan may be due to high iodine intake, although this has not been demonstrated scientifically. Povidone-iodine solutions have been used as a part of alternative cancer regimens, such as the Hoxsey formula. Preliminary study has also indicated povidone-iodone solution as a potential rectal washout for rectal cancer. Overall, no clear conclusion can be drawn based on the currently available evidence.

• Reactions can be severe, and deaths have occurred with exposure to iodine. Avoid iodine-based products if allergic or hypersensitive to iodine. Do no use for more than 14 days. Avoid Lugol solution and saturated solution of potassium iodide (SSKI, PIMA) with hyperkalemia (high amounts of potassium in the blood), pulmonary edema (fluid in the lungs), bronchitis, or tuberculosis. Use cautiously when applying to the skin because it may irritate/burn tissues. Use sodium iodide cautiously with kidney failure. Avoid sodium iodide with gastrointestinal obstruction.

• Jiaogulan: Preliminary evidence indicates that gypenosides extracted from Gynostemma pentaphyllum may decrease cancer cell viability, arrest the cell cycle, and induce apoptosis (cell death) in human cancer cells. Immune function in cancer patients has also been studied. Additional study is needed in this area.

• Avoid if allergic or hypersensitive to jiaogulan (Gynostemma pentaphyllum), its constituents, or members of the Cucurbitaceae family. Use cautiously with blood disorders or taking anticoagulants or anti-platelet drugs (blood thinners). Use cautiously with diabetes.

• Lavender: Perillyl alcohol (POH), derived from lavender (Lavendula officinalis), may be beneficial in the treatment of some types of cancer. Preliminary small studies in humans, involving the use of POH suggest safety and tolerability, but effectiveness has not been established.

• Avoid if allergic or hypersensitive to lavender. Avoid with a history of seizures, bleeding disorders, eating disorders (anorexia, bulimia), or anemia (low levels of iron).

• Lutein: Currently, there is insufficient available evidence to recommend for or against the use of lutein for cancer. Available evidence in humans is conflicting.

• Avoid if allergic or hypersensitive to lutein or zeaxanthin. Use cautiously if at risk for cardiovascular disease or cancer.

• Lycopene: High levels of lycopene are found in tomatoes and in tomato-based products. Tomatoes are also sources of other nutrients such as vitamin C, folate, and potassium. Early studies examining tomato-based products and blood lycopene levels suggest that lycopene may be associated with a lower risk of developing cancer and may help stimulate the immune system. Laboratory studies have reported that lycopene inhibits the growth of prostate cancer cells. However, due to a lack of well-designed human research using lycopene supplements, its effectiveness for cancer prevention remains unclear. Avoid if allergic to tomatoes or to lycopene.

• Maitake mushroom: Maitake is the Japanese name for the edible mushroom Grifola frondosa. Maitake has been used traditionally both as a food and for medicinal purposes. Early studies in the laboratory as well as in humans suggest that beta-glucan extracts from maitake may increase the body's ability to fight cancer. However, these studies have not been well designed, and better research is needed before the use of maitake for cancer can be recommended.

• Caution is advised when taking maitake supplements, as numerous adverse effects including an increased risk of bleeding and drug interactions are possible.

• Meditation: Not enough research has shown meditation to be of benefit in cancer prevention. More studies are needed.

• Use cautiously with underlying mental illnesses. People with psychiatric disorders should consult with their primary mental healthcare professional(s) before starting a program of meditation, and should explore how meditation may or may not fit in with their current treatment plan. Avoid with risk of seizures. The practice of meditation should not delay the time to diagnosis or treatment with more proven techniques or therapies, and should not be used as the sole approach to illnesses.

• Melatonin: There are several early-phase and controlled human trials of melatonin in patients with various advanced stage malignancies. There is currently not enough definitive scientific evidence to discern if melatonin is beneficial as a cancer treatment, whether it increases (or decreases) the effectiveness of other cancer therapies, or if it safely reduces chemotherapy side effects.

• Melatonin is not to be used for extended periods of time. Caution is advised when taking melatonin supplements, as numerous adverse effects including drug interactions are possible.

• Milk thistle: Milk thistle (Silybum marianum) has been used medicinally in China for over 2,000 years, most commonly for the treatment of liver and gallbladder disorders. There are early reports from laboratory experiments that the components silymarin and silibinin found in milk thistle may reduce the growth of human cancer cells. However, effects have not been shown in high-quality human trials.

• Caution is advised when taking milk thistle supplements, as numerous adverse effects including an increased risk of bleeding and drug interactions are possible.

• Mistletoe: Mistletoe is one of the most widely used unconventional cancer treatments in Europe. Mistletoe extracts have been studied for a variety of human cancers as well as melanoma and leukemia. However, efficacy has not been conclusively proven for any one condition. In fact, some studies have shown lack of efficacy of certain preparations for a variety of cancers. Larger, well-designed clinical trials are needed.

• Caution is advised when taking mistletoe supplements, as numerous adverse effects including nausea, vomiting, and drug interactions are possible.

• Modified citrus pectin: Pectins are gel-forming polysaccharides from plant cell walls, especially apple and citrus fruits. Modified citrus pectin may reduce the metastasis (spread to other areas of the body) of certain types of cancers, including lung, prostate, and breast cancer. More research is needed in this area, especially with other types of cancer and with other criteria for prostate cancer progression.

• Avoid if allergic or hypersensitive to modified citrus pectin. MCP may cause gastrointestinal discomfort in patients allergic or sensitive to MCP. Use cautiously if taking chelating medications or if under treatment for cancer. Use cautiously if taking oral drugs, herbs, or supplements as MCP may reduce or slow their absorption. Use cautiously in geriatric patients or patients with gastrointestinal disorders.

• Moxibustion: Moxibustion is a healing technique employed across the diverse traditions of acupuncture and oriental medicine for over 2,000 years. Moxibustion uses the principle of heat to stimulate circulation and break up congestion or stagnation of blood and chi. Moxibustion is closely related to acupuncture as it is applied to specific acupuncture points. Preliminary evidence suggests that moxibustion may reduce side effects of chemotherapy or radiation therapy. More studies are needed.

• Use cautiously over large blood vessels and thin or weak skin. Avoid with aneurysms, any kind of "heat syndrome," cardiac disease, convulsions or cramps, diabetic neuropathy, extreme fatigue and/or anemia, fever, inflammatory conditions, over allergic skin conditions or ulcerated sores, or skin adhesions. Avoid areas with an inflamed organ, contraindicated acupuncture points, face, genitals, head, inflamed areas in general, nipples, and skin adhesions. Avoid in patients who have just finished exercising or taking a hot bath or shower. Use cautiously with elderly people with large vessels. It is considered not advisable to bathe or shower for up to 24 hours after a moxibustion treatment.

• Oleander: Laboratory studies of oleander (Nerium oleander) suggest possible anti-cancer effects, although reliable research in humans is not currently available. There are reports that long-term use of oleander may have positive effects in patients several types of cancer. More research is needed.

• Caution is advised when taking oleander supplements, as numerous adverse effects including drug interactions are possible.

• Omega-3 fatty acids: Omega-3 fatty acids are essential fatty acids found in some plants and fish. A balance of omega-6 and omega-3 fatty acids is advised for health. Several population studies report that dietary omega-3 fatty acids or fish oil may reduce the risk of developing several different types of cancer. Well conducted clinical trials are necessary before a clear conclusion can be drawn regarding the use of omega-3 fatty acids for cancer prevention.

• Caution is advised when taking omega-3 fatty acid supplements, as numerous adverse effects including an increase in bleeding and drug interactions are possible.

• Para-aminobenzoic acid: N-butyl-p-aminobenzoate (BAB) has been shown to be a lipid-soluble local anesthetic. Early study found significant pain relief in patients with intractable cancer pain after an epidural injection of BAB suspension. Larger scale clinical study is needed to confirm these findings.

• Avoid with known hypersensitivity to PABA or its derivatives. Use cautiously in patients with renal disease, bleeding disorders or taking anticoagulants, diabetics or patients at risk for hypoglycemia. Discontinue use if rash, nausea, or anorexia occurs. Pharmaceutical doses of PABA and its derivatives should only be taken under appropriate medical supervision. PABA should not be given concurrently with sulfonamides.

• Perillyl alcohol: Perillyl alcohol has been used to treat cancer. However, high quality scientific studies are lacking. Further research is required before recommendations can be made.

• Avoid if allergic/hypersensitive to perillyl alcohol. Avoid use in the absence of medical supervision. Use cautiously in patients under medical supervision.

• PC-SPES: Studies of PC-SPES® have reported improvements in patients with prostate cancer. Overall, these studies found prostate-specificantigen (PSA) levels to fall by greater than 50% in most patients, improvements in bone scans and x-rays, reductions in pain scores, and improvements in quality of life. In addition, PC-SPES® extracts were reported to cause cell death (apoptosis) or to slow the growth of cancer cell lines. Because of these complicated circumstances, and the fact that PC-SPES® has never been compared to placebo or standard cancer treatments in a well-reported study, the question of effectiveness remains unclear.

• Note: PC-SPES ® has been recalled from the U.S. market and should not be used. Based on safety concerns associated with PC-SPES®, no dosage is recommended.

• Pomegranate: Consumption of pomegranate juice may be beneficial to patients with prostate cancer. Although early study is promising, more study is needed to a make a conclusion.

• Avoid if allergic or hypersensitive to pomegranate. Avoid with diarrhea or high or low blood pressure. Avoid taking pomegranate fruit husk with oil or fats to treat parasites. Pomegranate root/stem bark should only be used under supervision of a qualified healthcare professional. Use cautiously with liver damage or disease.

• Prayer: Initial studies of prayer in patients with cancer (such as leukemia) report variable effects on disease progression or death rates when intercessory prayer is used. Better quality research is necessary before a firm conclusion can be drawn.

• Prayer is not recommended as the sole treatment approach for potentially serious medical conditions, and should not delay the time it takes to consult with a healthcare professional or receive established therapies. Sometimes religious beliefs come into conflict with standard medical approaches, and require an open dialog between patients and caregivers. In clinical study, patients certain that they were receiving intercessory prayer had a higher incidence of complications following cardiac bypass surgery than those who did not know they were being prayed for.

• Red clover: Red clover is a legume that has plant-based chemicals that are similar to estrogen. Red clover isoflavones may have estrogen-like properties in the body, and have been proposed as a possible therapy in prostate cancer. Well designed human research is lacking in this area.

• Avoid if allergic to red clover or other isoflavones. Use cautiously if taking hormone replacement therapy (HRT). Use cautiously with a history of a bleeding disorder or if taking drugs that thin the blood.

• Reiki: Reiki may contribute to reduced perception of pain, improved quality of life, and reduced fatigue in cancer patients. More studies are needed.

• Reiki is not recommended as the sole treatment approach for potentially serious medical conditions, and should not delay the time it takes to consult with a healthcare professional or receive established therapies. Use cautiously with psychiatric illnesses.

• Reishi mushroom: Reishi (Ganoderma lucidum) has been shown to have antineoplastic and immunomodulatory effects in animal studies. Human studies exist of advanced cancer patients using Ganopoly®, a Ganoderma lucidum polysaccharide extract. Results show improved quality of life and enhanced immune responses, which are typically reduced or damaged in cancer patients receiving chemotherapy and/or radiation therapy. Well-designed long-term studies are needed confirm these results and to determine potential side effects.

• Caution is advised when taking reishi supplements, as numerous adverse effects including an increased risk of bleeding and drug interactions are possible.

• Resveratrol: The effects of resveratrol cannot be adequately assessed from trials using foods, wine, or combination products containing resveratrol and other substances. Well-designed clinical trials of resveratrol alone are needed before a recommendation can be made in regards to cancer prevention and/or treatment.

• Avoid if allergic or hypersensitive to resveratrol, grapes, red wine or polyphenols. Resveratrol is generally considered safe and is commonly found in food and beverages. Use cautiously with bleeding disorders, abnormal blood pressure. Use cautiously with drugs that are broken down by the body's cytochrome P450 system or digoxin (or digoxin-like drugs).

• Saw palmetto: There is not enough scientific evidence to recommend the product PC-SPES® (which contains saw palmetto) for prostate cancer. PC-SPES® also contains seven other herbs (Chrysanthemum morifolium, Isatis indigotica, Glycyrrhiza glabra, Ganoderma lucidum, Panax pseudo-ginseng, Rabdosia rubescens, and Scutellaria baicalensis). It has been a popular treatment for prostate cancer, but the U.S. Food and Drug Administration (FDA) has issued a warning not to use PC-SPES® because it contains the anticoagulant chemical warfarin and may cause bleeding.

• Avoid if allergic or hypersensitive to saw palmetto. Use cautiously with a history of health conditions involving the stomach, liver, heart, or lungs; hormone-sensitive conditions; or bleeding disorders. Use cautiously with drugs that thin the blood or hormonal drugs.

• Seaweed: Bladderwrack (Fucus vesiculosus) is a brown seaweed that grows on the northern coasts of the Atlantic and Pacific oceans, and the North and Baltic seas. Bladderwrack appears to suppress the growth of various cancer cells in animal and laboratory studies. However, reliable human studies to support a recommendation for use in cancer are currently lacking.

• Caution is advised when taking bladderwrack supplements, as numerous adverse effects including an increased risk of drug interactions are possible.

• Selenium: Several studies suggest that low levels of selenium (measured in the blood or in tissues such as toenail clippings), may be a risk factor for developing cancer. Population studies suggest that people with cancer are more likely to have low selenium levels than healthy matched individuals, but in most cases it is not clear if the low selenium levels are a cause or merely a consequence of disease. It currently remains unclear if selenium is beneficial for cancer prevention or cancer treatment.

• Avoid if allergic or sensitive to products containing selenium. Avoid with a history of nonmelanoma skin cancer.

• Shark cartilage: For several decades, shark cartilage has been proposed as a cancer treatment. Studies have shown shark cartilage or the shark cartilage product AE-941 (Neovastat®) to block the growth of new blood vessels, a process called "anti-angiogenesis," which is believed to play a role in controlling growth of some tumors. There have also been several reports of successful treatments of end-stage cancer patients with shark cartilage, but these have not been well-designed and have not included reliable comparisons to accepted treatments. Many studies have been supported by shark cartilage product manufacturers, which may influence the results. In the United States, shark cartilage products cannot claim to cure cancer, and the U.S. Food and Drug Administration (FDA) has sent warning letters to companies not to promote products in this way. Without further evidence from well-designed human trials, it remains unclear if shark cartilage is of any benefit in cancer and patients are advised to check with their doctor and pharmacist before taking shark cartilage.

• Shark cartilage available in Asian grocery stores and restaurants should not be eaten due to declining populations of sharks. Caution is advised when taking shark cartilage supplements, as numerous adverse effects including an increased risk of drug interactions are possible.

• Shiitake mushroom: Shiitake (Lentinus edodes) has been taken by mouth for boosting the immune system, decreasing cholesterol levels, and for anti-aging. Lentinan, derived from shiitake, has been injected as an adjunct treatment for cancer and HIV infection. Laboratory, animal and human studies of lentinan have shown positive results in cancer patients when used as a chemotherapy adjunct. Further well-designed clinical trials on all types of cancer are required to confirm these results.

• Caution is advised when taking shiitake supplements, as numerous adverse effects including an increased risk of bleeding and drug interactions are possible.

• Slippery elm: Slippery elm is found as a common ingredient in a purported herbal anticancer product called Essiac® and a number of Essiac-like products. These products contain other herbs such as rhubarb, sorrel, and burdock root. Currently, there is not enough evidence to recommend for or against the use of this herbal mixture as a therapy for any type of cancer. Avoid if allergic or hypersensitive to slippery elm.

• Sorrel: Early evidence suggests that herbal formulations containing sorrel, such as Essiac®, do not shrink tumor size or increase life expectancy in patients with cancer. However, currently there is a lack of studies evaluating sorrel as the sole treatment for cancer. A conclusion cannot be made without further research.

• Avoid with a known allergy or hypersensitivity to sorrel. Avoid large doses due to reports of toxicity and death, possibly because of the oxalate found in sorrel. Many tinctures contain high levels of alcohol and should be avoided when driving or operating heavy machinery. Sorrel formulations may cause nausea or vomiting when taken with the prescription drugs metronidazole (Flagyl®) or disulfiram (Antabuse®).

• Soy: Soy (Glycine max) contains compounds which have been reported to be effective as a cancer treatment. Genistein, an isoflavone found in soy, has been found in laboratory and animal studies to possess anti-cancer effects, such as blocking new blood vessel growth (anti-angiogenesis), acting as a tyrosine kinase inhibitor (a mechanism of many new cancer treatments), or causing cancer cell death (apoptosis). In contrast, genistein has also been reported to increase the growth of pancreas tumor cells in laboratory research. Until reliable human research is available, it remains unclear if dietary soy or soy isoflavone supplements are beneficial, harmful, or neutral in people with various types of cancer.

• Early research has tested the effects of dietary soy intake on prostate cancer development in humans, but the results have not been conclusive. Better research is needed before a recommendation can be made for prostate cancer prevention.

• Caution is advised when taking soy supplements, as numerous adverse effects including an increased risk of drug interactions are possible.

• Spiritual healing: Cancer patients, especially those who fear recurrence or are unhappy with their physicians, commonly use prayer and spiritual healing. More research is needed to address the effects of spiritual healing on anxiety, depression, and quality of life in patients with cancer.

• Spiritual healing should not be used as the only treatment approach for medical or psychiatric conditions, and should not delay the time it takes to consider more proven therapies.

• Sweet annie: Certain constituents found in sweet annie show promise for use in cancer when used in combination with standard chemotherapy. However, currently there is not enough scientific evidence in humans to make a strong recommendation for this use.

• Avoid if allergic or hypersensitive to sweet annie (Artemisia annua), its constituents, or members of the Asteraceae/Compositae family such dandelion, goldenrod, ragweed, sunflower, and daisies. Use cautiously in patients who are taking angiogenic agents, or recovering from surgery or other wounds. Use cautiously if taking cardiotoxic or neurotoxic agents or with compromised cardiac or neural function. Use cautiously if taking immunostimulants or quinolines.

• Transcutaneous electrical nerve stimulation (TENS): Transcutaneous electrical nerve stimulation (TENS) is a non-invasive technique in which a low-voltage electrical current is delivered through wires from a small power unit to electrodes located on the skin. Although TENS has been used with some success in cancer pain, there is not enough reliable evidence to draw a firm conclusion in this area. TENS is often used in combination with acupuncture.

• Avoid with implantable devices, like defibrillators, pacemakers, intravenous infusion pumps, or hepatic artery infusion pumps. Use cautiously with decreased sensation, like neuropathy, and with seizure disorders.

• Thiamin (Vitamin B1): Thiamin deficiency has been observed in some cancer patients, possibly due to increased metabolic needs. It is not clear if lowered levels of thiamin in such patients may actually be beneficial. Currently, it remains unclear if thiamin supplementation plays a role in the management of any particular type(s) of cancer.

• Thiamin is generally considered safe and relatively nontoxic. Avoid if allergic or hypersensitive to thiamin. Rare hypersensitivity/allergic reactions have occurred with thiamin supplementation. Skin irritation, burning, or itching may rarely occur at injection sites. Large doses may cause drowsiness or muscle relaxation.

• Thymus extract: Preliminary evidence suggests that thymus extract may increase disease-free survival and immunological improvement in several types of cancer. Additional study is needed in this area.

• Avoid if allergic or hypersensitive to thymus extracts. Use bovine thymus extract supplements cautiously due to potential for exposure to the virus that causes "mad cow disease." Avoid with an organ transplant or other forms of allografts or xenografts. Avoid if receiving immunosuppressive therapy, with thymic tumors, myasthenia gravis (neuromuscular disorder), untreated hypothyroidism, or if taking hormonal therapy.

• Traditional Chinese Medicine (TCM): The ancient Chinese philosophy of Taoism provided the basis for the development of Chinese medical theory. TCM uses over 120 different herbs in cancer treatment, depending on the type of cancer and its cause according to Chinese medical theory. Studies have reported significant benefits include reducing tumors, reducing treatment side effects and improved response to treatment. More studies of stronger design are needed before TCM can be recommended with confidence as an adjunct to cancer treatment, although centuries of traditional use in cancer cannot be discounted.

• Chinese herbs can be potent and may interact with other herbs, foods or drugs. Consult a qualified healthcare professional before taking. There have been reports of manufactured or processed Chinese herbal products being tainted with toxins or heavy metal or not containing the listed ingredients. Herbal products should be purchased from reliable sources. Avoid ma huang, which is the active ingredient in ephedra.

• Turmeric: Turmeric (Curcuma longa) is commonly used for its anti-inflammatory properties. Several early animal and laboratory studies report anti-cancer (colon, skin, breast) properties of curcumin. Many mechanisms have been considered, including antioxidant activity, anti-angiogenesis (prevention of new blood vessel growth), and direct effects on cancer cells. Currently it remains unclear if turmeric or curcumin has a role in preventing or treating human cancer. There are several ongoing studies in this area.

• Caution is advised when taking turmeric supplements, as numerous adverse effects including an increased risk of bleeding and drug interactions are possible.

• Vitamin C (ascorbic acid): Dietary intake of fruits and vegetables high in vitamin C has been associated with a reduced risk of various types of cancer in population studies (particularly cancers of the mouth, esophagus, stomach, colon, or lung). However, it is not clear that it is specifically the vitamin C in these foods that is beneficial, and vitamin C supplements have not been found to be associated with this protective effect. Experts have recommended increasing dietary consumption of fruits and vegetables high in vitamin C, such as apples, asparagus, berries, broccoli, cabbage, melon (cantaloupe, honeydew, watermelon), cauliflower, citrus fruits (lemons, oranges), fortified breads/grains/cereal, kale, kiwi, potatoes, spinach, and tomatoes. Vitamin C has a long history of adjunctive use in cancer therapy, and although there have not been any definitive studies using intravenous (or oral) vitamin C, there is evidence that it has benefit in some cases. Better-designed studies are needed to better determine the role of vitamin C in cancer prevention and cancer treatment. Vitamin C has been used in prostate cancer, however, there is currently a lack of evidence to determine its specific effect in this condition

• Avoid if allergic or sensitive to vitamin C product ingredients. Vitamin C is generally considered safe in amounts found in foods. Vitamin C supplements are also generally considered safe in most individuals if taken in recommended doses. Large doses (greater than 2 grams) may cause diarrhea and gastrointestinal upset. Avoid high doses of vitamin C with glucose 6-phosphate dehydrogenase deficiency, kidney disorders or stones, cirrhosis (inflammation of the liver), gout, or paroxysmal nocturnal hemoglobinuria (bleeding disorder).

• Vitamin D: Limited research suggests that synthetic vitamin D analogs may play a role in the treatment of human cancers. However, it remains unclear if vitamin D deficiency raises cancer risk, or if an increased intake of vitamin D is protective against some cancers. Until additional trials are conducted, it is premature to advise the use of regular vitamin D supplementation for cancer prevention.

• Avoid if allergic or hypersensitive to vitamin D or any of its components. Vitamin D is generally well-tolerated in recommended doses; doses higher than recommended may cause toxic effects. Use cautiously with hyperparathyroidism (overactive thyroid), kidney disease, sarcoidosis, tuberculosis, and histoplasmosis.

• Vitamin E: Reliable scientific evidence that vitamin E is effective as a cancer treatment is currently lacking. In addition, the role of vitamin E supplementation for prostate cancer prevention is controversial. There are numerous laboratory studies that support possible anti-cancer properties. However, the results of population research and human research have been mixed, with some studies reporting benefits and others finding no effects. Vitamin E succinate (one specific form of vitamin E) has been reported in laboratory studies to inhibit the growth of human prostate cancer cells.

• Caution is merited in people undergoing chemotherapy or radiation, because it has been proposed that the use of high-dose antioxidants may actually reduce the anti-cancer effects of these therapies. This remains an area of controversy and studies have produced variable results. Patients interested in using high-dose antioxidants such as vitamin E during chemotherapy or radiation should discuss this decision with their medical oncologist or radiation oncologist. Caution is advised when taking vitamin E supplements, as numerous adverse effects including an increased risk of bleeding and drug interactions are possible. Avoid if allergic or hypersensitive to vitamin E. Avoid with retinitis pigmentosa (loss of peripheral vision). Use cautiously with bleeding disorders or if taking blood thinners.

• Fair negative scientific evidence:

• Apricot: Available clinical trials on the use of whole apricots for cancer are currently lacking. However, some research has been conducted on "Laetrile™," an alternative cancer drug marketed in Mexico and other countries outside of the U.S. Laetrile™ is derived from amygdalin found in apricot pits and nuts such as bitter almond. There are multiple animal studies and initial human evidence to suggest that Laetrile™ is not beneficial in the treatment of cancer. Based on a phase II trial in 1982, the U.S. National Cancer Institute concluded that Laetrile™ is not an effective chemotherapeutic agent. Nonetheless, many people still travel to use this therapy outside the U.S.

• Multiple cases of cyanide poisoning, including deaths, have been associated with Laetrile™ therapy. Avoid if allergic to apricot, its constituents or members of the Rosaceae family, especially the Prunoideae subfamily of plants. Avoid eating excessive amounts of apricot kernels (about 7 grams daily, or more than ten kernels daily). Use cautiously with diabetes. Use cautiously when taking supplements containing beta-carotene, iron, niacin, potassium, thiamine or vitamin C. Use cautiously when taking products that may lower blood pressure.

• Beta-carotene: While diets high in fruits and vegetables rich in beta-carotene have been shown to potentially reduce certain cancer incidences, results from randomized controlled trials with oral supplements do not support this claim.

• There is some concern that beta-carotene metabolites with pharmacological activity can accumulate and potentially have cancer-causing (carcinogenic) effects. A higher, statistically significant incidence of lung cancer in male smokers who took beta-carotene supplements has been discovered. Beta-carotene/vitamin A supplements may have an adverse effect on the incidence of lung cancer and on the risk of death in smokers and asbestos exposed people or in those who ingest significant amounts of alcohol. In addition, high-dose antioxidants theoretically may interfere with the activity of some chemotherapy drugs or radiation therapy. Therefore, individuals undergoing cancer treatment should speak with their oncologist if they are taking or considering the use of high dose antioxidants. Beta-carotene in the amounts normally found in food does not appear to have this adverse effect. Avoid if sensitive to beta-carotene, vitamin A or any other ingredients in beta-carotene products.

• Bitter almond: "Laetrile" is an alternative cancer drug marketed in Mexico and other countries outside of the United States. Laetrile is derived from amygdalin, found in the pits of fruits and nuts such as the bitter almond. Early evidence suggests that laetrile is not beneficial in the treatment of cancer. In 1982, the U.S. National Cancer Institute concluded that laetrile was not effective for cancer therapy. Nonetheless, many people still travel to use this therapy outside the United States.

• Multiple cases of cyanide poisoning, including deaths, have been associated with laetrile therapy. Avoid if allergic to almonds or other nuts. Use cautiously if driving or operating machinery.

• Hypnotherapy, hypnosis: Hypnosis did not reduce radiotherapy side effects such as anxiety and did not improve quality of life in patients undergoing curative radiotherapy in early high-quality studies.

• Use cautiously with mental illnesses like psychosis/schizophrenia, manic depression, multiple personality disorder or dissociative disorders, or with seizure disorders.

• Iridology: There is currently limited available data supporting iridology as a tool for cancer diagnosis. Additional study is needed.

• Iridology should not be used alone to diagnose disease. Studies of iridology have reported incorrect diagnoses, and thus, potentially severe medical problems may go undiagnosed. In addition, research suggests that iridology may lead to inappropriate treatment. Iridology is therefore not recommended as a sole method of diagnosis or treatment for any condition.

• Vitamin D: There is preliminary evidence suggesting that high-dose vitamin D may be beneficial in the treatment of prostate cancer. This area is under active investigation, but clear evidence of benefit is not yet available.

• Avoid if allergic or hypersensitive to vitamin D or any of its components. Vitamin D is generally well-tolerated in recommended doses; doses higher than recommended may cause toxic effects. Use cautiously with hyperparathyroidism (overactive thyroid), kidney disease, sarcoidosis, tuberculosis, and histoplasmosis.

• Vitamin E: Recent evidence from well-conducted clinical study reports no reduction in the development of cancer with the use of natural-source vitamin E taken daily. Previously, there have been laboratory, population, and other human trials examining whether vitamin E is beneficial in general cancer prevention, including that for prostate, colon, or stomach cancer. Results of these prior studies have been variable. At this time, based on the best available scientific evidence, and recent concerns about the safety of vitamin E supplementation, vitamin E cannot be recommended for cancer prevention.

• Avoid if allergic or hypersensitive to vitamin E. Avoid with retinitis pigmentosa (loss of peripheral vision). Use cautiously with bleeding disorders or if taking blood thinners.

Prevention

• Prostate screening: The American Urological Association (AUA) encourages men who are in good health to have annual PSA testing starting at age 50, or at age 40 if they're in high-risk groups, such as black men or those with a father, brother, or son with the disease.

• Vaccine: A new vaccine, although not FDA-approved, has been developed to help extend survival for patients with deadly metastatic prostate cancer. The FDA has requested additional clinical data before the vaccine, called Provenge®, can be approved. The vaccine is targeted at individuals with prostate cancer who have ceased responding to hormone therapy and have cancer that has spread to other organs and tissues. Reported side effects include fever, chills, and fatigue (tiredness).

• Lifestyle changes: Diets should include less high-fat dairy products, such as cheese, sour cream, and ice cream. High fat dairy products and the calcium contained in dairy may increase the risks of developing prostate cancer. Cruciferous vegetables (such as broccoli, cabbage, and cauliflower) have been reported to contain cancer-fighting phytochemicals that may decrease the chances of developing prostate cancer. Antioxidant containing foods, including fruits (such as berries, grapes, and tomatoes) and vegetables (such as peppers and carrots) may help prevent the development of prostate cancer. Dietary consumption of red meat and/or processed meats may increase the risks of developing cancer of the colon, rectum, stomach, pancreas, bladder, ovaries, prostate, breast and lung, and other diseases such as heart disease, rheumatoid arthritis, type 2 diabetes, and Alzheimer's disease. Exercise (at least 30 minutes daily for five days a week), smoking cessation, and relaxation all may contribute to decreasing the risk factors associated with developing prostate cancer.

Author Information

• This information has been edited and peer-reviewed by contributors to the Natural Standard Research Collaboration (www.naturalstandard.com).

Bibliography

Natural Standard developed the above evidence-based information based on a thorough systematic review of the available scientific articles. For comprehensive information about alternative and complementary therapies on the professional level, go to www.naturalstandard.com. Selected references are listed below.

1. American Academy of Family Physicians. http://familydoctor.org.

2. American Cancer Society. www.cancer.org.

3. American Urological Association. www.auanet.org.

4. Koh KA, Sesso HD, Paffenbarger RS Jr, Lee IM. Dairy products, calcium and prostate cancer risk. Br J Cancer. 2006;95(11):1582-5. View Abstract.

5. Kristal AR, Stanford JL. Cruciferous vegetables and prostate cancer risk: confounding by PSA screening. Cancer Epidemiol Biomarkers Prev. 2004;13(7):1265. View Abstract.

6. Natural Standard: The Authority on Integrative Medicine. www.naturalstandard.com. Accessed April 22, 2009

7. Peters U, Foster CB, Chatterjee N, et al., Serum selenium and risk of prostate cancer-a nested case-control study. Am J Clin Nutr. 2007 Jan;85(1):209-17. View Abstract.

8. Prostate Cancer Foundation.com www.prostatecancerfoundation.org.