Herbal Therapies

Herbs are seed plants whose stems wither after each growing season. Herbal therapies are especially attractive to men with prostate cancer, in that they are widely used in China, where the incidence of prostate cancer is very low. Many men assume, therefore, that some cause-and-effect relationship must exist. Herbs are generally considered to be natural, pure, and safe, although this is not always the case. Advocates point out that a quarter of all existing medications, including digitalis and morphine, are derived from plants. Herbal therapies are also popular because the ingredients are available in health food stores and on the Internet without a prescription. Many consumers do not realize that as long as the product is not advertised to treat a specific disease, essentially no regulation or testing of the compounds takes place.

The number of men with prostate cancer who use herbal therapies is impressive, ranging from 10 to 22 percent in various surveys. A study of 238 men treated by surgery or radiation for prostate cancer in Charlottesville, Virginia, reported that 12 percent were also using herbs, and a questionnaire returned by 1,099 men being treated at six major urology treatment centers in the United States revealed that 16 percent were using herbal therapy. Studies of men being screened for prostate cancer show a high utilization of herbal therapies as well, ranging from 21 percent in Denver to 29 percent in Toronto.2

The herb that is most popular among men with prostate cancer is saw palmetto, an extract of the dwarf palm that grows in the southeastern United States. It is said that Native Americans used its berries for urinary problems. Extracts of the berries are prepared in a variety of ways and contain a mixture of fatty acids, sterols, flavonoids, and other compounds. The composition of saw palmetto preparations may vary, since its manufacture has not been standardized.

Saw palmetto is thought to have some ability to block testosterone. Tested widely in men with benign prostatic hypertrophy (BPH), it has been found to increase urine flow, decrease urinary obstruction, and decrease the number of times the individual has to get up at night.3 In one study, saw palmetto was as effective as finasteride

(Proscar), which is widely used to treat BPH; in another study, however, saw palmetto was only one third as effective.

Saw palmetto has not been demonstrated to have any effect on cancer cells but may provide small symptomatic relief by increasing urine flow. Nevertheless, it is widely used for prostate cancer; two studies in Canada reported that 12 and 20 percent of patients were taking saw palmetto, and a study of six American treatment centers reported 16 percent. Saw palmetto is also popular among men who fear getting prostate cancer; in one study 15 percent of brothers of men with prostate cancer were using it.4

Several studies of alternative therapies have noted that men who are relatively young and those who have more education, more money, and more advanced prostate cancers than others are more likely to use these therapies. A study in San Francisco comparing the use of alternative therapies by ethnic group found that herbal remedies were used almost equally by white (14 percent), Hispanic (17 percent), African American (19 percent), and Asian (19 percent) men with prostate cancer.5 The majority of men using herbs or other alternative therapies do not inform their treating physician—but they should do so, for herbs may interact with other medications.

A major problem in evaluating the effectiveness of herbal therapies for treating prostate cancer is that most men do not take just one herb. Many who take saw palmetto, for example, also take pygeum, which comes from the bark of a tree native to Africa, where it has traditionally been used to treat urinary problems. Evaluation becomes even more difficult when men are using combinations of herbs, such as rasagenthi lehyam, a traditional Indian treatment for cancer that contains ''38 different botanicals . . . and 8 inorganic compounds, all prepared into a paste in a palm sugar and hen's egg base.''6

Men who use herbal therapy are likely to be simultaneously using other forms of alternative medicine. Shark cartilage is an example, intermittently used for many years in cancer patients with the mistaken belief that sharks do not get cancer. In a study in the United States, 8 percent of men with prostate cancer were taking shark cartilage, while in a Canadian study, 24 percent were using it. One study of shark cartilage in men with prostate cancer reported that it had no effect; other studies are currently under way, funded by the National

''Well, yes, some of them do have side effects.''

A Novel Treatment

One of my favorite examples of a patient's strategy comes from a man I know who also has prostate cancer: Instead of imagining his good cells attacking his bad cells, he goes to Europe from time to time and imposes Continental images on his bad cells. He reminds me that in an earlier, more holistic age, doctors used to advise sick people to go abroad for their health.

—Anatole Broyard, Intoxicated by My Illness

Center for Complementary Medicine under the National Institutes of Health.7

Alternative therapies may, of course, have side effects. For saw palmetto, these include headache, gastrointestinal distress, and increased blood pressure. Other herbal products have been reported to have serious complications in some individuals, including liver failure from kava kava, hepatitis from jin bu huan, and seizures from yohimbe. The risk of such complications is increased by the fact that there is virtually no regulation of the manufacturing or content of these preparations.

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