Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2016 Apr;117 Suppl 4(Suppl 4):17-34.
doi: 10.1111/bju.13361. Epub 2016 Feb 22.

Phytotherapeutic interventions in the management of biochemically recurrent prostate cancer: a systematic review of randomised trials

Margaret Diana van Die  1 , Kerry M Bone  2   3 , Jon Emery  1 , Scott G Williams  1   4 , Marie V Pirotta  1 , Channing J Paller  5
Affiliations

Phytotherapeutic interventions in the management of biochemically recurrent prostate cancer: a systematic review of randomised trials

Margaret Diana van Die et al. BJU Int. 2016 Apr.

Abstract

Objective: To evaluate the evidence from randomised trials for the efficacy and safety of phytotherapeutic interventions in the management of biochemically recurrent (BCR) prostate cancer, indicated by prostate-specific antigen (PSA) progression, numbers progressing to/time to initiation of androgen-deprivation therapy or salvage therapy.

Patients and methods: MEDLINE (Ovid), EMBASE (Ovid), AMED (Ovid), CINAHL (EBSCO) and the Cochrane Library databases were searched. Clinical trials investigating phytotherapeutic interventions as dietary supplements or dietary components, including multi-component herbal formulations, in men with BCR prostate cancer were located. Eight of nine authors contacted for further information responded. Methodological quality was assessed using the Cochrane Collaboration's risk of bias assessment tool. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement for reporting systematic reviews was followed.

Results: Of 23 full-text articles assessed for eligibility, five met the criteria for inclusion. Two studies were placebo controlled; two were active control trials; and one a high-/low-dose trial. The interventions were administered as isolated phytochemicals (sulphoraphane), phytotherapeutic extracts [Pomi-T (pomegranate, turmeric, green tea and broccoli sprout extract), soy, lycopene, and POMx (pomegranate extract)], or plant-derived dietary items (soy and lycopene). All studies found serum PSA levels to stabilise, decrease or rise more slowly in a significant number of men, and three studies reported stabilising or lengthening of PSA-doubling time. Studies were generally of good quality, but sample sizes were predominantly small, and durations short.

Conclusions: High-quality studies in this area are lacking. Sulphoraphane, lycopene, soy isoflavones, POMx, and Pomi-T are safe and well tolerated. There is limited evidence that they can affect PSA dynamics. No recommendation can be made for the use of these agents in managing prostate cancer morbidity and mortality until high-quality, fully powered studies are available. Recommendations are made for improving reproducibility and translation of findings with regard to study population, study endpoints, design, and the reporting of phytotherapeutic interventions.

Keywords: biochemical recurrence; clinical trials; herbal medicine; phytotherapy; prostate cancer; systematic review.

PubMed Disclaimer

Conflict of interest statement

Conflict of Interest

Prof. Kerry Bone works as a consultant director of Research and Development for MediHerb (Integria) Australia, manufacturers of herbal medicines. He and Dr Diana van Die are in-laws.

Figures

Fig. 1
Fig. 1
Flowchart of selection process.
Fig. 2
Fig. 2
Risk of bias summary (a) and graph (b) of included studies.
See this image and copyright information in PMC

Similar articles

See all similar articles

Cited by

See all "Cited by" articles

References

    1. Klotz LH. PSA recurrence: definitions, PSA kinetics, and identifying patients at risk. Can J Urol 2006; 13(Suppl. 2): 43–7 - PubMed
    1. Antonarakis ES, Feng Z, Trock BJ et al. The natural history of metastatic progression in men with prostate-specific antigen recurrence after radical prostatectomy: long-term follow-up. BJU Int 2012; 109: 32–9 - PMC - PubMed
    1. Freedland SJ, Humphreys EB, Mangold LA et al. Risk of prostate cancer-specific mortality following biochemical recurrence after radical prostatectomy. JAMA 2005; 294: 433–9 - PubMed
    1. Dorff TB, Groshen S, Tsao-Wei DD et al. A Phase II trial of a combination herbal supplement for men with biochemically recurrent prostate cancer. Prostate Cancer Prostatic Dis 2014; 17: 359–65 - PMC - PubMed
    1. Paller CJ, Antonarakis ES. Management of biochemically recurrent prostate cancer after local therapy: evolving standards of care and new directions. Clin Adv Hematol Oncol 2013; 11: 14–23 - PMC - PubMed

Publication types