Wednesday, September 5, 2012

CAM for Prevention of Bladder Cancer, BPH?


Recent articles published in Journal of Urology and British Journal of Urology International address the use of complementary and alternative medicine (CAM) in urologic patients. The National Center for Complementary and Alternative Medicine has defined CAM "as a group of diverse medicinal and health care systems, practices, and products that are not generally considered part of conventional medicine."
1- Evaluation of Vitamin E and Selenium Supplementation for the Prevention of Bladder Cancer in SWOG Coordinated SELECT
Study Summary
Lotan and colleagues performed a secondary analysis of the randomized, placebo-controlled Selenium and Vitamin E Cancer Prevention Trial (SELECT), which was initially conducted for the prevention of prostate cancer. In that highly anticipated and deeply disappointing trial, patients were randomly assigned to receive selenium alone, vitamin E alone, both agents, or placebo. The results were negative, with no reduction of the incidence of prostate cancer in any of the treatment groups. I was personally disappointed, because I had several patients who were receiving this combination, on the basis of earlier studies. In this follow-up study, patients were followed for over 7 years, and there was no effect on any of the treatment groups for the prevention of bladder cancer.
Viewpoint
The results raised the questions of why these studies were done and what the rationale was for the large clinical study. I contacted Ziya Kirkali, MD, Senior Scientific Advisor at the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), and asked him for a list of National Institutes of Health-sponsored studies in this area. Remarkably, he sent me a list of 156 studies of selenium and 93 involving vitamin E. Numerous small-animal and cell culture studies showed inhibition of cancer cell growth by both compounds. There were certainly enough data to warrant a well-constructed clinical trial. The results reminded me of a saying by the former chief of the Division of Urology at New York Hospital-Cornell Medical Center, Victor Marshall, MD: "Some men are rats, but no rats are men."

2- Serenoa repens Monotherapy for Benign Prostatic Hyperplasia (BPH): An Updated Cochrane Systematic Review

Study Summary

This review by MacDonald and colleagues addresses the use of Serenoa repens, the active agent extracted from saw palmetto. A 2002 survey revealed that S repens was used by 2.5 million men in the United States for the prevention of BPH. Those investigators identified about 30 phytotherapeutic compounds available for the treatment of BPH, most of which contained this agent. The current review identified 17 randomized controlled trials that met inclusion criteria.

Viewpoint

It is almost impossible to watch television or read a men's health article without encountering an advertisement forS repens or saw palmetto. However, the bottom line is that S repens is no better than placebo in reducing lower urinary tract symptoms, on the basis of the American Urological Association International Prostate Symptom Score or any urodynamic studies in the literature reviewed. One long-term trial with a 2-3 times dose escalation also did not show any improvement compared with placebo. Adverse effects were mild. Thus, it behooves us to inform patients that there is no evidence that these compounds are useful for the prevention of BPH.

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