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
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.
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."