Health myths die hard. A recent article on healthy aging in the Washington Post suggested that taking vitamin E can help men prevent prostate and other cancers. That certainly isn’t what the evidence shows. In fact, a key clinical trial of vitamin E was stopped early because it showed that taking a vitamin E supplement failed to prevent prostate cancer and could—emphasis on could—promote prostate cancer.

Early cell culture and animal studies put a spotlight on vitamin E. Under controlled conditions, it was shown to slow prostate cancer growth. But as is so often the case in medical research, these results haven’t held up in humans.

Back in 1998, the Alpha-Tocopherol, Beta-Carotene (ATBC) Cancer Prevention Trial raised hopes that taking vitamin E supplements could lower prostate cancer risk. (Alpha-tocopherol is the most active of the eight naturally occurring forms of vitamin E.) The trial found that men who took daily alpha-tocopherol supplements experienced 32% fewer prostate cancer diagnoses and 41% fewer prostate cancer deaths than men who took a placebo. While promising, these results weren’t considered conclusive. That’s because the ATBC trial wasn’t specifically designed to evaluate prostate cancer risk, and almost all of the participants were Caucasian smokers.

To clarify the ATBC results, the Selenium and Vitamin E Cancer Prevention Trial (SELECT) was specifically designed to assess the effect of supplemental vitamin E on prostate cancer risk. As its name suggests, SELECT also looked at whether another antioxidant nutrient, selenium, affects cancer risk. All of the 35,533 participants were men aged 50 who did not have prostate cancer, and nearly one quarter were minorities. Participants were randomly assigned to take daily pills that contained alpha-tocopherol, selenium, both, or neither. The trial was initially planned to continue for 12 years, with five scheduled interim analyses.

At the second interim analysis in September 2008, the trial’s Data and Safety Monitoring Committee concluded that neither vitamin E nor selenium—alone or in combination—offered protection against prostate cancer. In fact, the monitoring committee noted that the rate of prostate cancer in the vitamin E group was slightly higher than the rates in the other three groups. The difference was not statistically significant, meaning it might have been due to chance, but the trend was worrisome. The committee decided to stop the trial early, and participants were told to stop taking their supplements in October 2008.

SELECT had some limitations. For example, the researchers did not test different doses or formulations of vitamin E.  But SELECT’s robust design and large number of participants make its results trustworthy.  The results are also likely to be widely applicable, due to the trial’s substantial proportion of non-white men and equal distribution of prostate cancer risk factors across all four study groups.

We know that eating a healthy, balanced diet can help prevent prostate cancer. Based on the results of the SELECT trial, I strongly discourage my patients from taking supplemental vitamin E or selenium. Though surprised, nearly all heed this advice and, in the process, many become more educated consumers of supplements and neutraceuticals.

Related content:
Cancer prevention trial (SELECT) comes to a halt

Video: Disappointing results for Vitamin E and selenium supplements

The study, published in the Journal for Health Care Quality, evaluated 400 randomly selected hospital Web sites. Researchers looked at the placement of information about robot-assisted surgery on the sites, claims about its risks and benefits, and the use of images or text provided by the robot’s manufacturer.

About two in five of the Web sites described the availability and mechanics of robotic surgery. Of these, 37% mentioned robot-assisted surgery on the home page and 66% cited information about the procedure within one click of the home page. Nearly three-quarters of the sites used industry-provided marketing materials or linked to the manufacturer’s Web site. When describing robotic surgery, nearly all of the hospital Web sites claimed clinical superiority to other surgical methods; one-third also reported improved cancer control. None of the sites noted any risks.

The number of patients undergoing robot-assisted surgery has grown 400% over the last four years. Advocates say that robotic procedures result in less pain, smaller incisions, and shorter hospital stays, but these claims are anecdotal. Currently, no long-term studies have been published that demonstrate any benefits.

Dr. Marty Makary, the study’s leader, questions how hospitals arrived at their claims about the robot’s benefits and voices concern about potential conflict-of-interest, given that robotic procedures typically cost more than traditional ones.

“The public regards a hospital’s official Web site as an authoritative source of medical information,” he said in a statement issued by Johns Hopkins. “Hospitals need to be more conscientious of their role as trusted medical advisers and ensure that information provided on their Web sites represents the best available evidence.”

Another study, presented at the American Urological Association’s annual meeting in May 2011, found that the number of prostatectomies performed between 2005 and 2008 increased by nearly 50%—even though the incidence of prostate cancer has declined. That dramatic change coincided with the introduction of robot-assisted procedures. In fact, robot-assisted surgery accounted for 15% of all prostatectomies in 2004, but more than 80% of them in 2008, implying that hospitals’ marketing efforts are working.

Sources: Jin LX, Ibrahim AM, Newman NA, et al. Robotic Surgery Claims on United States Hospital Websites. Journal for Healthcare Quality 2011. [E-publication.]

Lavery HJ, et al. Not a Zero-Sum Game: The Widespread Adoption of Robotics Has Increased Prostatectomy Utilization in the United States. American Urological Association 2011 Annual Meeting; abstract 76.

Published June 10, 2011.

Researchers followed 321 current smokers and 309 nonsmokers who had their prostate cancer treated with surgery between 1989 and 2005. Compared to nonsmokers, men who smoked were more likely to experience a rise in their prostate-specific antigen (PSA) level, a sign that cancer has returned; levels rose about 1% per pack-year smoked. (Smoking a pack of cigarettes every day for a year constitutes a pack-year; two packs a day for a year equals two pack-years.) Men who smoked 20 pack-years or more had the highest risk of recurrence. Also, recurrent cancers were larger and more aggressive in smokers than in nonsmokers.

“These data indicate that smoking history could provide valuable insight and should be included in risk-assessment models for prostate cancer,” said Dr. Joseph C. Presti, who presented the study’s findings.

Source: Ngo T, Lee J, Brooks J, et al. Smoking and Adverse Outcomes at Radical Prostatectomy. American Urological Association 2011 Annual Meeting; abstract 459.

Published June 10, 2011.

Through an Internet-based survey, 92 gay men from the United States and Canada answered questions relating to urinary, bowel, and hormone symptoms. Compared to their heterosexual counterparts, they reported worse physical and mental health functioning, poorer sexual and ejaculatory function, and a greater fear that their cancer would return.

“This is one of the early studies demonstrating that quality of life is more significantly impacted by prostate cancer in the gay population,” said Dr. Tomas Griebling, the AUA spokesman who moderated the press briefing.

Literature on this topic is limited; additional research may help determine why gay men experience the effects of prostate cancer treatment more acutely than straight men. Of note, these findings are considered preliminary because they have not yet been published in a peer-reviewed journal.

Posted May 25, 2011

Researchers at Henry Ford Hospital followed more than 3,300 patients between January 2005 and December 2009 and found that there were 368 complications in 326 of the patients. Most complications, such as intestinal obstruction, urinary tract infection, stomach pain, and internal bleeding, were considered minor and occurred within 30 days of the surgery. Of note, the study did not assess the procedure’s effects on urinary continence and erectile function, critical quality-of-life issues that patients need to consider prior to surgery. This is a major shortcoming of the study.

Older men with higher prostate-specific antigen (PSA) and Gleason scores, as well as those men with other medical problems, such as heart disease and gastroesophageal reflux disease, were more likely to suffer complications.

During RARP, a surgeon uses remote control to manipulate the robot’s arms, which are tipped with miniature tools, and remove the prostate through a tiny incision. The entire surgical team can view the operation using a 3-D monitoring system. Claimed benefits of RARP include less surgical trauma and shorter hospital stays (about one day in this study) and recovery times. But experts say that it can cost up to $2,000 more per patient compared with other surgical methods.

The researchers emphasized that surgical results depend on the experience of the surgeon controlling the robot, not the robot itself. In this study, the two lead surgeons had performed thousands of RARP procedures; less-experienced surgeons may have higher complication rates. The study did not compare RARP to other procedures, so whether it causes fewer complications than, say, an open prostatectomy or proves better at controlling cancer remains unclear.

Source: Argawal PK, Sammon J, Bhandari A, et al. Safety Profile of Robot-Assisted Radical Prostatectomy: A Standardized Report of Complications in 3317 Patients. European Urology 2011;59:684-98. PMID: 21324583.

Published May 24, 2011

Investigators at Johns Hopkins conducted a two-part study to explore whether drugs currently on the market for other conditions could treat prostate cancer. They first screened 38 non-chemotherapy drugs from a database of more than 3,100 compounds to see if they had any effect on cancer. Digoxin reduced the growth of prostate cancer cells in the laboratory by 50%.

Next, the researchers examined the impact of digoxin use in 47,884 men between the ages of 40 and 75 who participated in the Health Professionals Follow-up Study from 1986 through 2006. At the start of the study, none of the participants had cancer, and 2% of them reported regularly using digoxin.

After 20 years, some 5,000 cases of prostate cancer had been reported. The digoxin users had a 25% lower risk of prostate cancer than nonusers, and the risk was lower still among men who had used the drug for 10 years or longer. Even after accounting for family history of prostate cancer, use of additional heart medications, and other factors, the reduction in prostate cancer risk held up.

Although the findings are promising, they come with caveats. First, researchers aren’t exactly sure how digoxin exerts its anticancer effect, knowledge that’s needed to declare it a therapy for prostate cancer. And because the study does not prove that digoxin prevents prostate cancer, giving it to healthy people for that purpose poses risks. The drug can cause serious side effects including an irregular heartbeat and breast enlargement, as well as nausea, vomiting, and headaches. However, additional research may yield other compounds that work in a similar way while causing fewer side effects.

Because digoxin treats heart failure and heart rhythm problems, it’s possible that men who take the drug don’t live as long as other men. Although the researchers made no note of this, “it is possible that digoxin users in the study had a shortened lifespan, decreasing the amount of time available for them to develop prostate cancer,” said Marc B. Garnick, editor in chief of Harvard Health Publications’ Annual Report on Prostate Diseases. “These analyses are difficult to fully interpret and should serve as a basis for further studies.”

Source: Platz EA, Yegnasubramanian S, Liu J, et al. A Novel Two-Stage, Transdisciplinary Study Identifies Digoxin as a Possible Drug for Prostate Cancer Treatment. Cancer Discovery 2011;1:OF67-75.

Posted May 17, 2011.

Over the past four years, I’ve read numerous studies and spoken with several experts on the connection between nutrition and prostate cancer. Although their recommendations for men concerned about prostate health haven’t always been consistent, most agreed on two things: eat more healthy fat, particularly the omega-3 fats found in fatty fish like salmon, and eat less unhealthy fat, namely trans and saturated fats. So I did a double take when I came across a study in the American Journal of Epidemiology that came to the opposite conclusion.

Chronic inflammation may play a role in the development and progression of prostate cancer. Omega-3 fats tend to be calm inflammation, while trans fats tend promote it. So researchers analyzed data and blood samples from 3,461 men ages 55 to 84 in the nationwide Prostate Cancer Prevention Trial to examine the relationship between the levels of these and other fats and prostate cancer risk.

Men with the highest levels of DHA, a type of omega-3, were 2.5 times more likely to have developed aggressive, high-grade prostate cancer over a seven-year period compared with men who had the lowest levels of DHA—the exact opposite of what the researchers had hypothesized. Another surprising result was that men with the highest blood levels of trans fats, often found in processed foods, were 50% less likely to have developed aggressive, high-grade prostate cancer compared with those who had the lowest levels.

“Our findings are disconcerting,” the researchers wrote,” as they suggest that omega-3 fatty acids, considered beneficial for coronary artery disease prevention, may increase high-grade prostate cancer risk, whereas trans fatty acids, considered harmful, may reduce high-grade prostate cancer risk.”

Should these results prompt men to scale back on fish and eat more processed food? I put that question to Stacy Kennedy, senior clinical nutritionist at Dana-Farber Cancer Institute, and Dr. David Rosenthal, director of Harvard University Health Service and medical director of the Leonard P. Zakim Center for Integrative Therapies at Dana-Farber. Both gave me an emphatic “no.” One key reason: the risk of dying from heart disease is much higher than the risk of dying from prostate cancer.

Eating moderate amounts of wild salmon, walnuts, pumpkin seeds, and other foods rich in omega-3s is a healthy strategy, Kennedy told me. The best “medicine” for men who are worried about their risk of prostate cancer is to maintain a healthy weight, eat plenty of fruits and vegetables, exercise regularly, and control stress. The good news is that taking these steps will promote heart health, too.

Posted May 5, 2011

Approval was granted based on findings of a large, multicenter phase III clinical trial that were announced last fall. Participants who were treated with both abiraterone and the steroid prednisone lived, on average, almost four months longer than those treated with the steroid alone (14.8 months compared with 10.9 months). The trial involved 1,195 men from 13 countries with castration-resistant prostate cancer, which means that traditional hormone therapy is no longer keeping the disease in check. Prior to the trial, patients had also received docetaxel (Taxotere), a type of chemotherapy.

The most commonly reported side effects of abiraterone included joint swelling or discomfort, low levels of potassium in the blood, fluid retention in the legs and feet, increases in blood pressure, muscle aches, hot flashes, and urinary and gastrointestinal problems.

Abiraterone is the third drug to be approved for men with late-stage prostate cancer in the last year. In April 2010, the FDA approved sipuleucel-T (Provenge), a vaccine that uses the immune system to fight advanced-stage disease. Two months later, the agency gave the green light to the chemotherapy drug cabazitaxel (Jevtana). Prior to that, patients had few options.

Bloomberg business news reported that abiraterone’s manufacturer, Johnson & Johnson, is likely to sell the drug for an average wholesale price of $5,000 a month, with treatment typically lasting about eight months.

For more information, read the FDA’s press release.

Published May 2, 2011.