One-fourth of prostate cancer patients take complementary agents

San Antonio-The United States and United Kingdom are two nations united by a common language and also an apparent proclivity for using complementary therapies to treat prostate cancer. A study presented at the AUA annual meeting found that one in four prostate cancer patients in the United Kingdom used complementary medicines. A similar report, published 2 years ago in the Journal of Clinical Oncology (2003; 21:2199-210), found that 23.5% of U.S. patients used complementary medicine.

"These are not trivial findings," co-author Gerald Chodak, MD, director of the Midwest Prostate and Urologic Health Center in Chicago, told Urology Times. "The over-the-counter drugs, herbs, and concoctions these men are ingesting are not necessarily innocuous. They have the potential to produce significant side effects, and we have little knowledge about their possible interaction with prescribed drugs. They could enhance the side effects of other medications or they could diminish their absorption or efficacy.

"The message is that complementary drugs are common. A quarter of all men with prostate cancer are using them. Doctors need to know that this is not an uncommon practice, and that it is growing," Dr. Chodak explained.

The study led by Dr. Chodak and Simon Wilkinson, MD, of Southampton University Hospital in the United Kingdom was sent to 405 U.K. men who were identified as receiving treatment for diagnosed prostate cancer. Of that number, 294 (73%) of the men responded; of these, 73 (25%) stated they were taking complementary medicine.

Who takes complementary therapies?

One aspect of this study that set it apart from similar preceding studies was that the investigators sought to acquire psychological and mental health data from survey respondents. They theorized that patients who turned to complementary agents might have worse physical or mental health than those who adhered to prescribed therapies alone.

The investigators observed no differences in physical and mental health between those supplementing their therapies with complementary medicines and those who were not. The only notable differences between the two groups were that those using complementary medication were younger and were more likely to be on "active surveillance" or watchful waiting.

Dr. Chodak said that in U.S. studies, the men likely to use complementary therapy tend to have more advanced cancers.

"Their attitude seems to be: What have I got to lose?" he said.

Risky business

One finding that troubled the researchers was that nearly half (43%) of the complementary medicine users failed to inform their physicians about the agents they were taking. That failure to communicate could have clinical consequences.

Dr. Chodak said that he was concerned both about the nature of the agents these men may be taking and the character of the people promoting them. He cited the example of PC-SPES, a popular complementary prostate health supplement that was recalled in September 2002, when it was found to be adulterated with warfarin and alprazolam.

It appears that PC-SPES has been replaced by a new "natural" product called Prostasol. Information on the Internet lists its ingredients as quercetin, reishi, baikal skullcap, rabdosea, dyer's woad, chrysanthemum, saw palmetto, san-qi ginseng, and licorice.

"I am not certain what is in it, and I don't know if it has been laced with other agents, but I do know that some of my patients are taking it," Dr. Chodak said, adding that the concoction of oriental herbs is not innocuous, in that breast tenderness and breast lumps are observable side effects in men taking the remedy.

He added that the herbs also may affect PSA levels.

"If a man takes Prostasol while being prescribed cancer agents, the cause of a drop in his PSA may not be clear," he said.