By Geo Espinosa, ND, LAc, IFMCP, CNS

Introduction

Prostate cancer (PrCa) is the second most common cancer in men after lung cancer and accounts for more than 1.2 million newly diagnosed cases a year worldwide. Furthermore, this disease globally kills over 350,000 annually.¹

Here in the United States roughly 250,000 men are diagnosed with PrCa yearly, accounting for about 35,000 deaths from the disease.²

Numerous environmental and lifestyle factors, such as diet, obesity, smoking, and exercise, have been linked to PrCa. Nutrition and diet have long been thought to be associated with PrCa development and progression. 

The use of nutraceuticals, prescribed by holistic practitioners or self-prescribed by the patient, to mitigate PrCa has increased by 128% from 1996 to 2016 for sole therapeutic purposes or in an integrative fashion combined with conventional medical approaches.³

As such, PrCa patients need expert guidance with the proper use of targeted nutraceuticals to manage their disease and optimize quality of life

The purpose of this article is to present the nutraceuticals I use most in the management/co-management of PrCa patients and in what disease stage I use them. 

I attempt to provide objective evidence when possible and offer reasoning with my approach, dictated by almost twenty years of practice in working mainly with PrCa patients. 

Dr. Geo Espinosa Nutraceutical Approach to Prostate Cancer

The goal with treating patients with PrCa is to treat the biological soil or, as many in the integrative/holistic oncology field would call, “the terrain.” Such ideas of treating the microenvironment are not new. In the late 1880s, Dr. Steven Paget published his “seed and soil” theory proposing that the spread of tumor cells is governed by interaction and cooperation between the cancer cells (seed) and the host organ (soil).⁴ The goal then is to make such biological soil in the patient hostile to cancer. 

In PrCa, an inhospitable cancer microenvironment is done by the following:

1. Reducing pro-carcinogenic inflammatory processes like factor NF-kB and inflammatory cytokines such as TNF-α and IL-6,⁵
2. Minimizing oxidative stress by modulating uncontrolled cellular reactive oxygen species (ROS) – a contributor to PrCa development and progression,⁶
3. Optimize immune and natural killer (NK) cell function. Robust NK cell activity may improve the prognosis of PrCa patients,⁷
4. Improve insulin levels and optimize glucose metabolism in pre-treatment patients or those on androgen deprivation therapy (ADT). Insulin resistance and glucose metabolic dysfunction are contributory to PrCa.⁸

Secondly, nutraceuticals work as part of applying other lifestyle practices, like a plant-based, whole food focused diet, rigorous physical exercise, and good sleep. Thus, nutraceuticals/dietary supplements complement lifestyle practices to support patients with PrCa. 

Lastly, the nutraceuticals suggested here are the most common recommendations for PrCa patients in my practice and may not be complete for the sake of brevity as a full book can be written on the topic. 

The methods implemented in my practice are broken down into three categories of PrCa patients:

1. The active surveillance patient. 
2. The post-procedure patient. 
3. The patient on androgen deprivation therapy (ADT) for advanced disease.

Again, despite the category the patient fits in from the above description, nutraceuticals/dietary supplements should be one element and complement targeted lifestyle interventions with diet, physical exercise, and good quality sleep to minimize progression of PrCa and optimize quality of life despite the disease or side effects from associated medical treatments. 

In general, the key nutraceuticals I recommend for patients with PrCa include curcumin, grape seed extract, medicinal mushrooms, active hexose correlated compounds (AHCC), broccoli extract, vitamin D, zinc, selenium from selenized yeast, green tea extract (EGCG), vitamin E (high in gamma-tocopherol), Andrographis, magnolia bark, and modified citrus pectin (MCP). Further down in this article, scientific support for most recommendations is provided.

The Active-Surveillance Patient

This type of patient has low-risk PrCa, does not need medical treatment at diagnosis, and is fit for active surveillance (AS) by his medical physician. Low-risk disease is described by a patient with reduced stage PrCa, relatively low PSA <10, and thought unlikely to die from prostate cancer if untreated with medical interventions.

Investigators have found that patients eligible for AS are at low risk of dying from prostate cancer or developing metastatic disease at 10 or 15 years (less than 1%).⁹

The goal here is to closely monitor men on AS for changes in the aggressiveness of their cancer via serial biopsies and PSA measurements and, if an unfavorable change is detected, to offer definitive local therapy with curative intent.¹⁰

A holistic view with patients on AS is essential since many men in this category often die prematurely from something other than prostate cancer, like heart disease. 

While reducing the risk of prostate cancer progression is essential, the nutraceutical approach should help avoid/manage prostate-related, lower urinary tract symptoms, lower the risk of cardiovascular disease as this is the number one killer in men, mitigate overall cancer formation in the body, or decrease the risk of any other illness the patients is genetically predisposed to.

The nutraceutical recommendations for the AS patient are the following botanicals and nutrients, emphasizing prostate health-supporting ingredients like rye pollen extract, quercetin, ginger extract, cranberry extract, and other nutraceuticals based on patients overall individual needs. The therapeutic goal is to lower the risk of PrCa progression where hopefully, aggressive medical interventions are unnecessary and reduce the risk of premature mortality from all causes. 

The Post-Procedure Patient

This patient has a low to intermediate stage of PrCa and has undergone a medical procedure for his disease. The goal with this type of patient is to keep him from developing PrCa recurrence or minimize the need for aggressive medical interventions, if possible after PrCa recurs.

The post-procedure patient likely has intermediate-grade prostate cancer, PSA 10 to 20, likely underwent surgical removal of the prostate or radiation therapy, and either has no recurrence or mild recurrence after medical treatment. 

The nutraceutical recommendations for the post-procedure patient are the following botanicals and nutrients, emphasizing Agaricus mushroom and about 4 grams of curcumin. The therapeutic goal is to lower the risk of cancer recurrence or cancer progression. 

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