Phytotherapeutic interventions in the management of biochemically recurrent prostate cancer: a systematic review of randomised trials

• Published in: BJU international Vol. 117; no. S4; pp. 17 - 34
• Main Authors: Die, Margaret Diana, Bone, Kerry M., Emery, Jon, Williams, Scott G., Pirotta, Marie V., Paller, Channing J.
• Format: Journal Article
• Language: English
• Published: England Wiley Subscription Services, Inc 01.04.2016
• Subjects: Antineoplastic Agents, Phytogenic - therapeutic use; biochemical recurrence; Brassica; Carotenoids - therapeutic use; clinical trials; Curcuma; Glycine max; herbal medicine; Humans; Isothiocyanates - therapeutic use; Lycopene; Lythraceae; Male; phytotherapy; Phytotherapy - adverse effects; Plant Extracts - therapeutic use; Prostate cancer; Prostate-Specific Antigen - blood; Prostatic Neoplasms - blood; Prostatic Neoplasms - drug therapy; Quality; Randomized Controlled Trials as Topic; Studies; Sulfoxides; systematic review; Tea; prostate cancer; clinical trials; systematic review; biochemical recurrence; herbal medicine; phytotherapy
• ISSN: 1464-4096; 1464-410X
• DOI: 10.1111/bju.13361

Objective To evaluate the evidence from randomised trials for the efficacy and safety of phytotherapeutic interventions in the management of biochemically recurrent (BCR) prostate cancer, indicated by prostate‐specific antigen (PSA) progression, numbers progressing to/time to initiation of androgen‐deprivation therapy or salvage therapy. Patients and Methods MEDLINE (Ovid), EMBASE (Ovid), AMED (Ovid), CINAHL (EBSCO) and the Cochrane Library databases were searched. Clinical trials investigating phytotherapeutic interventions as dietary supplements or dietary components, including multi‐component herbal formulations, in men with BCR prostate cancer were located. Eight of nine authors contacted for further information responded. Methodological quality was assessed using the Cochrane Collaboration's risk of bias assessment tool. The Preferred Reporting Items for Systematic Reviews and Meta‐Analyses (PRISMA) statement for reporting systematic reviews was followed. Results Of 23 full‐text articles assessed for eligibility, five met the criteria for inclusion. Two studies were placebo controlled; two were active control trials; and one a high‐/low‐dose trial. The interventions were administered as isolated phytochemicals (sulphoraphane), phytotherapeutic extracts [Pomi‐T (pomegranate, turmeric, green tea and broccoli sprout extract), soy, lycopene, and POMx (pomegranate extract)], or plant‐derived dietary items (soy and lycopene). All studies found serum PSA levels to stabilise, decrease or rise more slowly in a significant number of men, and three studies reported stabilising or lengthening of PSA‐doubling time. Studies were generally of good quality, but sample sizes were predominantly small, and durations short. Conclusions High‐quality studies in this area are lacking. Sulphoraphane, lycopene, soy isoflavones, POMx, and Pomi‐T are safe and well tolerated. There is limited evidence that they can affect PSA dynamics. No recommendation can be made for the use of these agents in managing prostate cancer morbidity and mortality until high‐quality, fully powered studies are available. Recommendations are made for improving reproducibility and translation of findings with regard to study population, study endpoints, design, and the reporting of phytotherapeutic interventions.