Video: Choosing Supplements For Prostate Cancer: Part Two

Prostate Cancer Staging Guide | Transcription

Hi, I'm Dr. Scholz. Let's talk about prostate cancer.

This video is part of a two-part series on supplements, and it's really only a very brief introduction to this vast field. In the first video, we covered some of the principles behind how you select a supplement. In this video, we're going to cover briefly a variety of individual agents and how they might have application. What makes this complex and a vast subject is that men with prostate cancer don't take supplements just to inhibit prostate cancer; they take supplements to strengthen their bones, to improve their memory, to help sleep, all kinds of different needs that men with prostate cancer have because they live a long time with this condition. So, I'll just cover a few agents that we routinely check in my practice and go through the pros and cons and help you understand our thinking on these different supplements. 

Let's start with a couple of very common vitamins: Vitamin D and vitamin B12. These are fairly commonly low in men in the age group that has prostate cancer. So, it is our policy to check vitamin B12 and vitamin D levels in all of our patients annually. And I would say we see low levels in about 10, 20% of people, and of course, we're in southern California and that'll tend to keep vitamin D levels up because of the sun exposure that we get. Problems with vitamin B12 deficiency or vitamin D deficiency are very insidious. People can feel tired, they can develop nerve problems, memory problems, problems with their bones, and these are easily corrected with supplementation. Many people just shotgun the situation and take these supplements automatically. I don't recommend that. Many people have normal levels without supplementation, but if low levels are detected on a blood test, adequate amounts of vitamin D or B12 should be administered to bring the levels into the normal range. 

When talking about prostate cancer, many men are on hormonal therapy, and as such, they rapidly lose calcium from their bones. So men that are on hormonal therapy should be on some vitamin D and perhaps even a pharmacologic agent like Prolia or Boniva. But calcium in relatively small doses at bedtime is a very sensible thing to do. 500 milligrams at bedtime is a reasonable dose. Why at bedtime? All your bone metabolism occurs at night while you're sleeping. So studies have shown calcium taken in the morning just washes out in the urine and has little impact. So small amounts of calcium at bedtime for men on hormonal therapy are eminently reasonably. Large amounts of calcium have previously been shown to have a stimulatory effect on prostate cancer, and this kind of leads into minerals in general. Copper, selenium, zinc have all been shown to have a stimulatory effect on prostate cancer growth. Why would this be? Well, think of a new cancer cell as being constructed by a variety of different substrates. The building blocks of cells include minerals and cell growth or cell replication can be inhibited by deficiencies. So a lot of times people seem to have backwards thinking about the use of supplements. Their idea, of course, is to stimulate their immune system so it can fight the cancer better, but this thinking doesn't really hold water because problems with prostate cancer are usually not related to an immune deficiency. The problem is that the immune system just isn't seeing the cancer, it's blind or it's cloaked. So oftentimes, supplementation with minerals can actually stimulate cell growth and accelerate cancer growth. So typically we advise staying away from mineral supplements—that would include iron as well—to create an environment, an internal environment, that doesn't promote cell growth. 

One supplement we commonly recommend because many of our patients are taking statin drugs. Statin drugs such as Crestor or Lipitor have a salutary effect reducing the incidence of strokes and heart attacks, but also seem to have an inhibitory effect on cancer growth. Since many of our patients are on statins and we know that these can deplete coenzyme q10 and create a deficiency state, we recommend that patients supplement their diets with coq10, 50-200 milligrams a day on a routine basis as long as they're continuing on their statin drugs. 

Certain anti-inflammatory supplements like turmeric or Zyflanend are often recommended to bring down PSA levels, and I think actually what's happening is that men that still have their prostates in place, many who are on active surveillance, notice their PSAs will bounce around and when they take Zyflanend or Tumeric, which has anti-inflammatory properties, their PSAs will come down, and this is, in my view, not an inhibitory effect on the cancer growth; it's an inhibition of the inflammation that many of us men harbor in our prostates chronically. So, you can see PSA impact from these anti-inflammatories and over-the-counter agents such as Advil or Aleve can accomplish the same thing—or Celebrex which is a prescription anti-inflammatory. So Zyflanend and turmeric seem to function in the same capacity as other anti-inflammatories. 

One supplement I hear patients talk about is arginine to help restore erectile function. I don't typically recommend it because the pharmacologic agents like Levitra, Viagra, and Cialis are so effective, but many patients report to me that arginine, which is also less expensive, can help restore normal erectile function. 

There are also a variety of supplements to help men with big prostates. Men with prostate cancer many times have benign prostatic hypertrophy and agents such as saw palmetto or stinging nettle and other such agents are used to ameliorate the symptoms that come along with urinary frequency at night, problems with urinary urgency. And these agents seem to have some benefit, again, there are other, more potent, FDA-approved pharmacologic agents which we tend to rely on more heavily. 

The same rule-of-thumb that we described for minerals, I think, also carries over for multivitamins. Multivitamins can give the necessary substrates for cellular production and replication. In other words, they could actually help cancer growth. So unless people have an actual deficiency, I'm not recommending that people take any routine multivitamin supplements when they have prostate cancer.

So in summary, supplements are very similar to pills or pharmacologic agents. They have a specific directed purpose. There's a lot of supplements for other things like memory and energy, and as we described in part one of the series, you need to evaluate how you are reacting to any potential supplement and do them one at a time to determine if it's effective. Give it 30 days, 60 days, and then reevaluate whether it's doing any good. In my experience, a lot of these supplements have relatively mild effects, in terms of side effects, and they also have relatively mild effects in terms of correcting problems. So I don't tend to go directly to supplements first when a problem needs to be solved, but the nice thing, of course, is they're widely available and accessible to all of you that want to try and experiment with different agents and that's certainly reasonable as long as you track your progress.