Prostate cancer is a cancerous (malignant) tumor that originates in the prostate gland and can eventually spread to other organs, bones, and tissues. The prostate is a cluster of small glands located beneath the bladder that surrounds the urethra, the tube that carries urine from the bladder out through the penis. Its principle function is to manufacture fluid that constitutes a portion of the semen.

Prostate cancer is the third most common cause of death from cancer in men of all ages and is the most common cause of death from cancer in men over 75 years old. Prostate cancer is rarely found in men younger than 40. Men at higher risk include African-America men older than 60, farmers, tire plant workers, painters, and men exposed to cadmium. The lowest number of cases occurs in Japanese men and those who do not eat meat (vegetarians).

Fortunately, prostate cancer tends to be slow-growing compared to many other cancers -- the majority of prostate cancers either do not spread or cause harm for decades.

Many people with prostate cancer experience no symptoms at all.

Some symptoms that may indicate prostate cancer include:

• Difficult and painful urination
• Frequent urination and a feeling that one has to urinate even when the bladder is empty
• Incomplete emptying of the bladder, which may lead to dribbling of urine
• Awakening frequently in the night to urinate
• Decreased force of urine stream
• Blood in the urine
• Hip and back pain

When the cancer has spread to other parts of the body, symptoms can include:

• Bone pain
• Weakness or paralysis caused by compression of the spinal cord
• Weight loss
• Anemia
• Kidney failure

The cause of prostate cancer is unknown, although some studies have shown a relationship between high dietary fat intake and increased testosterone levels.. The influence of genes on the development of prostate cancer is suggested by the fact that prostate cancer tends to occur in men who are related to one another (see Risk Factors section). In addition, researchers have identified a gene that is associated with 30% of family-related prostate cancers.

Reports also indicate that farmers as well as men who work in tire, rubber, and sheet metal factories tend to have high rates of prostate cancer or more aggressive forms of the cancer. Some researchers speculate that environmental exposure to cadmium (present in commercial fungicides) and other harmful substances may be responsible for the high rates of prostate cancer in these men.

Nutrition has been implicated in the development of prostate cancer because disease rates among men from countries with low prostate cancer rates (such as Japan) increase when they immigrate to the United States. This rise in incidence is thought to be due to the switch to a typical American diet, which is high in saturated fat. Elevated levels of male sex hormones, such as testosterone, may also play a role in the development of prostate cancer.

The following factors may increase a man's risk for prostate cancer:

• Older age -- prostate cancer is most common among men who are older than 55.
• Race -- African-Americans have a greater risk of developing prostate cancer than Caucasians who, in turn, have a greater risk than Native and Latin Americans.
• Family history of prostate cancer -- having a brother with prostate cancer makes a man 4.5 times more likely to develop the disease. Having a father with prostate cancer makes a man 2.3 times more likely to develop prostate cancer.
• High-fat diet -- foods rich in saturated fat may increase testosterone levels.
• Lack of exercise may increase the risk in those who eat a high-fat diet.
• Occupation -- people who are regularly exposed to the chemicals dimethyl formamide and acrylonitrate, and the metal cadmium (such as metal workers and farmers), have high rates of prostate cancer.

Two standard tests are used for early detection of prostate cancer:

• Digital rectal exam (DRE) -- in this test, the physician inserts a gloved, lubricated finger into the patient's rectum in order to feel the prostate for bumps or other abnormalities. Many malignant tumors originate in the outer part of the prostate where they may be detected by this exam. Some men find this test embarrassing, but the DRE is quick and relatively painless, and helps detect many prostate cancers. Although some tumors identified using DRE have already spread outside of the prostate gland, studies indicate that regular DREs still save lives.
• PSA test -- blood test measuring the level of prostate-specific antigen (PSA), a protein produced in the prostate gland that keeps semen in liquid form. Prostate cancer cells produce elevated quantities of PSA, so measuring PSA levels allows physicians to detect cancer while it is still microscopic. Unfortunately, the test is not accurate enough to definitively rule out or confirm cancer. For example, advancing age and benign conditions such as enlarged prostate can also elevate PSA levels.

If either the DRE or PSA test suggests the possible presence of cancer, the following tests will be performed to make a definite diagnosis:

• Transrectal Ultrasound -- a visual image of the prostate is obtained by using ultrasound.
• Biopsy of the prostate -- a tissue sample is obtained through the rectum and examined for cancerous cells under the microscope.

If the biopsy confirms the presence of cancer, several tests will be performed to detect any spread of the disease. This information gauges how serious the prostate cancer is at the time of diagnosis. Likely tests include the following:

• Imaging tests (CT and MRI) -- computerized tomography (CT) or magnetic resonance imaging (MRI) scans may pinpoint the location of cancer that has spread beyond the prostate.
• Bone scans and x-rays -- these techniques look for spread of cancer to the bones.
• Lymph node dissection -- this is part of a surgical procedure to determine if the cancer has spread to the lymphatic system.

Regular screening with the DRE and PSA exams by a doctor may help detect prostate cancer in the early stages, before it has spread. Both the American Cancer Society and the American Urological Association recommend that men between the ages of 50 - 70 should have annual DRE or PSA tests. African-American men or those with a family history of prostate cancer should begin screening at age 40.

Studies also suggest that the following lifestyle modifications may minimize the risk of prostate cancer:

• Consuming a low-fat diet, rich in fruits and vegetables
• Eating foods rich in selenium (such as brewer's yeast, wheat germ, chicken liver, nuts and seeds, tuna and herring) and vitamin E (such as wheat germ, organ meats, sweet potatoes, leafy vegetables including spinach, nuts and seeds, eggs, soybeans, and lima beans)
• Exercising regularly, because exercise temporarily lowers testosterone

Treatment for prostate cancer depends on the stage of the disease, the age of the individual, the presence of other medical conditions, and the man's preferences in conjunction with the physician's recommendations.

If prostate cancer is detected early, treatment usually involves either surgical removal of the prostate or radiation therapy. For more advanced cases of prostate cancer, or if cancer spreads beyond the prostate, hormone medications are the preferred treatment.

If the man is older than 70 and has only a slow-growing tumor, the physician may adopt a strategy called "watchful waiting," in which the man returns frequently for check-ups. Treatment occurs only if the man's condition worsens.

Dietary modifications may slow the growth of the cancer in men undergoing watchful waiting, as well as those who have had surgery or are being treated iwth with medication or radiation. For example, eating a low-fat diet, rich in fruits, vegetables, soy, selenium, and fiber has been associated with a decreased risk of prostate cancer.

Saw palmetto, a widely studied herb, appears to significantly reduce symptoms associated with benign prostatic hypertrophy (BPH) and may be used in prostate cancer, but only under the supervision of a doctor.

Acupuncture can relieve pain and the side effects of surgery while meditation and massage may reduce stress and anxiety associated with having prostate cancer.

Medications

Medications are considered the best therapy for people with advanced stages of prostate cancer or when cancer spreads from the prostate to other parts of the body. Drugs may also be prescribed prior to radiation therapy or when surgical procedures fail to lower PSA levels. Most medications for prostate cancer lower levels of male sex hormones (such as testosterone). Lowering testosterone levels can cause tumors to shrink or slow their growth.

Some commonly prescribed medications include:

• Luteinizing Hormone-Releasing Hormone (LH-RH) agonists (such as leuprolide, goserelin, and buserelin) -- LH-RH is natural hormone, released by the hypothalamus in the brain, that lowers the production of testosterone, and the medication encourages the release of this natural hormone. Side effects can include hot flashes, weight gain, development of male breast tissue, breast pain, and nausea.
• Hormones including antiandrogens (such as flutamide, bicalutamide, and nilutamide) and estrogens (such as diethylstilbestrol) -- these medications reduce testosterone levels, but side effects can include reduced sex drive, fatigue, nausea, impotence, diarrhea, and hot flashes.
• Chemotherapeutic medications (such as mitoxantrone and estramustine) -- improve symptoms in advanced cancer but do not increase life expectancy

Surgery and Other Procedures

• Removal of the prostate (prostatectomy) -- offers an excellent cure for men with prostate cancer that is completely confined to the prostate, and is performed if life expectancy is at least 10 years and cancer is confined to the prostate. Side effects include incontinence and impotence, but new procedures that spare nerves near the prostate preserve sexual function in 25 - 90 % of men.
• Surgical exploration of lymph nodes -- may be performed to evaluate whether prostate cancer has spread to the lymphatic system.
• Resection of the prostate (called TURP or transurethral resection of the prostate) -- removal of all or part of the prostate gland to eliminate cancer and to relieve obstruction of urine.
• Removal of the testes (orchiectomy) -- lowers testosterone levels, but side effects can include impotence and hot flashes.

In addition to these surgical procedures, radiation therapy may be effective for cancer confined to the prostate, particularly for older men. Radiation can be administered through an external source, or irradiated seeds can be placed internally near the prostate. Using irradiated seeds actually lowers the risk of damage to organs surrounding the prostate from radiation because administration can be more precise in both amount and location. Side effects can include proctitis (inflammation of the lining of the rectum), urinary tract infections, and impotence.

Nutrition and Dietary Supplements

A comprehensive treatment plan for support of the health of men living with prostate cancer may include a range of complementary and alternative therapies. Preliminary studies suggest that nutritional supplements may reduce the symptoms of some prostate cancer. Ask your team of health care providers about the best ways to incorporate these therapies into your overall treatment plan. Always tell your health care provider about the herbs and supplements you are using or considering using.

Following these nutritional tips may help reduce symptoms:

• Eat foods high in B-vitamins and calcium, such as almonds, beans, whole grains (if no allergy), dark leafy greens (such as spinach and kale), and sea vegetables. A study found that men who consumed 28 or more servings of vegetables per week were 35% less likely to develop prostate cancer than those who had less than 14 servings per week.
• Eat antioxidant foods, including fruits (such as blueberries, cherries, and tomatoes) and vegetables (such as squash and bell peppers).
• Avoid refined foods, such as white breads, pastas, and especially sugar.
• Quality protein sources, such as organic meat and eggs, whey, and vegetable protein shakes, may be used as part of balanced program aimed at gaining muscle and preventing weight loss that can sometimes be a side effect of cancer therapy. Try to eat fewer red meats and more lean meats such as chicken and fish, tofu (soy, if no allergy), or beans for protein.
• Eat cruciferous vegetables (such as broccoli, cabbage, and cauliflower) -- they contain special cancer fighting chemicals.
• Use healthy oils in foods, such as olive oil or vegetable oil.
• Reduce or eliminate trans-fatty acids, found in commercially baked goods such as cookies, crackers, cakes, French fries, onion rings, donuts, processed foods, and margarine.
• Avoid coffee and other stimulants, alcohol, and tobacco.
• Drink 6 - 8 glasses of filtered water daily.
• Exercise at least 30 minutes daily, 5 days a week.

You may address nutritional deficiencies with the following supplements:

• A daily multivitamin, containing the antioxidant vitamins A, C, E, the B-complex vitamins, and trace minerals such as magnesium, calcium, and selenium.
• Calcium D-glucarate, 200 - 400 mg daily, for support of immunity and anticancer effects.
• Omega-3 fatty acids, such as fish oil, 1 - 2 capsules or 1 - 3 tablespoonfuls oil, one to three times daily, to help decrease inflammation and help with immunity. Cold-water fish, such as salmon or halibut, are good sources but not substitutes for supplementation.
• Whey protein, 10 - 20 grams daily mixed in favorite beverage, when needed as a protein supplement for support of immunity and weight gain; or creatine, 5 - 7 grams daily, when needed for muscle weakness and wasting. Talk with your health care provider.
• N-acetyl cysteine, 200 mg one to three times daily, for antioxidant effects.
• Probiotic supplement (containing Lactobacillus acidophilus among other strains), 5 - 10 billion CFUs (colony forming units) a day, when needed for maintenance of gastrointestinal and immune health. You should refrigerate your probiotic supplements for best results.
• Astaxanthin, 2 - 6 mg daily, for immune and antioxidant support.
• Coenzyme Q10, 100 - 200 mg at bedtime, for antioxidant and immune activity.
• Vitamin C, 500 - 1,000 mg one to three times daily, as an antioxidant and for immune support. Some doctors will use higher doses in alternative cancer therapies. Check with your health care provider.
• Lycopene, 5 mg one to three times daily, for antioxidant and anticancer activity. In a large study, lycopene levels were significantly lower in those with prostate cancer compared to those without.
• L-glutamine, 500 - 1,000 mg three times daily, for support of gastrointestinal health and immunity.
• Melatonin, 2 - 5 mg one hour before bedtime, for sleep and immune protection. Ask your health care provider about potential drug interactions with the use of melatonin.

Herbs

Herbs are generally a safe way to strengthen and tone the body's systems. As with any therapy, you should work with your health care provider to get your problem diagnosed before starting any treatment. You may use herbs as dried extracts (capsules, powders, teas), glycerites (glycerine extracts), or tinctures (alcohol extracts). Unless otherwise indicated, you should make teas with 1 tsp. herb per cup of hot water. Steep covered 5 - 10 minutes for leaf or flowers, and 10 - 20 minutes for roots. Drink 2 - 4 cups per day.

• Green tea (Camellia sinensis) standardized extract, 250 - 500 mg daily, for antioxidant, anti-inflammatory and immune effects. Use caffeine-free products. You may also prepare teas from the leaf of this herb.
• Saw palmetto (Serenoa repens) standardized extract, 160 mg two times daily, for hormonal support. There has been some concern that saw palmetto could mask prostate cancer by lowering prostate-specific antigen (PSA) levels. However, a randomized study of more than 1,000 patients did not demonstrate this effect on PSA levels. Talk to your health care provider about using saw palmetto for your condition.
• Fermented wheat germ extract, 1 packet dissolved in favorite beverage once daily, for anticancer and immune effects. Ask your health care provider for more about this supplement.
• Bitter Melon (Momordica charantia) standardized extract, 200 mg two to three times daily, for anticancer and immune support.
• Maitake mushroom (Grifola frondosa) standardized extract (D-fraction), 600 mg twice daily, for immune and antiviral effects. You may also take a tincture of this mushroom extract, 30 - 60 drops two to three times a day.
• Garlic (Allium sativum), standardized extract, 400 mg two to three times daily, for antibacterial or antifungal and immune activity.

Acupuncture

Acupuncture may provide relief from side effects of orchiectomy (removal of the testes). Studies also support the use of acupuncture for the pain that often occurs when cancer has spread beyond the prostate (particularly to the bones). A National Institutes of Health statement released in 1997 also supports the use of acupuncture to alleviate nausea associated with chemotherapy.

Evidence suggests acupuncture can be a valuable therapy for cancer-related symptoms (particularly nausea and vomiting that often accompanies chemotherapy treatment). Studies have also indicated that acupuncture may help reduce pain and shortness of breath. Acupressure (pressing on rather than needling acupuncture points) has also proved useful in controlling breathlessness and is a technique that patients can learn and then use to treat themselves.

Massage and Physical Therapy

Studies suggest that massage reduces stress and boosts immune function, so it may help relieve anxiety for men undergoing treatment for prostate cancer.

Pelvic floor exercises -- the repetitive use of muscles that start and stop the flow of urine -- may help decrease incontinence caused by prostatectomy (removal of the prostate). This therapeutic approach is often combined with biofeedback.

Mind-Body Medicine

Meditation

Meditation may benefit men with prostate cancer by helping them to reduce stress, ease anxiety, and regain a sense of self-control.

Biofeedback and Pelvic Muscle Training (PMT)

Several studies have found that learning to start and stop the flow of urine by repeatedly using the muscles of the pelvis (PMT) in combination with biofeedback can reduce the duration of incontinence after prostate cancer surgery. Other studies suggest however, that PMT alone, with or without biofeedback, is responsible for the beneficial effects. Either way, both PMT and biofeedback are safe, noninvasive therapies that may benefit men who suffer from incontinence following either surgical removal of the prostate or other treatments for prostate cancer.

Prognosis and Complications

Most complications from prostate cancer result from specific treatments. These include:

• Prostatectomy -- can cause incontinence and impotence
• Radiation therapy -- can cause proctitis (inflammation of the lining of the rectum), bladder infections, and impotence
• Hormone medications -- can cause loss of libido, impotence, hot flashes, excessive development of male breasts, and tenderness in male breast tissue
• Removal of testes -- can cause impotence and hot flashes

The outlook for a man with prostate cancer depends on his age, the stage of tumor growth, whether he has any underlying medical illnesses, and his PSA levels. The prognosis for men with cancer that has not spread beyond the prostate is quite good. Most of these cancers are curable with appropriate treatment, and after 15 years the same number of these men will be alive as those who never had prostate cancer. If the cancer spreads beyond the prostate and does not respond to hormone medications, however, there is little hope for a cure. Still, prostate tumors are slow-growing, and even men with advanced prostate cancer can survive for 5 years or more.

Alimi D, Rubino C, Leandri EP, Brule SF. Analgesic effects of auricular acupuncture for cancer pain [letter]. J Pain Symptom Manage. 2000;19(2):81-82.

Aronson WJ, Glaspy JA, Reddy ST, Reese D, Heber D, Bagga D. Modulation of omega-3/omega-6 polyunsaturated ratios with dietary fish oils in men with prostate cancer. Urology. 2001;58(2):283-288.

Bairati I, Meyer F, Fradet Y, Moore L. Dietary fat and advanced prostate cancer. J Urol. 1998;159:1271-1275.

Bales GT, Gerber GS, Minor TX, et al. Effect of preoperative biofeedback/pelvic floor training on continence in men undergoing radical prostatectomy. Urology. 2000;56(4):627-630.

Cabrera C, Artacho R, Gimenez R. Beneficial effects of green tea -- a review. J Am Coll Nutr. 2006;25(2):79-99.

Chan JM, Giovannucci E, Andresson SO, Yuen J, Adami HO, Wolk A. Dairy products, calcium, phosphorous, vitamin D, and risk of prostate cancer (Sweden). Cancer Causes Control. 1998;9(6):559-566.

Clark LC, Combs GF, Turnbull BW, et al. Effects of selenium supplementation for cancer prevention in patients with carcinoma of the skin. A randomized controlled trial. Nutritional Prevention of Cancer Study Group. JAMA. 1996;276(24):1957-63.

Cohen JH, Kristal AR, Stanford JL. Fruit and vegetable intakes and prostate cancer risk. J Nat Can Inst. 2000;92(1):61-68.

Coker KH. Meditation and prostate cancer: Integrating a mind/body intervention with traditional therapies. Sem Urol Oncol. 1999;17(2):111-118.

Cook NR, Stampfer MJ, Ma J, et al. Beta-carotene supplementation for patients with low baseline levels and decreased risks of total and prostate carcinoma. Cancer. 1999;86(9):1783-1792.

Doron S, Gorbach SL. Probiotics: their role in the treatment and prevention of disease. Expert Rev Anti Infect Ther. 2006;4(2):261-75.

Ezzo J, Berman B, Hadhazy VA, Jadad AR, Lao L, Singh BB. Is acupuncture effective for the treatment of chronic pain? A systematic review. Pain. 2000;86:217-225.

Filshie J, Penn K, Ashley S, Davis CL. Acupuncture for the relief of cancer-related breathlessness. Palliat Med. 1998;10:145-150.

Fleshner NE, Klotz LH. Diet, androgens, oxidative stress and prostate cancer susceptibility. Cancer and Metastasis Reviews. 1999;17:325-330.

Franke JJ, Gilbert WB, Grier J, Koch MO, Shyr Y, Smith JA. Early post-prostatectomy pelvic floor biofeedback. J Urol. 2000;163:191-193.

Fraschini F, Demartini G, Esposti D, Scaglione F. Melatonin involvement in immunity and cancer. Biol Signals Recept. 1998;7(1):61-72.

Freeman VL, Meydani M, Yong S, Pyle J, Flanigan RC, Waters WB, Wojcik EM. Prostatic levels of fatty acids and the histopathology of localized prostate cancer. J Urol. 2000;164(6):2168-2172.

Gann PH, Ma J, Giovannucci E, et al. Lower prostate cancer risk in men with elevated plasma lycopene levels: results of a prospective analysis. Cancer Research. 1999;59:1225-1230.

Giovannucci E, Rimm EB, Wolk A, et al. Calcium and fructose intake in relation to risk of prostate cancer. Cancer Res. 1998;58(3):442-447.

Giovannucci E, Ascherio A, Rimm EB, Stampfer MJ, Colditz GA, Willett WC. Intake of carotenoids and retinol in relation to risk of prostate cancer. J Natl Cancer Inst. 1995;87(23):1767-1776.

Grant WB. An ecologic study of dietary links to prostate cancer. Altern Med Rev. 1999;4(3):162-169.

Hammar M, Frisk J, Grimas O, Hook M, Spetz AC, Wyon Y. Acupuncture treatment of vasomotor symptoms in men with prostatic carcinoma: A pilot study. J Urol. 1999;161:853-856.

Hayes RB, Ziegler RG, Gridley G, et al. Dietary factors and risks for prostate cancer among blacks and whites in the United States. Cancer Epidemiol Biomarkers Prev. 1999;8(1):25-34.

Helzlsouer KJ, Huang HY, Alberg AJ, et al. Association between alpha-tocopherol, gamma-tocopherol, selenium and subsequent prostate cancer. J Natl Cancer Inst. 2000:92(24):2018-2023.

Hirsch IH. Integrative urology: a spectrum of complementary and alternative therapy. Urology. 2000:56:185-189.

Jackson J, Emerson L, Johnston B, Wilson J, Morales A. Biofeedback: a noninvasive treatment for incontinence after radical prostatectomy. Urol Nurs. 1996:16(2):50-54.

Kelly GS. Clinical applications of N-acetylcysteine. Altern Med Rev. 1998;3(2):114-127.

Kolonel LN, Nomura AM, Cooney RV. Dietary fat and prostate cancer: Current Status. JNatl Cancer Inst. 1999;91(5):414-428.

LaValle JB, Krinsky DL, Hawkins EB, et al. Natural Therapeutics Pocket Guide. Hudson, OH:LexiComp; 2000: 452-454.

Lee M, Paffenbarger RS, Hsieh CC. Physical activity and risk of prostate cancer among college alumni. Am J of Epidemiology. 1992;135(2):169-179.

Lissoni P, Cazzaniga M, Tancini G, Scardino E, Musci R, Barni S, Maffezzini M, Meroni T, Rocco F, Conti A, Maestroni G. Reversal of clinical resistance to LHRH analogue in metastatic prostate cancer by the pineal hormone melatonin: efficacy of LHRH analogue plus melatonin in patients progressing on LHRH analogue alone. Eur Urol. 1997;31(2):178-181.

Lokeshwar BL, Schwartz GG, Selzer MG, et al. Inhibition of prostate cancer metastasis in vivo: a comparison of ,23-dihydroxyvitamin D (calcitriol) and EB1089. Cancer Epidemiol Biomarkers Rev. 1999;8(3):241-248.

Lyn-Cook BD, Rogers T, Yan Y, Blann EB, Kadlubar FF, Hammons GJ. Chemopreventive effects of tea extracts and various components on human pancreatic and prostate tumor cells in vitro. Nutr Cancer. 1999;35(1):80-86.

Maa SH, Gauthier D, Turner M. Acupressure as an adjunct to a pulmonary rehabilitation program. J Cardiopulm Rehabil. 1997;17(4):268-276.

Massion AO, Teas J, Hebert JR, Wertheimer MD, Kabat-Zinn J. Meditation, melatonin and breast/prostate cancer: hypothesis and preliminary data. Med Hypo. 1995;44:39-46.

Mathewson-Chapman M. Pelvic Muscle Exercise/Biofeedback for urinary incontinence after prostatectomy. J Cancer Educ. 1997:12(4):218-223.

Moore KN, Cody DJ, Glazener CMA. Conservative management for post prostatectomy incontinence (Cochrane Review). In: The Cochrane Library, Issue 4, 2000.

Moretti RM, Marelli MM, Maggi R, Dondi D, Motta M, Limonta P. Antiproliferative action of melatonin on human prostate cancer LNCaP cells. Oncol Rep. 2000;7(2):347-351.

Moyad M. Soy, disease prevention, and prostate cancer. Sem Urol Oncol. 1999;17(2):97-102.

Moyad MA, Hathaway S, Ni HS. Traditional Chinese medicine, acupuncture, and other alternative medicines for prostate cancer: an introduction and the need for more research. Sem Urol Oncol. 1999;17(2):103-110.

Nelson MA, Porterfield BW, Jacobs ET, Clark LC. Selenium and prostate cancer prevention. Sem Urol Oncol. 1999;17(2):91-96.

Neri B, de Leonardis V, Gemelli MT, di Loro F, Mottola A, Ponchietti R, Raugei A, Cini G. Melatonin as biological response modifier in cancer patients. Anticancer Res. 1998;18(2B):1329-1332.

Newcomer LM, King IB, Wicklund KG, Stanford JL. The association of fatty acids with prostate cancer risk. Prostate. 2001;47(4):262-268.

Pan CX, Morrison RS, Ness J, Fugh-Berman A, Leipzig RM. Complementary and alternative medicine in the management of pain, dyspnea, and nausea and vomiting near the end of life: a systematic review. J Pain Symptom Manage. 2000;20(5):374-387.

Rotsein OD. Oxidants and antioxidant therapy. Crit Care Clin. 2001;17(1):239-47.

Sellick SM, Zaza C. Critical review of five nonpharmacologic strategies for managing cancer pain. Cancer Prev Control. 1998;2(1):7-14.

Shen J, Wenger N, Glaspy J, et al. Electroacupuncture for control of myeloablative chemotherapy-induced emesis. JAMA. 2000;284(21):2755-2761.

Slater S, Oliver RT. Testosterone: its role in development of prostate cancer and potential risk from use as hormonal replacement therapy. Drugs Aging. 2000;17(6):431-439.

Small EJ, Frohlich MW, Bok R, et al. A prospective trial of the herbal supplement PC-SPES in patients with progressive prostate cancer. J Clin Oncol. 2000;18(21):3595-3603.

Tariq N, Jenkins D, Vidgen E, et al. Effect of soluble and insoluble fiber diets on serum prostate specific antigen in men. J Urol. 2000;163:114-118.

Terry P, Lichtenstein P, Feychting M, Ahlbom A, Wolk A. Fatty fish consumption and risk of prostate cancer. Lancet. 2001;357(9270):1764-1766.

Tymchuk CN, Tessler SB, Aronson WJ, Barnard RJ. Effects of diet and exercise on insulin, sex hormone-binding globulin, and prostate-specific antigen. Nutr Cancer. 1998;31(2):127-131.

Van Kampen M, De Weerdt W, Van Poppel H, De Ridder D, Feys H, Baert L. Effect of pelvic-floor re-education on duration and degree of incontinence after radical prostatectomy: a randomized controlled trial. Lancet. 2000;355:98-102.

Vickers AJ. Can acupuncture have specific effects on health? A systematic review of acupuncture antiemesis trials. J R Soc Med. 1996;89:303-311.

Walaszek Z, Szemraj J, Narog M. Metabolism, uptake, and excretion of a D-glucaric acid salt and its potential use in cancer prevention. Cancer Detect Prev 1997;21:178-90.

Wang HK. The therapeutic potential of flavonoids. Expert Opin Investig Drugs. 2000;9(9):2103-19.

Xing N, Chen Y, Mitchell SH, Young CY. Quercetin inhibits the expression and function of the androgen receptor in LNCaP prostate cancer cells. Carcinogenesis. 2001;22(3):409-414.

Zhou JR, Gugger ET, Tanaka T, Guo Y, Blackburn GL, Clinton SK. Soybean phytochemicals inhibit the growth of transplantable human prostate carcinoma and tumor angiogenesis in mice. J Nutr. 1999;129:1628-1635.