Complementary approaches and the limits of the evidence

Three words that are not synonyms

The National Center for Complementary and Integrative Health uses the words this way. A complementary approach is a non-mainstream practice used together with conventional care. An alternative approach is a non-mainstream practice used instead of conventional care. Integrative health tries to combine conventional and complementary care in a coordinated plan, with attention to the whole person.

Most people who use non-mainstream approaches also use conventional care. That pattern is safer than leaving an effective treatment in order to try an untested one. It is not automatically safe. Herbs and supplements can still interact with cancer medicines, blood thinners, and drugs used for urinary symptoms.

What counts as evidence-based medical care

For prostate conditions, evidence-based care means the evaluation and treatments a clinician offers because human studies and clinical guidelines support them for a defined situation. Examples include antibiotics for acute bacterial infection, prescription medicines or procedures for bothersome enlargement, and cancer treatment or surveillance chosen after a biopsy and a risk assessment. This page does not rank those options. The point is that they are medical decisions, with known benefits and known harms, made with someone who can follow the result.

A laboratory experiment or a story from one patient does not move a product into that category.

Complementary approaches

NCCIH groups complementary approaches as nutritional (herbs, vitamins, probiotics), psychological (such as mindfulness), physical (such as massage), or a combination (such as yoga or tai chi). Some of these have been studied for symptoms such as pain, fatigue, anxiety, or sleep in people with cancer or other illnesses. A possible effect on a symptom is not an effect on the cancer itself. Massage, for example, has been studied for short-term changes in pain and mood. That research is not a reason to delay a biopsy or to skip a prescribed cancer treatment.

If a cancer center offers acupuncture, meditation, or similar services during ordinary treatment, the useful questions are practical: What symptom is it for? What happened in studies of that symptom? Will it interfere with my medicines? Who is qualified to provide it? The National Cancer Institute’s prevention summary does not list these practices as proven ways to stop prostate cancer from starting.

Alternative approaches offered as a replacement

Products sold as a natural replacement for surgery, radiation, or prescription medicine fall into the alternative category when they are meant to take the place of that care. For prostate enlargement, saw palmetto is the best-known example. NCCIH concludes it is probably not helpful for those urinary symptoms. For cancer risk, selenium and vitamin E supplements failed the test they were given in SELECT, and vitamin E alone was associated with more prostate cancers. A seller who still describes those ingredients as protection is not describing that trial.

There is not enough evidence to call other popular prostate herbs effective. Absence of a large trial is not a quiet endorsement. It means a benefit has not been shown, and a harm may not have been looked for.

Safety questions to ask every time

• What is the exact ingredient and dose, and does the label match the study?
• Could this change a PSA result or interact with a prescribed drug?
• Is the product being offered instead of a test or treatment I still need?
• Who profits if I believe the claim?
• What side effects or quality problems has the FDA already reported for this type of product?

Bring the answer to your own clinician. A coordinated plan is possible only if every person on the plan knows what you are taking.