Vitamin E Protects Against Prostate Cancer, and More
Different forms of this vitamin are found to be important for optimal health
By Dr. Edward R. Rosick

ancer. This may be the single most feared word by most Americans. Unlike some overhyped fears, the fear of cancer is, unfortunately, well grounded in reality. In today's world of high-tech medicine, we no longer have to fear the common killers of our grandparents, such as smallpox, measles, and tuberculosis. Those diseases, like many other infections, have been either wiped out or made almost irrelevant by vaccines and antibiotics. The incidence of many forms of cancer, however, has stayed stubbornly constant, or even increased, despite many billions of dollars spent on the so-called war against cancer.

Many people argue that we are losing this war because far more money is spent on treatments (which often produce side effects worse than the cancer itself) than on prevention. Yet, despite the reluctance of mainstream medicine to embrace preventive measures against cancer, researchers have shown that certain supplements, such as vitamin E, may indeed protect against many cancers, including cancer of the prostate gland.

Prostate - A Jewel That Can Turn Deadly

The prostate, a small, walnut-sized gland located between the bladder and the rectum, secretes a fluid that nourishes and carries sperm during orgasm. It also converts the male sex hormone testosterone into a more powerful form called dihydrotestosterone. Of the 200,000 men in this country who are diagnosed with prostate cancer every year, over 37,000 will succumb to it. Prostate cancer is so prevalent that it's the second leading cancer killer of men, just behind lung cancer. Certain habits that are still all too common in America, including smoking cigarettes and eating fatty foods, are thought to contribute to the development of this disease.

Although prostate cancer can be cured if caught early, most cases are quite advanced by the time a diagnosis is made, because the disease has practically no symptoms in the early stages. As it attacks more and more of the prostate, however, symptoms such as frequent urination, pain or burning during urination, and even blood in the urine can occur. Unfortunately, by the time many men notice these problems, the cancer has spread beyond the prostate gland, making it much more difficult to treat.

Benign Prostatic Hyperplasia Does Not Lead to Cancer

Another problem posed by prostate cancer is that it is often mistaken for benign prostatic hyperplasia, or BPH (the H can also stand for hypertrophy).* In BPH, the prostate, for reasons not yet known, starts to grow larger. As the name of the condition implies, however, the enlargement is nonmalignant. This malady can start affecting men in their 40s, although it is more commonly seen in men in their 50s or older. It becomes increasingly prevalent with age and is virtually universal in men in their 90s.


*Hyperplasia refers to an increase in the number of prostate cells; hypertrophy refers to an increase in the size of the existing cells. Whichever it is in a given case, the result is an abnormal enlargement of the prostate.


The symptoms of BPH are often similar, or even identical, to those of prostate cancer, and this leads, understandably, to a great deal of worry in men who have the condition. The good news, however (if there can be any good news about BPH), is that most researchers believe BPH and prostate cancer are not linked. In BPH, the inner cells of the gland seem to be the ones that grow larger in number or in size, whereas in prostate cancer, it appears that it's the cells in the outer portion of the gland that start proliferating in an unregulated fashion.

Can Annual Testing Detect Prostate Cancer?

If there's one silver lining in prostate cancer, it is that, in most cases (especially when compared to some other cancers), it's relatively slow-growing. This is good news, because early detection of the cancer can help prevent its spread to other parts of the body.

Two tests that doctors often use to help them detect prostate cancer in its early stages are the digital rectal exam (DRE) and the prostate-specific antigen (PSA) test. In the DRE, a doctor inserts his finger (gloved, of course!) into a man's rectum to feel the prostate. Most cancers of the prostate proliferate on the back part of the gland, so the doctor can check for bumps or other abnormalities that might be signs of cancer. Although the DRE is not a very reliable procedure, missing between 40 and 60% of all prostate cancers, most physicians still recommend that men 50 years or older have a DRE annually.1

The PSA test is a blood test that checks the levels of PSA, a protein normally produced in small amounts in the prostate to keep semen in liquid form. Normally PSA levels are below 4. Men whose levels are between 4 and 10 are thought to have a 25% chance of having prostate cancer. PSA levels greater than 10 are thought to indicate a 65% (or greater) chance of having the disease.


Only recently has mainstream
medicine begun to embrace the
idea that vitamin E supple-
mentation may play a pivotal role
in preventing prostate cancer.


While the PSA test has made it easier for physicians to detect early cases of prostate cancer, it is far from perfect: it's thought that approximately 65% of men who have PSA levels that are suspicious for prostate cancer do not, in fact, have the disease, since other noncancerous conditions of the prostate, such as BPH, can cause elevated PSA levels.1 Ultimately, the best way to diagnose prostate cancer is by biopsy of a tissue sample.

The Dark Side of Prostate Cancer Treatment

Even when prostate cancer is caught in the early stages, the treatments can cause multiple and significant side effects. For localized prostate cancer, the two main conventional options are surgery to remove the prostate gland, or high-dose radiation to destroy it. With both procedures, common side effects include urinary incontinence (inability to control the flow of urine) and impotence (inability to achieve an erection).

For cancer that is more advanced, the recommended treatment is with drugs called antiandrogens, which suppress the levels of androgenic (male) hormones, such as testosterone. These drugs are used because prostate cancer cells seem to grow even faster in the presence of androgens. By inhibiting the production of androgens, doctors can decelerate the cancer's growth. Hydroxyflutamide, an antiandrogen commonly used in prostate cancer, can cause numerous debilitating side effects, including loss of sexual function, loss of muscle mass, fatigue, depression, and liver damage.

Vitamin E Also Benefits Your Heart, Eyes, and Brain

The list of benefits of vitamin E supplementation keeps growing. Besides its positive effects on prostate health, new studies are showing that vitamin E may also help prevent heart disease and cataracts, and even protect against Alzheimer's disease.

Coronary heart disease, or CHD, is the number one killer of both men and women in this country today. Scientists believe that one of the contributing factors to this disease is the oxidation of LDL, or "bad cholesterol." When LDL is oxidized, it tends to form plaque deposits that obstruct the coronary arteries (among others). Supplementation with antioxidant vitamin E, however, inhibits this process, thus helping to prevent CHD.

Cataracts have long been thought to be an inevitable, unfortunate consequence of growing old. If the eye is thought of as a camera, then a cataract can be thought of as a dirty lens - and if there's dirt on the lens, you can't take good pictures. Some preliminary studies are now showing that people who take vitamin E supplements are less susceptible to cataract formation than those who do not.

Losing one's mind is probably an even more terrifying prospect then losing one's vision. Alzheimer's disease steals the memories and minds of millions of older Americans each year. While pharmaceutical companies are pouring hundreds of millions of dollars into the search for a cure, there is growing evidence that supplementation with vitamin E may protect people from this dreadful disease.

A study published recently in the Journal of the American Medical Association showed that people who consumed foods rich in vitamin E were significantly less likely to develop Alzheimer's disease later in life than people who did not.1 Although this study did not include people who took vitamin E supplements, earlier studies have shown that daily supplementation with vitamin E may very well be a potent protector against Alzheimer's disease.

  1. Morris MC, Evans DA, Bienias JL, et al. Dietary intake of antioxidant nutrients and the risk of incident Alzheimer disease in a biracial community study. JAMA 2002;287:3230-7.

Vitamin E - A Powerful Agent Against Prostate Cancer

Despite all the bad news about prostate cancer and its treatment, there is encouraging news about the benefits that can come from taking vitamin E supplements. Vitamin E, which exists in eight chemically similar forms (four tocopherols and four tocotrienols), is a potent antioxidant that has long been known in the alternative medicine world as an integral part of cancer prevention. Only recently, however, has mainstream medicine begun to embrace the idea, albeit slowly, that vitamin E supplementation may play a pivotal role in preventing prostate cancer.

One of the first large-scale studies (over 29,000 men were involved) to show the significant impact that vitamin E can have on the development of prostate cancer was the Finnish Alpha-Tocopherol, Beta-Carotene Cancer Prevention Study, called the ATBC study for short.2 Alpha-tocopherol is the most potent form of vitamin E, and beta-carotene is a precursor of vitamin A. The study was originally designed to see if these compounds could help prevent lung cancer. Unfortunately, neither AT nor BC was shown in this study to do so. In analyzing the data, however, the researchers found that daily supplementation with 50 mg of alpha-tocopherol decreased the incidence of prostate cancer by 32% and reduced the mortality from prostate cancer by 41%.

Because of the ATBC study's unexpected but impressive results, further research has been done on how alpha-tocopherol might work against prostate cancer. In 2000, scientists at the University of Utah examined the effects of this vitamin on human prostate cancer cells.3 They showed that adding it to these cells in the laboratory caused them to fragment and die.

Gamma-Tocopherol - A Sleeper?

While alpha-tocopherol has been the most widely studied form of vitamin E, other forms are also showing promise in the fight against prostate cancer. A report published recently in the American Journal of Clinical Nutrition examined the importance of gamma-tocopherol in our diet.4 The authors concluded that "Results from recent epidemiologic studies suggest a potential protective effect of gamma-tocopherol against cardiovascular disease and prostate cancer. . . . We propose that, although alpha-tocopherol is certainly a very important, if not the most important, component of vitamin E, gamma-tocopherol may contribute significantly to human health in ways that have not yet been recognized."

Both Alpha and Gamma Forms of Vitamin E Are Potent

Another recent study, at The Johns Hopkins University School of Hygiene and Public Health, examined the association between different forms of vitamin E - including alpha-tocopherol and the closely related gamma-tocopherol - and the development of prostate cancer.5 The study also included the mineral selenium, a potent antioxidant in its own right, because earlier studies had shown that selenomethionine, a selenium-containing organic compound, was a potent inhibitor of prostate cancer cells.6

In the Johns Hopkins study, 10,456 men were followed over an 8-year period, during which 145 of them developed prostate cancer. Of these 145 men, 117 were then compared to 233 very similar men in the study who had not developed the disease. Blood samples were examined for levels of alpha- and gamma-tocopherols, and selenium levels were measured as well.


". . . gamma-tocopherol may
contribute significantly to
human health in ways that have
not yet been recognized."


The results were promising in terms of using vitamin E for the prevention of prostate cancer. Blood levels of both alpha- and gamma-tocopherols were found to be lower in men who developed prostate cancer then in men who did not. As stated in the article, "The risk of prostate cancer was lower among men with higher concentrations of alpha-tocopherol, gamma-tocopherol, and selenium." Interestingly, the strongest association was found with gamma-tocopherol.

It's important to note that two earlier studies looking at the association between gamma-tocopherol and prostate cancer did not produce these results. While further research is therefore needed on the effects of different forms of vitamin E on prostate cancer, an editorial in the Journal of the National Cancer Institute, commenting on the above research, noted that "There are now a number of compounds . . . for which there are varying degrees of evidence - none definitive - for protection against prostate cancer. These include selenium, alpha-tocopherol, gamma-tocopherol, and lycopene."7

How to Keep Prostate Cancer at Bay

About 200,000 men will be diagnosed with prostate cancer this year. Many thousands of them will have prostate surgery or take medications that could leave them incontinent, impotent, and depressed. However, by not smoking, eating less of the wrong kinds of fat, and taking supplements that contain both alpha- and gamma-tocopherols along with selenomethionine and lycopene, men can optimize their chances of leading a long and happy life, free of the specter of prostate cancer, and with their private parts functioning as nature intended.

References

  1. Canadian Task Force on Preventive Health Care. Screening for Prostate Cancer. www.ctfphc.org.
  2. Heinonen OP, Albanes D, Virtamo J, et al. Prostate cancer and supplementation with alpha-tocopherol and beta-carotene: incidence and mortality in a controlled trial. J Natl Cancer Inst 1998;90(6):440-6.
  3. Gunawardena K, Murray DK, Meikle AW. Vitamin E and other antioxidants inhibit human prostate cancer cells through apoptosis. Prostate 2000;44(4):287-95.
  4. Jiang Q, Christen S, Shigenaga MK, Ames BN. Gamma-tocopherol, the major form of vitamin E in the US diet, deserves more attention. Am J Clin Nutr 2001;74:714-22.
  5. 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):2018-23.
  6. Redman C. Inhibitory effect of selenomethionine on the growth of three selected human tumor cell lines. Cancer Lett 1998;125(1-2):103-10.
  7. Giovannucci, E. Gamma-tocopherol: a new player in prostate cancer prevention? J Natl Cancer Inst 2000;92(24):1966-7.


Dr. Rosick is an attending physician and clinical assistant professor of medicine at Pennsylvania State University, where he specializes in preventive and alternative medicine. He also holds a master's degree in healthcare administration.

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