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Clinical Observation |

The Effect of Herbal Medications on Thyroid Hormone Economy and Estrogen-Sensitive Hepatic Proteins in a Patient With Prostate Cancer

Lavanya Viswanathan, MD; Robert A. Vigersky, MD
Arch Intern Med. 2012;172(1):58-60. doi:10.1001/archinternmed.2011.596.
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Nonprescription drugs such as PC-SPES (Botanic Lab) (PC, abbreviation for prostate cancer; SPES, Latin for hope)—an herbal therapy for prostate cancer—are part of the complementary and alternative medicine (CAM) approach to health. PC-SPES was removed from the US market in 2002 owing to contamination with indomethacin, diethylstilbestrol, and warfarin.1 Yet it and similar preparations remain widely used because they are available online. Their clinical effect on nonprostatic, hormonally responsive systems has not been studied.

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The American Medical Association is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. The AMA designates this journal-based CME activity for a maximum of 1 AMA PRA Category 1 CreditTM per course. Physicians should claim only the credit commensurate with the extent of their participation in the activity. Physicians who complete the CME course and score at least 80% correct on the quiz are eligible for AMA PRA Category 1 CreditTM.
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Inaccurate herbal product descriptions
Posted on January 17, 2012
Wendy L. Applequist, PhD
Missouri Botanical Garden Send reply
Conflict of Interest: None Declared
This article may lead to the impression that GCP and Zyflamend ("all of these products that affected his PSA...") contain saw palmetto and Panax pseudoginseng. The eTable intended to provide more accurate information contains inaccuracies, at least for Zyflamend. It states that Zyflamend contains the fungus Ganoderma lucidum; omits seven ingredients, including some (turmeric, ginger, green tea) with well-demonstrated anti-cancer activities; and lists marker compounds present in two listed botanicals (resveratrol and wogonin, of which only 0.08 mg is present) as if they were separately added ingredients. It also lists "rhizome" as a separate ingredient, whereas this term references a type of plant organ. Zyflamend is a mixture of anti-inflammatory botanicals that contains no species commonly used for prostate disorders, yet it has been reported to reduce PSA levels in about half of subjects at increased risk of prostate cancer (1). By contrast, saw palmetto, used alone, has repeatedly been reported not to affect PSA levels. It seems premature to conclude that saw palmetto and Panax pseudoginseng are "the 2 key components of PC-SPES" merely because one patient had modestly reduced PSA levels during a relatively brief period in which he took a product, PC Plus, that had only those two ingredients in common with PC-SPES. The evidence does indicate that one of those two plants is likely to be responsible for the other idiosyncratic metabolic effects (elevation of TSH, HDL-C, etc.) reported for this person. The probably more interesting question of which ingredients in the last-used combination of supplements are responsible for the very impressive long-term suppression of PSA levels has not been answered. (1) Capodice JL, Gorroochurn P, Cammack AS, et al. Zyflamend in men with high-grade prostatic intraepithelial neoplasia: results of a phase I clinical trial. J Soc Integr Oncol 2009;7(2):43-51.
Conflict of Interest: None declared
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