Abstract
Introduction. Products that advertise “prostate health” are readily available at most major supplement and vitamin shops. The SELECT trial, SELenium and vitamin E Cancer prevention Trial, showed that men who were supplemented with vitamin E and selenium faced a higher risk of developing prostate cancer. We opted to look at nationally available products from major retailers that advertised prostate health to determine if they could potentially cause harm by inclusion of selenium and/or vitamin E. Methods. We collected data from national retailers including Vitamin Shoppe, General Nutrition Corporation (GNC), that sell vitamins and supplements. Any product that advertised terms such as “prostate health” or “prostate cancer prevention” or similar were analyzed. In total, 97 products were assessed. The ingredients were analyzed to see if the product contained selenium or vitamin E. The remaining ingredients were also recorded. Results. Of all the products, 17% contained both selenium and vitamin E, 36% had selenium without vitamin E, and 16% had vitamin E without selenium. Overall, more than 50% contained selenium. Of the products containing selenium, 35% had 200 µg daily; the amount used in the SELECT trial. Of the products containing vitamin E, none had the 400 IU used in the SELECT trial. The most common ingredient used in the nationally available supplements advertised for prostate health was saw palmetto, with 85% containing this ingredient. Conclusion. Nearly one fifth of all products advertised for prostate health contained both selenium and vitamin E, although vitamin E was at levels lower than used in the SELECT trial. Selenium was, however, much more common and often at the doses per the SELECT trial. These data do not take into account other supplements and vitamins that people may be taking that also contain these ingredients. According to results from the SELECT trial, products that contain selenium and vitamin E should not be used for prostate health. Patients should exercise caution in selecting nonprescription therapies for prostate health and should receive education from their physicians or pharmacists if seeking these products.
‘It [prostate cancer] is also one of the more deadly cancers, resulting in nearly 30 000 deaths per year’
Prostate cancer is one of the most common cancers in men, occurring in 233 000 cases per year. It is also one of the more deadly cancers, resulting in nearly 30 000 deaths per year. 1 In the past few years, we have had several innovations in the treatment of this condition at its advanced stages, but the need to prevent cancers from developing altogether remains paramount. As the population continues to live longer, we expect to see an increase in prostate cancers and resultant prostate cancer–related mortality. 2
In an article initially published in 2008, Dunn et al looked at a novel approach in the prevention of prostate cancer. 3 In the trial known as SELECT, patients at risk for prostate cancer were randomized to receive selenium, vitamin E, or a combination of the two. This trial was met with great enthusiasm and accrued over 35 000 healthy patients. Despite the hopes of these agents preventing prostate cancer, prostate cancer incidence did not differ among the 4 arms: hazard ratios (99% confidence intervals [CIs]) for prostate cancer were 1.13 (99% CI = 0.95-1.35, P = .06; n = 473) for vitamin E, 1.04 (99% CI = 0.87-1.24, P = .62; n = 432) for selenium, and 1.05 (99% CI = 0.88-1.25, P = .52; n = 437) for selenium + vitamin E versus 1.00 (n = 416) for placebo. A disturbing trend was found in that prostate cancer may have actually been more common in the population taking vitamin E and that diabetes may have developed more commonly in those on selenium. 3 A 2014 update confirmed the increased risk of prostate cancer in folks taking vitamin E. 4 Due to these findings, the recommendation is that men not take supplements containing selenium/vitamin E for the purpose of prostate cancer prevention.
At most health food stores or pharmacies, nonprescription products are sold that claim to improve prostate health or serve as adjunctive agents for prostate cancer. Given how common prostate cancer and other prostate-related issues (benign prostatic hypertrophy for instance) are, it is understandable that men are seeking agents to improve their prostate-related health. It is not clear if the majority of men seeking these over-the-counter agents are aware of the potential dangers of vitamin E/selenium for their prostates. For this reason, we opted to look at products that advertise prostate health and see if they contain selenium or vitamin E. Additionally, other ingredients in the products were recorded to look for trends in the various products.
Methods
We collected data from popular chain retailers, including Vitamin Shoppe, General Nutrition Center, Amazon, Walgreens, CVS, and so on, that sell vitamins and supplements. Brick and mortar retailers and Internet retailers were both considered on accessibility. All retailers were picked based on them being widely available to consumers. We opted to look at products based on the purported benefits listed on the labels. Most analyzed products had terms such as “Prostate Health” or “Prostate Fix.” Ultimately, 97 products from various retailers were identified for inclusion. Charts were then prepared and compared to assess product ingredients, specifically whether or not the product contained selenium and/or vitamin E and the amount either of that the product contained. Other predominate ingredients were also charted.
Results
In total, 17% of products advertised for prostate health contained both selenium and vitamin E, 36% had selenium without vitamin E, and 16% had vitamin E without selenium. Of all the 97 products assessed, more than 50% contained selenium. Of the products containing selenium, 35% had 200 µg daily, the amount used in the SELECT trial, while the other products had less. Of the products containing vitamin E, none had the 400 IU used in the SELECT trial; however, 55% of products offered 100 IU. Of remaining ingredients, 85% had saw palmetto. Other common ingredients included bee pollen, zinc, copper, green tea, turmeric among others. However, there were not enough products containing these other ingredients to draw conclusions about them.
Discussion
It stands to reason that men want to seek our therapy to help improve their prostate health, whether for prevention of prostate cancer or other prostate health concerns. Unfortunately, not all products that are routinely available and claim to benefit prostate health are without the potential to do harm.
Based on data from the SELECT trial, we know that there are potential dangers to taking products containing selenium and/or vitamin E. Authors of the SELECT trial concluded a 17% increased risk of prostate cancer in taking additional vitamin E and selenium supplements. Despite the dose of vitamin E being significantly lower in the products we analyzed, it is quite conceivable that men may take other products that also contain vitamin E, such as a daily multivitamin. With this in mind, it is advisable that men not take these products containing additional selenium and vitamin E that may be detrimental to their prostate health. It is unknown, but unlikely, that men are aware of these dangerous data, so more education from physicians and other health care workers may be necessary. A thorough evaluation of medication use, including prescription products, should be assessed and recommendations against taking supplements containing vitamin E and/or selenium should be made.
The other most commonly encountered ingredient in products advertised for prostate health was Saw Palmetto. The authors of this article are not aware of potential health detriment from Saw Palmetto, but its benefits in prostatic hypertrophy have been called into question. Benefits in BPH symptoms and sexual dysfunctional have been suggested with some clinical trials. 5
Until data become available that proves a product can prevent prostate cancer, men should be cautioned against some of the products currently available over the counter.