Objective To assess the effectiveness of PC‐SPES, a dietary supplement containing eight herbal extracts, which is a popular alternative therapy among patients with hormone‐refractory prostate cancer; anecdotal reports claim that this agent provides relief of metastatic pain, improvements in quality of life and reduction of prostatic specific antigen (PSA) level. Patients and methods Sixteen men treated for advanced metastatic prostate cancer (stage D3) with either orchidectomy or a luteinizing‐hormone releasing hormone agonist, with or without anti‐androgen, were enrolled into a prospective clinical trial to evaluate the possible toxic and beneficial effects of PC‐SPES. After hormone‐ablative therapy had failed, and with established disease progression, all patients received supplemental treatment with PC‐SPES (2.88 g daily) for 5 months. Hormonal therapy was continued throughout the trial to avoid the known withdrawal effect of anti‐androgen on PSA levels. Results The supplemental intake of PC‐SPES was associated with significant (P < 0.05–0.01) improvements in quality‐of‐life measures, reductions in patient’s pain ratings (P < 0.05–0.01), and a decline in PSA levels (P < 0.01), with no major side‐effects. Conclusions These results support the anecdotal reports of the beneficial effects of PC‐SPES as a comparable alternative to current management regimens in hormone‐refractory prostate cancer. However, no conclusions can be drawn about the long‐term effects of this new herbal therapy.

Cross-tolerance to epidural morphine after prior systemic morphine therapy was studied in 26 cancer patients treated for relief of pain secondary to metastatic disease. A 'tolerance index' was calculated for each patient by multiplying the duration of previous morphine therapy with the daily dose just prior to the study and then compared with changes in the following variables measured after epidural morphine administration: with pain scores on a scale from 0 (no pain) to 10 (maximal pain), heart rate, blood pressure, respiratory rate and minute volume, arterial blood gas tensions of oxygen and carbon dioxide and arterial pH. There was no significant analgesic cross-tolerance to epidural morphine, but clear evidence for cross-tolerance regarding morphine's respiratory depressant action. The duration of the previous morphine therapy exerted a greater influence on the development of ventilatory cross-tolerance than the dose.

No indication of toxicity or effectiveness was found in an uncontrolled, consecutively selected series of 46 cancer patients undergoing IAT treatment. In addition, the therapy did not appear to contribute to improved quality of life in most patients. This study does not justify its continued use.

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