Prostate Cancer in Herbs' Points of View

 By Kyle J. Norton (Draft article)

The widespread of prostate cancer, once considered as a disease of aging male, now have become major concerns of governments and scientific community in South East Asian with tendency to spread to younger age population. Suggestions emerged of over consuming bad fats in any time in history accompanied with unhealthy diet and life style may be the possible causes of the disease, linking to the economic prosperity over 2 decades. Herbal medicine for diseases' management have been prescribed in folk medicine over thousands of year as one of best medicine of nature in preventing and treating diseases, including prostate cancer.
Prostate cancer is defined as a condition in which the cells of prostate has become cancerous, causing abnormal cell growth with possibility of spreading to the distant parts of the body. Most prostate cancers are slow growing and enlarged prostate and prostate cancer may be detected during physical (rectum) exams.
1. Aloe vera
Aloe Vera is species of succulent plant in the genus Aloe, belonging to the Family Xanthorrhoeaceae, native to Sudan. It has become very popular for commercial cultivation due to its health benefits. Aloe vera has been used in herbal medicine in treating many kinds of disease, including wound, burn healing, minor skin infections, sebaceous cysts, diabetes, and elevated of cholesterol, etc. It is also one of many popular herb studied in scientific ways with some conflicted results.
Aloe-emodin, a chemical constituent in Aloe vera, inhibited both proliferation and anchorage-independent growth of PC3 cells through activation of the downstream substrates of mTORC2, Akt and PKCα causes of apoptosis, cell proliferation(1). prostate cancer, LNCaP expression of N-acetylated by cytosolic N-acetyltransferase (NAT) activity and mRNA inhibited by aloe-emodin in doses depending mannerthrough its kinase activity in cellular transformation(2)(3).

2. Cascara sagrada
Cascara sagrada is a species of buckthorn, genus Rhamnus, belonging to the family Rhamnaceae, native to western North America, it's bark has been used in traditional medicine for gastrointestinal support. and it is thought to have a laxative and natural cleansing, etc., effect.
Emodin, a cemical compoubd found in Cascara sagrada, inhibited cellular migration and invasion in prostate cancer through downregulate CXCR4 expression which is involved in promoting invasion and metastasis in tumors(4). In human prostate cancer cell LNCaP, amodin increased apoptosis and  decreased in cell proliferation through down regualting the expression of expression of androgen receptor (AR) and prostate specific antigen (PSA) and upregulating the expression of p53(Anti tumor antigen) and p21(( regulator of cell cycle progression at G₁ and S phase)(5), In other study, Emodin enhanced the  cytotoxic effectiveness of chemotherapeutic drugs in prostate cancer cells through ROS(reactive oxygen spiecies)-mediated suppression of multidrug resistance and hypoxia inducible factor-1(influence cell metabolism, cell survival and angiogenesis to maintain biological homeostasis)(6).

3. Green tea
Green tea contains more amount of antioxidants than any drinks or food with the same volume, and is the leaves of Camellia sinensis, undergone minimal oxidation during processing, originated from China. Green tea has been a precious drink in traditional Chinese culture and used exceptional in socialization for more than 4000 thousand years. Because of their health benefits, they have been cultivated for commercial purposes all over the world.
Epigallocatechin-3-gallate (Chit-nanoEGCG), a phytochemical in green tea, exerted a significant inhibition of tumor growth and secreted prostate-specific antigen levels compared with EGCG and control groups, trough induction of poly (ADP-ribose) polymerases cleavage, increase in the protein expression of Bax(involved in p53-mediated apoptosis)  with accompanied decrease in Bcl-2(family of regulator proteins that regulate cell death), and activation of caspases(mechanisms of apoptosis) and reduction in Ki-67 and proliferating cell nuclear antigen(7). In androgen-independent prostate cancer, synthetic derivative, EGCG (EGCG-P) and EGCG treatment suppressed the growth of the tumor correlated with the decrease of serum PSA level together with the reduction in tumor angiogenesis and an increase in apoptosis on prostate cancer cells(8). In anticancer drug cisplatin, EGCG ehnaced the effectiveness of the chemo agent in reduction of cell survival of prostate cancer cell line PC3 and induced apoptosis(9).

4. Pomegranate
Pomegranates is a fruit-bearing small tree, genus Punica, belonging to family Lythraceae, native to Iran but has been cultivated in Asian since ancient time.
POMx, a pomegranate extract (PE) fomula, exhibited potent in vitro cytotoxicity in metastatic castration-resistant PCa cells through inhibition of survivin, induced apoptosis, retarded C4-2 tumor growth in skeleton and significantly enhanced the efficacy of docetaxel(Chemodrug) in athymic nude mice(10). Ellagic acid (EA) converted from Ellagitannins (ETs) found in from pomegranate juice (PJ) showed to induce apoptosis in both cell lines, DU-145 and PC-3 through induced  cell cycle arrest in S phase associated with decreased cyclin B1 and cyclin D1 levels in regulation ofcell cycle progression(11). Pomegranate juice (PJ) PJ components luteolin, ellagic acid, and punicic acid together found to inhibit growth of hormone-dependent and hormone-refractory prostate cancer cells and their migration, increase the expression of cell adhesion genes and decrease expression of genes involved in cell cycle control through suppression microRNAs (miRNAs), decrease several oncogenic miRNAs, and inhibit the chemokines receptor type 4 (CXCR4)/SDF1α chemotaxis axis(decreased PSA cell migration)(12).

6. Garlic
Garlic (Allium sativum) is a species in the onion genus, belonging to family Amaryllidaceae, native to central Asia. It has been used popularly in traditional and Chinese medicine in treating common cold and flu to the Plague, blood pressure cholesterol levels, natural antibiotic, etc.
In androgen-independent prostate cancer, garlic-derived organosulfur compound S-allylmercaptocysteinesuppresses invasion and cell motility of androgen-independent prostate cancer cells via the up-regulation of cell-adhesion molecule E-cadherin(Loss of E-cadherin expression has been implicated in cancer progression and metastasis)(16). Garlic compound diallyl disulfid,a oil soluble organosulfur compound of garlic, exerted its antiproliferative and inhibited effect on prostate cancer cells, through induction of DNA damage in a dose dependent manner(17). Garlic constituent diallyl trisulfide (DATS), induced apoptosis in prostate cancer cells is mediated in part by suppression of XIAP(a protein that stops apoptotic cell death) protein expression(18).

7. Chamomile
Chamomile is also known as camomile, common name of many species daisy-like plants in the family Asteraceae. The herb has been used in traditional medicine as antispasmodic and anti-inflammatory constituents and to treat menstrual cramps and sleep disorders, reduce cramping and spastic pain in the bowels, relieve excessive gas and bloating in the intestine, etc.
Phenolic profile of chamomile showed to inhibited the cell proliferation and to reduce IL-8 (an important mediator of the immune reaction in the innate immune system response) levels in PC3 prostate cancer cells(19). Traditional Botanical Supplement-101 (TBS-101), including the extracts of Panax ginseng, cranberry, green tea, grape skin, grape seed, Ganoderma lucidum and chamomile, showed to inhibit in hormone-refractory PC-3 cells and large aggressive PC-3 tumors cell growth in a dose-dependent manner(20). In human cancer cell lines PC-3, A-549 and MCF-7, Chamomile's essential oils, induced cytotoxicity of prostate carcinoma cell (PC-3), significantly stronger than on human lung carcinoma (A549) and human breast cancer (MCF-7) cell lines(21).

8. Onion
The onion is a close relation of garlic plant in the genus Allium, belonging to the family Alliaceae.  It is often called the "king of vegetables" because of its pungent taste and found in a large number of recipes and preparations, spanning almost the totality of the world's cultures. Depending on the variety, an onion can be sharp, spicy, tangy, pungent, mild or sweet.
Data from southern European populations showed intake of allium vegetables, including onion are  inversely associated reduced  risk of several common cancers, including breast cancer(22).
 Fisetin, a chemical constituent found in Onion, in prostate cancer, it exerted anti cell profilerative effect as a dual inhibitor of the PI3K/Akt (anti-apoptosis and increased cell proliferation) and the mTOR(regulates cell growth, cell proliferation, cell motility, cell survival, protein synthesis, and transcription) pathways(23). Quercetin, also found in onion, inhibited the prostate cancer line PC-3 through DNA fragmentation and protein expressions of Bcl-2, Bcl-xL, Bax and caspase-3 (cell apoptosis) pathways(24).

9. Turmeric
Turmeric is a perennial plant in the genus Curcuma, belonging to the family Zingiberaceae, native to tropical South Asia. The herb has been used in traditional medicine as anti-oxidant, hypoglycemic, colorant, antiseptic, wound healing agent, and to treat flatulence, bloating, and appetite loss, ulcers, eczema, inflammations, etc.
In PC-3M prostate cancer cell line, extract from turmeric, showed significant inhibitory effects on anti profilerative ability in PC-3M in clonogenic assays(25). Demethoxycurcumin (DMC), one of mjor chemical constituents found in turmeric, exerted it antitumor effects on prostate cancer cells via AMPK((cellular energy homeostasis))-induced down-regulation of HSP70 (upregulated by and toxic chemicals, particularly heavy metals) and EGFR(over expression of epidermal growth factor receptor  have been associated with a number of cancers)(26)(27). Curcumin, a non-nutritive yellow pigment derived from the turmeric showed a inhibitory effects on the expression of  NF-κB (a transcription factor that has crucial roles in inflammation, immunity, cell proliferation and apoptosis)correlated with their effects on growth inhibition and apoptosis stimulation in PC-3 cells(28).

10. Ginseng
Ginseng is a slow-growing perennial plants with fleshy roots, the genus Panax, belonging to the family Araliaceae. Depending to the climate where it grows, ginseng can be classified mainly into Panax ginseng Asian ginseng (root), Red ginseng, wild ginseng, American ginseng (root).
In a highly metastatic PC-3M prostate cancer cell line,  Ginsenoside Rg3 (Rg3), a bioactive extract from ginseng, suppressed migration of PC-3M cells by down-regulating AQP1(a molecular water channel protein) expression through p38 (highly expressed in aggressive and invasive cancers)MAPK(Increased MAPK expression and activity in primary human carcinoma) pathway and some transcription factors acting on the AQP1 promoter(29). Ginsenoside 20(S)-Rh2  of Ginsenosides, a main component of ginseng, found to be effective in proliferation inhibition on androgen-dependent and -independent prostate cancer cells(30). Formula of Botanical Supplement-101 (TBS-101), containing Panax ginseng, cranberry, green tea, grape skin, grape seed, Ganoderma lucidum and chamomile showed significant inhibition of tumor growth and invasion in a dose-dependent manner(31).

11. Grape Seed Extract
Grape Seed Extract is the commercial extracts from whole grape seeds containing many concentrations, including vitamin E, flavonoids, linoleic acid, oligomeric proanthocyanidins(OPCs), etc.. The herb has been used in traditional medicine as antioxidant, anti-inflammatory agents and to treat skin wounds with less scarring, allergies, macular degeneration, arthritis, enhance circulation of blood vessels, lower cholesterol, etc.
Grape seed extract (GSE), inhibited HAT(HAT mutations are associated to certain cancers), leading to decreased AR(plays roles in prostate development and cancer (PCa))-mediated transcription and cancer cell growth, and implicate GSE as a novel candidate for therapeutic activity against prostate cancer(32). B2G2 from total GSE, derived from Procyanidin B2 3,3″-di-O-gallate, a Biologically Active Constituent of Grape Seed Extract inhibited cell growth, decreased clonogenicity(colony expansion), and induced cell cycle arrest and apoptotic death, in various human PCa cell lines(33).
In a highly metastatic androgen-independent PC3 prostate cancer, Grape seed extract (GSE),  inhibited DNA-binding activity of the transcription factor nuclear factor kappa B (NFkappaB)(a transcription factor that has crucial roles in inflammation, immunity, cell proliferation and apoptosis), which in turn decreased NFkappaB-dependent uPA(in tumor invasion and metastasis) transcription(33).

12. Danshen (Salvia miltiorrhiza Bunge)
Dan Shen is also known as Red Sage Root. The bitter and slightly cold herb has been used in TCM as antithrombotic, antihypertonic (lowering blood pressure), antimicrobial, antipyretic, anti-inflammatory, sedative agent and to treat dysmenorrhea, amenorrhea, palpable tumors, angina,restlessness, insomnia, irritability, etc., by enhancing the functions of heart and liver channels.
Tanshinones, a chemical constituent found in Chinese herb Dan Shen, was found to be effective in inhibition of the growth of growth of prostate cancer sell lines, in a dose-dependent manner through cell cycle arrest and apoptosis induction(34)and specially in LNCaP cells more than several androgen-independent PCa cell, through suppression of  prostate cancer growth and androgen receptor(AR) signaling.(35) or through induction of  G1 arrest via activation of p53(tumor antigen) signaling and inhibition of AR in LNCaP cells(36).

13. Ginkgo biloba
Ginkgo biloba is oldest living tree species, genus Ginkgo, belonging to the family Ginkgoaceae, native to China, from temperate zone to subtropical zone and some parts of north America. It has been used in traditional herbal medicine in treating impotence, memory loss,respiratory diseases, circulatory disorders and deafness as well as preventing drunkenness, and bedwetting.
Ginkgetin, isolated from leaves of Ginkgo biloba L, inhibited PC-3 cells in a concentration-dependent manner, through significantly increased the sub-G1(detection of cumulative apoptosis)  DNA contents of cell cycle by activated caspase-3 (mechanisms of apoptosis) and weakened  the expression of survival genes such as Bcl-2, Bcl-xL,(family of regulator proteins that regulate cell death) Survivin (baculoviral inhibitor), and Cyclin D1(regulating cell cycle progression) at protein and mRNA levels(37). Unfortunately, Some reseachers suggested that There were no associations for use of  ginkgo biloba in reduced risk of prostate cabcer(38)(39)

14. Licorice (Glycyrrhiza Glabra)
Licorice (Glycyrrhiza Glabra) also known as sweetwood, is the genus Glycyrrhiza, belonging to the family Fabaceae, native to the Mediterranean and certain areas of Asia. The herb has been used in traditional medicine to treat skin diseases, coughs, constipation, bronchitis, inflammation.
Licochalcone-A, isolated from licorice, induced modest level of apoptosis of androgen-independent PC-3 prostate cancer cells through the cell cycle progression arresting cells in G2/M, accompanied by suppression of cyclin B1 and cdc2(cell division cycle 2)(40). Isoangustone A (IAA) in licorice,  attenuated the growth of prostate cancer cell cultures and xenograft tumors attributed to inhibition of the G1/S phase cell cycle transition and the accumulation of p27(cell cycle inhibitor)(41). Other chemical compound such as Glycyrrhetinic acid found in licorice, in the experiment of prostate cancer cell line DU-145, inhibited proliferation and growth of these cells by inducing apoptosis, through down regulated expression of NF-κB (p65). (42).

15. Peppermint
Peppermint is a hybrid mint with small purple or white flowers and downy leaves, in the genus Mentha, belonging to the family Lamiaceae, native to  Europe. The herb has been used in folk medicine as analgesic, antiseptic, antispasmodic, decongestant, agent and to relieve gas, nausea, and stomach pain due to an irritable bowel, intestinal cramps, or indigestion, infecttion, etc.
essential oils of peppermint exerted its cytotoxic effect against of  prostate cancer (LNCaP) cell lines(43). Menthol, a naturally isolated from peppermint oil, induces cell death in PC-3 cells independent to Ca(2+) influx pathways(44). When combined with 1alpha,25-dihydroxyvitamin D(3) [1alpha,25(OH)(2)D(3)], the most active form of vitamin D(3), menthol increases an anti-proliferation activity of 1alpha,25(OH)(2)D(3) in LNCaP prostate cancer cells, through evoking the increase in [Ca(2+)](45).

16. Wolfberry
Wolfberry is the common name for the fruit of two very closely related species, the genus of Lycium, belong to family Solanaceae, native to native to southeastern Europe and Asia.
Lycium barbarum polysaccharides (LBPs) in dose and time-dependently inhibited the growth of both PC-3 and DU-145 cells through exhibiting  the breakage of DNA strands of PC-3 and DU-145 cells; and induced apoptosis(46). Extract from Lycium barbarum. showed an inhibited effect against  PC3 cell proliferation(47).

18. Rosemary 
Rosemary is a perennial herb with fragrant, evergreen, needle-like leaves, the genus Rosmarinus, belonging to the family Lamiaceae. Its fresh and dried leaves has been used frequently in traditional Mediterranean cuisine and as flavor foods while barbecuing.
Polyphenols isolated from rosemary, inhibited prostate cancer cell through targeting multiple signaling pathways involved in cell cycle modulation and apoptosis(48). Carnosic acid (CA), a polyphenolic diterpene, isolated from rosemary, inhibited apoptosis of PC-3 cells, by activation of PP2A(play critical roles in cell cycle and apoptosis) through modulation of Akt/IKK/NF-κB pathway(49).

Taking altogether, The above herbs have shown effectively in reduced risk and treatments of prostate cancer, through induced apoptosis, exhibited anti proliferation of prostate cancer cell line in cell cycle arrest, down regulation of pro cell growth pathways, etc.. Please consult with your doctor or related field specialist before applying.
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References
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(2) Effect of inhibition of aloe-emodin on N-acetyltransferase activity and gene expression in human malignant melanoma cells (A375.S2) by Lin SY, Yang JH, Hsia TC, Lee JH, Chiu TH, Wei YH, Chung JG.(PubMed)
(3) Aloe-emodin suppresses prostate cancer by targeting the mTOR complex 2 by Liu K, Park C, Li S, Lee KW, Liu H, He L, Soung NK, Ahn JS, Bode AM, Dong Z, Kim BY, Dong Z.(PubMed)
(4) Emodin inhibits invasion and migration of prostate and lung cancer cells by downregulating the expression of chemokine receptor CXCR4 by Ok S, Kim SM, Kim C, Nam D, Shim BS, Kim SH, Ahn KS, Choi SH, Ahn KS.(PubMed)
(5) Emodin induces apoptosis in human prostate cancer cell LNCaP by Yu CX, Zhang XQ, Kang LD, Zhang PJ, Chen WW, Liu WW, Liu QW, Zhang JY.(PubMed)
(6) Chemosensitization by emodin, a plant-derived anti-cancer agent: mechanism of action by Sun Y.(PubMed)
(7) Oral administration of naturally occurring chitosan-based nanoformulated green tea polyphenol EGCG effectively inhibits prostate cancer cell growth in a xenograft model by Khan N, Bharali DJ, Adhami VM, Siddiqui IA, Cui H, Shabana SM, Mousa SA, Mukhtar H.(PubMed)
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(35) Tanshinones from Chinese medicinal herb Danshen (Salvia miltiorrhiza Bunge) suppress prostate cancer growth and androgen receptor signaling by Zhang Y, Won SH, Jiang C, Lee HJ, Jeong SJ, Lee EO, Zhang J, Ye M, Kim SH, Lü J.(PubMed)
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(46) Lycium barbarum polysaccharides induce apoptosis in human prostate cancer cells and inhibits prostate cancer growth in a xenograft mouse model of human prostate cancer by Luo Q, Li Z, Yan J, Zhu F, Xu RJ, Cai YZ.(PubMed)
(47) [Extraction and isolation of active component for inhibiting PC3 cell proliferation in vitro from the fruit of Lycium barbarum L].[Article in Chinese] by Liu XL, Sun JY, Li HY, Zhang L, Qian BC.(PubMed)
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(49) Carnosic acid modulates Akt/IKK/NF-κB signaling by PP2A and induces intrinsic and extrinsic pathway mediated apoptosis in human prostate carcinoma PC-3 cells by Kar S, Palit S, Ball WB, Das PK.(PubMed)