Reviewed: Johnson JJ, Bailey HH, Mukhtar H. Green tea polyphenols for prostate cancer chemoprevention: a translational perspective. Phytomed. 2010;17:3-13.

Every year nearly 200,000 men in the United States are diagnosed with prostate cancer, and around 29,000 men die from the disease. Worldwide, the highest rates of prostate cancer occur in “the West” (i.e., the United States, Canada, Australia, and Western Europe), and the lowest rates occur in Asia.

A variety of genetic and environmental factors are thought to contribute to the development of prostate cancer. Migratory studies have shown that Asian men who move to the United States and adopt a Western diet have a greater incidence of prostate cancer than do their native Asian counterparts. Many epidemiologists have therefore suggested that lifestyle and dietary factors play a role in the development of prostate cancer.

Asian populations are known to consume large quantities of green tea (Camellia sinensis, Theaceae). A major constituent of green tea—epigallocatechin-3-gallate (EGCG)—has been shown in cell culture models to decrease cell viability and to promote apoptosis in prostate cancer cell lines but not in noncancerous cell lines. In animal models, EGCG has been shown to delay the development and progression of prostate cancer.

The objective of the present study was to review the available data on the effects of green tea on prostate cancer chemoprevention.

Conflicting results have been observed in epidemiologic studies. Of 6 epidemiologic studies of green tea reviewed, the majority showed a significant decrease in the risk of developing prostate cancer with increasing intakes of green tea; however, other studies showed no significant decrease.

EGCG is the most abundant catechin in green tea and has been studied extensively. In preclinical studies, several mechanisms of action for the chemopreventive effects of EGCG have been observed. For example, EGCG has been shown to target inflammatory pathways (e.g., nuclear factor-kappa B and cyclooxygenase-2), MAP (mitogen-activated protein) kinases, insulin-like growth factor, androgen receptors, and detoxification enzymes. Preclinical pharmacokinetic studies of green tea have shown that the availability of green tea catechins (GTCs) is low (from 2% to 13%) after oral consumption. Many of these studies used a standardized pharmaceutical-grade preparation known as Polyphenon E® (200 mg of EGCG, 37 mg of epigallocatechin, and 31 mg of epicatechin per capsule; Mitsui Norin, Ltd.; Tokyo, Japan).

Thus far, 3 clinical trials on the role of different forms of green tea on the prevention (n = 1) or treatment (n = 2) of prostate cancer have been published.^1-3 Two of these trials were conducted in patients with hormone-refractory prostate cancer (advanced prostate cancer that has resulted in 3 consecutive prostate specific antigen [PSA] rises while the individual is still on hormone therapy). The patients were treated with green tea powder (1 g 6 times daily; n = 42) in the study by Jatoi et al¹ and with capsules of green tea extract (250 mg twice daily; n = 19) in the study by Choan et al.² Both studies showed little to no therapeutic effect, although one patient in the study by Jatoi et al had a significant decrease from baseline in his PSA level, although this effect was not sustained beyond 2 months.

Bettuzzi et al³ conducted a randomized clinical trial of the safety and efficacy of green tea in a chemoprevention trial in patients with prostatic intraepithelial neoplasia. Patients received either placebo (n = 30) or 600 mg GTCs (n = 30) daily (three 200-mg capsules); each capsule contained 5.5% epigallocatechin, 12.2% epicatechin, 51.9% EGCG, 6.1% epicatechin-3-gallate (a total of 75.7% GTCs), and <1% caffeine. After 1 year of treatment, 1 patient in the green tea group and 9 patients in the placebo group developed prostate cancer. The total PSA level was not “noticeably” different between the 2 groups of patients. A 2-year follow-up in a subset of these participants showed that the chemopreventive effect of green tea catechins was “long lasting.” The authors conclude that the results of this clinical trial “are encouraging and provide rationale for additional clinical trials evaluating the efficacy of green tea polyphenols as a cancer chemoprevention agent.”

A 2009 study of the effects of short-term supplementation with the active compounds in green tea (EGCG; Polyphenon E) on serum biomarkers in men with prostate cancer showed a significant reduction in serum levels of PSA, hepatocyte growth factor, and vascular endothelial growth factor, as well as no elevation in liver enzymes.⁴

According to the authors, it has become evident over time that standardized green tea polyphenols should be used, as opposed to green tea infusions, for interventional purposes to ensure the content of polyphenols being investigated. Evidence collected thus far on the effects of green tea polyphenols on prostate cancer prevention and treatment “suggests that green tea may be a promising agent for [prostate cancer] chemoprevention, and further clinical trials of participants at risk of [prostate cancer] or early stage [prostate cancer] are warranted.”