Hormone therapy, radiation, and surgery are the foundations of treatment for late-stage or metastatic prostate cancer, according to the American Cancer Society. But a practice called integrative medicine, which combines conventional cancer therapies with complementary and holistic treatments, is increasingly being used to manage the disease.

Integrative medicine isn’t the same as alternative medicine, in which you’d use therapies like acupuncture, supplements, and meditation instead of conventional therapies. “Integrative is in addition to,” says Nathan Handley, MD, the director of the integrative cancer recovery program at the Marcus Institute at Thomas Jefferson University in Philadelphia. “We don’t really use the word ‘alternative’ anymore. The real focus is on collaborative approaches and doing everything that we can, and that we ideally have evidence to support.”

While complementary therapies won’t necessarily slow your cancer, they work alongside your treatments to relieve symptoms like hot flashes, fatigue, or weight loss.

Let’s look at what the research has to say about integrative medicine for metastatic prostate cancer, and how to try these therapies safely.

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The traditional Chinese medicine practice of placing thin needles into various pressure points on the body has been around for thousands of years. In prostate cancer, acupuncture may be helpful for relieving hot flashes, which are a possible side effect of hormone therapy, according to the National Cancer Institute.Acupuncture may also relieve chemotherapy-induced nausea and vomiting, as well as nerve damage called peripheral neuropathy, according to Dr. Handley. Although acupuncture is generally safe, avoid it if you have a low platelet or white blood cell count because it might increase the risk of bleeding or infection.

Good nutrition is an important part of managing cancer. One reason is that a well-balanced diet helps with weight control. Obesity is linked to an increased risk of both getting prostate cancer and dying of it.

Donald Abrams, MD, an integrative oncologist at the UCSF Osher Center for Integrative Health and a professor emeritus of medicine at the University of California in San Francisco, recommends that men with prostate cancer eat a plant-based, antioxidant-rich, anti-inflammatory diet filled with real, whole foods.

Specific foods that may be worth adding to an overall healthy diet include:

• Cruciferous Vegetables Sulforaphane is a plant chemical found in broccoli and its cruciferous cousins like kale, cabbage, Brussels sprouts, and cauliflower. Studies suggest that sulforaphane may be helpful in both preventing prostate cancer and slowing its progression, although more research is needed to confirm this benefit. In one study, men who ate the most cruciferous vegetables had a nearly 60 percent lower risk of prostate cancer progression (meaning recurrence, need for secondary treatment, metastasis, or death), than those who ate the least amount of these vegetables.

• Soy Foods like soybeans, tofu, and miso contain plant-based compounds called isoflavones that may slow prostate cancer growth. Prostate cancer rates are lowest in Asian countries where soy is a staple of the diet. Studies find soy isoflavones helpful for reducing prostate cancer risk, and for lowering PSA, which is a marker of prostate cancer in the blood.

• Pomegranate This tart red fruit contains polyphenols that may help to slow prostate cancer growth. In one study, a supplement containing pomegranate extract significantly slowed the rise in PSA levels compared to an inactive placebo in men who were on active surveillance or whose cancer had returned after treatment.

• Green Tea The health effects of this popular beverage come from natural chemicals known as catechins. Studies have shown green tea’s potential for both preventing and slowing prostate cancer. Dr. Abrams is such a big believer in the health benefits of green tea that he drinks four cups of it every day.

• Tomato Lycopene is the plant pigment responsible for the brilliant red hue of tomatoes. It also has health benefits, including a lower risk of prostate cancer and of prostate cancer progression. Lycopene is more active in some forms of tomatoes than others. “Not just the raw tomato, but tomato sauce and tomato paste are the best ways to obtain the healthful benefits of lycopene,” says Abrams.

Although food is generally the best way to get prostate-friendly nutrients, Abrams also recommends certain supplements to improve outcomes in men with prostate cancer.

One is vitamin D. Research has linked a higher vitamin D level in the blood with a lower risk of death from prostate cancer. It may be worth getting your levels checked with a blood test, and taking a supplement if you’re low.Abrams also suggests taking omega-3 fatty acids, citing evidence from a study that found men who took fish oil supplements for four to six weeks before prostatectomy (prostate cancer surgery) had smaller prostates and fewer dividing cancer cells.Staying active is always important, but especially so when you have prostate cancer. Among men who lived for at least four years after their diagnosis, those who did vigorous aerobic exercises for three or more hours a week had a 61 percent lower risk of death from prostate cancer than men who were less active, a study found.

Abrams recommends combining aerobic exercises like jogging or biking with resistance training to strengthen muscles and bones (which hormone therapy can weaken by lowering testosterone levels).

Mindfulness describes a variety of techniques that focus the mind to promote relaxation and reduce stress. Handley recommends an eight-week program called mindfulness-based stress reduction (MBSR) or mindfulness-based cancer recovery (MBCR). These evidence-based programs reduce the severity of symptoms like pain and hot flashes by changing your reaction to them, he says. “I would say MBSR is the gold standard when it comes to a mindful-based approach.”

Yoga combines exercise with deep breathing to strengthen the body and relax the mind. As evidence of its benefits, men who practiced yoga twice a week while undergoing radiation therapy had less fatigue, as well as fewer urinary and sexual side effects than those who didn’t practice yoga.

An integrative medicine program for prostate cancer combines these approaches: diet, exercise, mind-body techniques, and possibly supplements. If you’re interested in trying integrative medicine, your cancer center is the place to start. It’s increasingly common for these centers to have an integrative oncology specialist on staff, says Handley.

If you don’t have access to one of these specialists and your oncologist isn’t familiar with complementary therapies, you can search for a naturopathic provider in your area on the KNOW (Knowledge in Integrative Oncology) website.

Check with your oncologist before you try any supplement or complementary therapy to make sure that it’s safe and it won’t interfere with your cancer treatment. For example, radiation therapy and some chemotherapy drugs kill cancer by creating harmful molecules called free radicals that damage the cancer’s DNA. Antioxidants like vitamins A, C, and E counteract that process, so Abrams recommends that his patients stop taking these supplements until they’ve finished treatment.

• Integrative medicine includes practices like acupuncture, nutrition, exercise, and mindfulness to complement standard prostate cancer treatments by easing symptoms and boosting quality of life.

• These therapies are not an alternative but used in conjunction with conventional therapies to support your overall treatment plan.

• Always consult with your oncologist before starting any new integrative therapies to ensure its safety alongside your current treatments.