Prostate Cancer

Prostate Cancer Chemoprevention
Treatment Choices for Localized Prostate Cancer
The Prostate Healthy Diet and Lifestyle

In 2009, more than 300,000 men will be diagnosed with prostate cancer in the United States. After lung cancer, prostate cancer is currently the second most common cause of cancer death in men.

Prostate Cancer Chemoprevention

Urologists recognize that certain men are at higher risk of being diagnosed with prostate cancer. One risk factor is race—we know that black men have more than twice the risk of white men. Another significant risk factor is family history. Any man with a first-degree male relative (father or brother) with prostate cancer has two to three times the risk. Men who have been found on an initial prostate biopsy to have a “pre-malignant” condition known as high-grade prostatic intraepithelial neoplasia (HGPIN) are also believed to be at higher risk for developing prostate cancer. Any man with one or more of these identifiable risk factors may be able to delay or prevent a cancer diagnosis by making appropriate modifications to his diet and lifestyle. The sooner they start—the better.

“Active Surveillance” or “Delayed Therapy”

For most of us, the thought that we might be diagnosed with cancer, but choose NOT to aggressively treat it seems crazy at first. However, many prostate cancers are very slow growing, and when diagnosed in older men, such a slow-growing cancer may not be life-threatening. This has lead to the understanding that “more men die WITH prostate cancer than FROM prostate cancer.”

Unfortunately, aggressive treatment of prostate cancer with surgery or radiation carries several well-known risks. So, many urologists will counsel older men with slow-growing prostate cancers ( i.e.; low Gleason scores) to defer or delay active treatment, and adopt a plan of “active surveillance.” This usually involves getting a PSA every 3 or 4 months, and periodic re-biopsy of the prostate.

These men, who have been diagnosed with prostate cancer, but chosen to defer aggressive treatment, should take every step possible to adopt a “prostate healthy” diet and lifestyle.

Treatment Choices for Localized Prostate Cancer

If, at the time of diagnosis, the cancer is confined to the prostate gland and has not spread elsewhere, then there are several possible treatment choices.

  • Radical Prostatectomy

    Surgical removal of the entire prostate is known as a radical prostatectomy. This involves detaching the prostate from the bladder above and the urethra below. The bladder and urethra are then reconnected. The operation may be done through a a single medium-sized incision, or with a laparoscopic or robotic approach which employs multiple smaller incisions. A good resource for learning more about radical prostatectomy can be found at

  • Radioactive Seed Implantation (aka Prostatic Brachytherapy, Interstitial Radiation)

    This is a type of radiation therapy in which dozens of tiny radioactive pellets (i.e.; seeds) are implanted into the prostate through needles which are inserted through the skin. This procedure, which is usually done under general anesthesia in a hospital or sugery center, takes 1 to 2 hours, and can be done on an outpatient basis. To learn more about seed implantation, check out this link.

  • External Beam Radiation Therapy ( IMRT, IGRT)

    This is a modern version of the type of radiation treatment that has been used to treat cancer for more than 50 years. IMRT and IGRT are types of radiation treatment in which very precise targeting techniques are used to concentrate the killing effects of the radiation beam onto the cancer, and spare the normal surrounding tissues. External beam radiation therapy is given in a series of daily treatments which may last as long as 8 weeks. For a detailed exploration of this treatment option, click here:

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After Prostate Cancer Treatment

After treatment of prostate cancer has been completed—whether it is surgery or some form of radiation, there is always a risk of recurrence of the cancer in the future. Statistically, that risk may be as low as 10%, or as high as 50-60%, depending on the initial stage and grade of the cancer.

Men who were treated for aggressive, fast-growing prostate cancers are at higher risk for a recurrence. For these men, making meaningful changes in diet and lifestyle may help prevent, or at least delay, the recurrence of the cancer.

When the PSA is Rising After Treatment

After the prostate cancer has been treated, the urologist will carefully monitor the PSA blood test for years to come. If treatment has been successful, the PSA will fall to almost undetectable levels, and stay there. If the PSA begins to rise again, it generally means that prostate cancer cells remained behind after treatment, and have started to grow again.

If the PSA begins to rise quickly, the urologist may recommend “hormone treatment” in which special injections are used to reduce the serum testosterone and slow the growth of the cancer. However, if the PSA is rising very slowly, the urologist may suggest delaying hormone treatment in favor of “close observation.” In these situations, research has clearly shown that diet and lifestyle modifications may help slow the rate of PSA rise, and decrease the prostate cancer cell growth.

Over the past 10 years, we have come to understand that the risk of developing prostate cancer—and—if diagnosed, the risk of dying from the cancer—is greatly affected by diet and lifestyle. Much like heart disease, any one person's risk is based on a combination of genetics (i.e.; family history) and lifestyle. Fortunately, the same diet and lifestyle habits which are “heart-healthy” are “prostate-healthy” as well. Research has revealed in which situations diet and lifestyle modifications may be helpful—and exactly what types of modifications make sense.

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The Prostate Healthy Diet and Lifestyle

Understanding Dietary Fats

A diet high in fat is not good for your prostate, heart, or waistline. Many studies have shown higher rates of prostate cancer, as well as advanced prostate cancer, among men with the highest total fat intakes. However, different types of fat appear to have different effects on the prostate.

Saturated fats occur naturally in foods from animal sources such as meat and dairy products. Studies have shown that high intakes of saturated fats can increase the risk of prostate cancer, not to mention clog your arteries. To limit the saturated fat in your diet, choose nonfat dairy products (skim milk, nonfat yogurt, and nonfat cheese) and avoid whole or 2% milk, cheese, and ice cream. Decrease the amount of higher fat meats you eat, such as fatty cuts of beef, lamb, pork, and poultry with skin. If you are accustomed to eating meat every day, try a vegetarian meal a few times per week as a healthy alternative. Some plant foods, however, such as palm oil and coconut oil, fried foods, and some baked goods are also rich in saturated fats and should therefore be limited.

Trans fats are made when manufacturers add hydrogen to vegetable oil in order to increase the shelf life and flavor stability of foods. Although the effect of trans fat on the prostate is not clear, these fats have been shown to increase inflammation and the risk of heart disease and stroke, and have also been associated with an increased risk of diabetes. Because of these negative effects, food with trans fat should be avoided.

Trans fat is found in vegetable shortenings, as well as some margarines, crackers, cookies, baked goods, and fried foods. Fortunately, food manufacturers are using less often, although it is still added to some pie crusts, frostings, biscuits, frozen pizzas, etc. To determine whether a packaged food contains trans fat, check the nutrition facts panel and read the list of ingredients. If one of the ingredients listed is “hydrogenated” or “partially hydrogenated” vegetable oil, the food contains trans fat.

Omega-3 fats are essential fats that your body needs to function properly, but cannot make on its own. Omega-3s from fish have been associated with a decreased risk of prostate cancer. Recent research has shown that eating fish more than three times per week decreases the risk of prostate cancer, especially advanced prostate cancer. The Health Professionals Follow-up Study, which followed 51,529 men for 10 years, showed that men who ate more fish after being diagnosed with prostate cancer reduced the risk of their cancer returning. This same study also showed a reduced risk of prostate cancer, as well as death from prostate cancer, among healthy men who ate moderate to high amounts of fish. The benefit was greatest for aggressive prostate cancer, which occurred 44% less often in the men who ate large amounts of fish compared to those who ate little fish.

It is thought that these benefits can be attributed partly to the unique omega-3 fatty acids found in fish. These fats, EPA (eicosapentaenoic acid) and DHA (docosahexaenoic acid), are found in fatty fish and seafood such as salmon, mackerel, sardines, herring, trout, and albacore tuna. Other fish contain some EPA and DHA, but in smaller amounts. Laboratory experiments suggest that these two fats slow the growth and spread of prostate cancer, and a recent study in Jamaican men found that low blood levels of EPA and DHA correlated with a higher-grade prostate cancer at diagnosis.

In addition to the benefits for your prostate, EPA and DHA may decrease the risk of coronary heart disease and ischemic stroke, decrease the risk of sudden death from heart disease, decrease serum triglyceride levels, decrease the risk of blood clots, slightly lower blood pressure, and decrease inflammation. These fats also appear to enhance the effectiveness of cholesterol-lowering medications. Because of this convincing evidence, the AHA (American Heart Association) now recommends that all adults eat a variety of fish, particularly fatty fish, at least twice weekly. The AHA recommends that adults with heart disease consume a total of approximately 1 gram per day of EPA and DHA from fish or fish oil supplements. ALA (alpha-linolenic acid), another type of omega-3 found in flaxseed oil may increase the risk of prostate cancer. Therefore, flaxseed oil supplements are not recommended for most men.

Flaxseeds (but not flaxseed oil) contain healthy fiber, lignans, vitamins, and minerals in addition to oil, and a recently published study showed that eating ground flaxseeds (added to yogurt, cereal, or baked into bread) decreased PSA levels and prostate cancer cell growth. Therefore, adding ground flaxseeds to your diet is recommended.

Omega-6 fats, like omega-3s, are considered “essential” because they are needed for proper body function but are not made by the body. Omega-6 fats are found in certain vegetable oils (soybean, safflower, sunflower or corn oils), nuts and seeds. Although eating foods rich in omega-6s in place of saturated and trans fats has been associated with a decreased risk of coronary heart disease, a diet high in omega-6 and low in omega-3s may increase the risk of prostate cancer. In the lab, omega-6s promote the progression of prostate cancer cell growth, while omega-3s decrease the progression. In order to reduce the amount of omega-6 fats in your diet, olive or canola oil should be used instead of other vegetable oils and combined with a diet high in heart healthy omega-3s.

Diets rich in monounsaturated fats have been shown to lower the risk of heart disease and stroke. Studies investigating the association between monounsaturated fats and prostate cancer have produced inconsistent results. Foods high in monounsaturated fats include olive oil, canola oil, avocados, peanut butter, and many nuts and seeds.

In summary, it is important to try to lower the amount of “bad” fats that you eat by limiting foods such as butter, margarine, baked goods (cakes, doughnuts, cookies), and potato chips to a small serving once or twice per week. Choosing the right fats is important. For example, choose olive oil instead of vegetable oils for cooking. Consume a diet rich in fish, along with whole grains, soy, vegetables, fruits, nuts and seeds, to help reduce your risk of prostate cancer, as well as your risk of heart disease and sudden cardiac death.

Weight control

Maintaining a healthy body weight is important to reduce your risk of cancer as well as other chronic diseases, such as heart disease and diabetes. We now understand that obesity triggers hormonal changes that may fuel cancer growth. Research has shown that obese men are 2 ½ times more likely to develop prostate cancer than normal weight men. Obesity has also been associated with having a higher grade of prostate cancer when diagnosed, and even a worse outcome after prostate cancer treatment

Exercise

In addition to a healthy diet, exercise and physical activity are very important in maintaining a healthy body weight and preventing chronic disease. Regular exercise releases tension, decreases stress, improves immune function, and may decrease the risk of prostate cancer by decreasing testosterone levels. Although this association remains somewhat unclear, evidence over the last decade has indicated that exercise is associated with a decreased risk of prostate cancer, as well as a decreased overall risk of death from cancer. Aim for 20-60 minutes of moderate activity, 3-5 days per week, for maximum benefit.

Read more about nutrition and prostate health.

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