Andrew Siegel MD 4/6/19
(Thank you, PublicDomainPictures.net for image above)
If you don’t want to read further, one simple thought to remember: You likely know what to do to maintain cardiac health: HEART-HEALTHY IS PROSTATE HEALTHY
One of nine men in the USA will develop prostate cancer, the most common male malignancy (aside from skin cancer). On a baseball field, that’s one of the nine players on the field. That’s scary common!
It would be awesome if the disease was preventable and would certainly lighten our urological work load. Although we are not there yet, we have become wiser and more enlightened about the means of decreasing chances of developing prostate cancer and also about earlier detection.
The risk factors for the prostate cancer are aging, genetics, race and lifestyle. The first three factors are beyond one’s control, but lifestyle is a modifiable risk factor. A healthy lifestyle, including a wholesome and nutritious diet, weight management, regular exercise and the avoidance of tobacco and excessive alcohol, can lessen one’s risk for all chronic diseases–cardiovascular disease, diabetes and a host of cancers including prostate cancer. It can also slow the growth and progression of prostate cancer in those afflicted.
Consider the fact that when Asian men—who have very low rates of prostate cancer—emigrate to western countries, their risk of prostate cancer increases over time. Clearly, a calorie-rich, nutrient-poor, Western diet and sedentary lifestyle is associated with a higher occurrence of many preventable problems, including prostate cancer.
Not uncommonly, pre-cancerous biopsies predate the onset of prostate cancer by many years. This, coupled with the increasing prevalence of prostate cancer with aging, suggests that the process of developing prostate cancer takes place over a prolonged period of time. It is estimated to take many years—often more than a decade—from the initial prostate cell mutation to the time when prostate cancer manifests itself with either a PSA (prostate specific antigen blood test) elevation or acceleration or an abnormal digital rectal examination. In theory, this provides the opportunity for preventive measures and intervention before the establishment of a cancer.
Ways to Reduce Risk for Prostate Cancer (and Detect it Early if it Occurs)
- Maintain a healthy weight. Obesity is correlated with an increased risk for prostate cancer occurrence, recurrence, progression and death. Research suggests a link between a high-fat diet and prostate cancer. In men with prostate cancer, the odds of spread and death are increased 1.3-fold in men with a body mass index (BMI) of 30-35 and 1.5-fold in men with a BMI > 35. Furthermore, carrying the burden of extra weight increases the complication rate following prostate cancer treatments.
- Eat real foods and avoid refined, over-processed, nutritionally empty foods; be moderate with animal fats and dairy consumption. A healthy diet includes whole grains and plenty of colorful vegetables and fruits. Vegetables and fruits are rich in anti-oxidants, vitamins, minerals and fiber. Anti-oxidants help protect cells from injury caused by free radicals, which can incur cellular damage and potentially cause cancer. Fruits such as berries (strawberries, blackberries, blueberries and raspberries), red cabbage and eggplant contain abundant anthocyanins, anti-oxidant pigments that give red, blue and purple plants their vibrant coloring. Tomatoes, tomato products and other red fruits and vegetables are rich in lycopenes, which are bright red carotenoid anti-oxidant pigments. Cruciferous vegetables (broccoli, cauliflower, Brussel sprouts, kale and cabbage) and dark green leafy vegetables are fiber-rich and contain lutein, a carotenoid anti-oxidant pigment. A healthy diet includes protein sources incorporating fish rich in anti-inflammatory omega-3 fatty acids (salmon, sardines and trout), lean poultry and plant proteins (legumes, nuts and seeds). Processed and charred meats should be avoided. Healthy vegetable-origin fats (olives, avocados, seeds and nuts) are preferred. An ideal diet that adheres to these general recommendations and is heart-healthy and prostate-healthy is the Mediterranean diet.
- Avoid tobacco and excessive alcohol intake. Tobacco use is associated with more aggressive prostate cancers and a higher risk of prostate cancer progression, recurrence and death. Prostate cancer risk rises with heavy alcohol use, so moderation is recommended.
- Stay active and exercise on a regular basis. Exercise lessens one’s risk of developing prostate cancer and decreases the death rate in those who do develop it. If stricken with prostate cancer, if one is physically fit, they will have an easier recovery from any intervention necessary to treat the disease. Exercise positively influences energy metabolism, oxidative stress and the immune system. Pelvic floor muscle exercises benefit prostate health by increasing pelvic blood flow and decreasing the tone of the part of the nervous system stimulated by stress, which can aggravate urinary symptoms. Furthermore, pelvic floor muscle exercises strengthen the muscles surrounding the prostate so that if one develops prostate cancer and requires treatment, he will experience an expedited recovery of urinary control and sexual function.
- Be proactive and see your doctor annually for a DRE (digital rectal exam) and a PSA (prostate specific antigen) blood test. The PSA test does not replace the DRE—both need to be done! Abnormal findings on these screening tests are what prompt further evaluation, including MRI and prostate biopsy, the definitive means of diagnosing prostate cancer. The most common scenario that ultimately leads to a diagnosis of prostate cancer is a PSA acceleration, an elevation above the expected incremental annual PSA rise based upon the aging process.
Important: An isolated PSA (out of context) is not particularly helpful. What is meaningful is comparing PSA on a year-to-year basis and observing for any acceleration above and beyond the expected annual incremental change associated with aging and benign prostate growth. Many labs use a PSA of 4.0 as a cutoff for abnormal, so it is possible that you can be falsely lulled into the impression that your PSA is normal. For example, if your PSA is 1.0 and a year later it is 3.0, it is still considered a “normal” PSA even though it has tripled (highly suspicious for a problem) and mandates further investigation.
- Finasteride (Proscar and Propecia) and dutasteride (Avodart), commonly used to treat benign prostate enlargement, reduce prostate cancer risk. These medications block the conversion of testosterone to its activated form that promotes prostate growth and male-pattern baldness. They help prevent prostate cancer, shrink the prostate, can improve lower urinary tract symptoms, help avoid prostate surgery, and grow hair on one’s scalp…a fountain of youth dispensed in a pill form!
Bottom Line: When it comes to health, it is advantageous to be proactive instead of reactive, making every effort to prevent problems instead of having to fix them. The cliché “an ounce of prevention is worth a pound of cure” is relevant to prostate cancer as it is to other health issues including diabetes and heart disease. A healthy lifestyle, including a wholesome and nutritious diet, maintaining proper weight, exercising regularly and avoiding tobacco and excessive alcohol can lessen one’s risk of all chronic diseases, including prostate cancer. Be proactive by getting a 15-second digital exam of the prostate and PSA blood test annually.
Wishing you the best of health,
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Dr. Andrew Siegel is a physician and urological surgeon who is board-certified in urology as well as in female pelvic medicine and reconstructive surgery. He is an Assistant Clinical Professor of Surgery at the Rutgers-New Jersey Medical School and is a Castle Connolly Top Doctor New York Metro Area, Inside Jersey Top Doctor and Inside Jersey Top Doctor for Women’s Health. His mission is to “bridge the gap” between the public and the medical community. He is a urologist at New Jersey Urology, the largest urology practice in the United States.
The content of this entry is excerpted from his new book, PROSTATE CANCER 20/20: A Practical Guide to Understanding Management Options for Patients and Their Families
Video trailer for Prostate Cancer 20/20
Preview of Prostate Cancer 20/20
Andrew Siegel MD Amazon author page
Prostate Cancer 20/20 on Apple iBooks
Dr. Siegel’s other books:
PROMISCUOUS EATING— Understanding and Ending Our Self-Destructive Relationship with Food
MALE PELVIC FITNESS: Optimizing Sexual and Urinary Health
THE KEGEL FIX: Recharging Female Pelvic, Sexual, and Urinary Health
Tags: Andrew Siegel MD, digital rectal exam, Finasteride, healthy lifetyle, prostate cancer, Prostate Cancer 20/20, prostate cancer risk reduction, PSA blood test
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