Since I have written the book I have perused the internet more often for prostate related news. I started this blog, I subscribe to RSS feeds that deal with prostate cancer news, and I search Twitter from time to time about Tweets related to the same. There is a consistent pattern of about three issues that I see over and over again and was a surprise to me as a practicing urologist for over twenty years. The emotion surrounding the PSA comes to mind and exemplified in the NYT Op-Ed by Richard Albin was news to me. The underlying distrust by many patients about their doctors and the feeling that everything is money driven. The biggest thing however is related to the importance many place on lifestyle and vitamins in both the treatment and prevention of prostate cancer. I think this may be so because there is a market money-wise in selling and promoting the various concoctions. (Am I equally as guilty about suspecting money as the root of the issue of all the talk about lifestyle and diet as it pertains to prostate cancer?) Anyway…see below a benign article on prostate cancer. The author, a PA, references the Prostate Cancer Foundation, as saying that 70% of prostate cancer is because of lifestyle and that lifestyle can prevent prostate cancer. What is behind this? Is there a motive that I am missing?The next article states that the major risk factors are age,heredity and ethnicity. Diet and other issues are discussed as well but are listed as minor players. Be sure to note that whether diet and lifestyle have role is controversial and has not been conclusively proven.Take me for instance. Low fat diet lover, excercise four times a week, love tomatoes, near ideal body weight and I got prostate cancer. So what’s the big deal? If someone wants to say that you can prevent something by living and eating better, what’s wrong with that? Well….you know that a normal PSA is around 4. And that a PSA in a patient with known prostate cancer that is in the hundreds would most probably indicate either cancer in the lymph nodes or in bone. So…I am watching this video clip on a “prostate cancer” survivor and he and his wife are stating that his PSA is 120 and that with high dose vitamins given to him through a homeopathic doctor the PSA had gone to 110. He then said,” I don’t feel that the vitamins after 6 months have done much good. My wife and I then decided it might be time to see our urologist.” This is the problem. Patients tend to take a small bit of information that they have learned from a friend or the internet and then broadly apply to their prostate cancer in an inappropriate fashion. Don’t think of me as a snooty urologist, but there are nuances about prostate cancer that you just cannot glean from the internet.So….be careful out there….live well and eat well but remember…. if you are betting on herbs, diet and lifestyle to prevent you from getting prostate cancer and you are black and your father had prostate cancer….bet on the latter. And another thing……tomatoes and supper dupper prostate pill vs. a Gleason’s 8….. go with the Gleason’s 8.Finally….the reason the first article caught my eye is that I have been to San Luis Obispo. My wife and I and our 4 month old first son drove to California in May of 1979 and pulled a pop-up camper the whole way behind a 1.2 liter Toyota Corolla. One night we were at the Grand Canyon in that camper and our son Clay would not go to sleep. We were miserable. So…we packed up everything and drove all night and arrived in California by the next morning. Where we ended up was at a big rock that was out in the bay. I suppose that was Morrow Bay that is very near San Luis Obispo. Seems there something else there like a nuclear power plant in which there had been a famous protest march or something. I remember when we camped there that the California squirrels were bigger and more fluffy than our Georgia squirrels.
Viewpoint: Prostate cancer not a death sentence
The numbers are staggering. Ten million Americans have had cancer (there are more than 100 known types). One in two men gets cancer (50 percent chance) and 1 in 3 women gets cancer. The American Cancer Society predicts that 217,730 men will be diagnosed with prostate cancer this year and 32,050 will lose their lives to this disease.
One in 6 men will develop prostate cancer. In the United States, prostate cancer is the most commonly diagnosed cancer in men. It is the second most common form of cancer in the world (skin cancer is number one). Prostate cancer is the second leading cause of cancer deaths in American men, behind lung cancer.
However, in comparison to overall causes of death, only 3 to 5 percent of American men die from prostate cancer, while 35 percent of men die of heart disease. Ninety-four to 98 percent of men diagnosed with prostate cancer are still alive 10 to 20 years later. Prostate cancer is not a death sentence.
This good news derives from a four-pronged approach:
• Prevention through lifestyle changes like diet and exercise (Prost-ate cancer is 70 percent lifestyle and 30 percent hereditary, according to the Prostate Cancer Foundation).
• Early diagnosis through prostate-specific antigen screenings plus a digital rectal exam.
• Better treatment options for localized disease (cancer confined to prostate), including active surveillance as well as surgery and radiation, with fewer side-effects.
• Better control of advanced disease (cancer outside prostate gland).
When prostate cancer is small, it is also silent, with no symptoms. That is why routine testing is so important to detect cancer as early as possible. Because of screening, most prostate cancer diagnosed today (93 percent) is found at an early stage and has not spread to other parts of the body.
In recent years, the press has reported on results of several scientific studies that at best have provoked discussion in the medical community of the advancing science, art and timing of screening for prostate cancer, as well as whether to swiftly treat every early localized disease or to “go slow,” monitoring the cancer (active surveillance) until treatment is needed. Unfortunately this discussion has led to much confusion among men and the public in general.
To help dispel this confusion and provide answers (and as part of Prostate Cancer Awareness Month), the specialists with the Hearst Cancer Resource Center at French Hospital Medical Center and The Wellness Community are offering a free educational forum about the disease. The forum will be held from 6 to 8 p.m. Monday in the French Hospital Auditorium. Registration is required and a complimentary meal will be served.
Tom Comar is the president of the Central Coast Nurse Practitioners and Physician Assistants group and a prostate cancer survivor.
© 2010 San Luis Obispo Tribune and wire service sources. All Rights Reserved.
And now….this view the role that diet and lifestyle play in prostate cancer. What’s a man to do? I’d say have a good lifestyle and a good diet, but don’t count on it preventing you from getting prostate cancer.
Prostate Cancer Overview
In-Depth From A.D.A.M. Risk Factors
The major risk factors for prostate cancer are age, family history, and ethnicity.
Prostate cancer occurs almost exclusively in men over age 40 and most often after age 50. Two-thirds of prostate cancers are found in men over age 65. By age 70, about 65% of men have at least microscopic evidence of prostate cancers. Fortunately, the cancer is usually very slow growing and older men with the cancer typically die of something else.
Family History and Genetic Factors
Heredity plays a role in some types of prostate cancers. Men with a family history of the disease have a higher risk of developing prostate cancer. Having one family member with prostate cancer doubles a man’s own risk, and having three family members increases risk by 11-fold. A specific gene, named HPC1 (for “hereditary prostate cancer”) is associated with this inherited type of the disease.
Scientists are researching other genetic variations that may increase prostate cancer risk.
Race and Ethnicity
African-American men have higher rates of prostate cancer than men of other races. They are also more likely to develop prostate cancer at a younger age and to have more aggressive forms of the disease. However, race alone does fully explain this difference. Prostate cancer is more common in North America and northern Europe, and less common in Africa, Latin America, and Asia. Diet and other factors may play a role. For example, Asians who live in the United States have a higher rate of prostate cancer than those who live in Asia.
Male hormones (androgens), particularly testosterone, may play a role in the development or aggressiveness of prostate cancer. Other types of hormones, such as the growth hormone insulin-like growth factor-1 (IGF-1), may also be associated with some types of prostate cancer.
Inflammation and Infection
Researchers are studying whether prostatitis (inflammation of the prostate gland) may be associated with increased prostate cancer risk. They are also examining the possible relationship between prostate cancer and sexually transmitted infections, such as herpes virus and human papillomavirus , but no definite association has yet been found.
Because a Western lifestyle is associated with prostate cancer, so dietary factors have been intensively studied. Results have been inconsistent and inconclusive, however.
Fats. Some studies have found an association between high fat-intake and prostate cancer. In particular, high consumption of red meat and high-fat dairy products has been linked to increased risk for prostate cancer. In contrast, the omega-3 fats in fish may be protective.
Vegetables and Fruits. A diet rich in vegetables, fruits, and legumes appears to protect against prostate cancer. However, it is not clear whether this is due to the nutrients contained in these foods, or the fact that these foods are low in fat. No specific vegetable or fruit has been proven to decrease risk. Lycopene, which is found in tomatoes, has been a target of research interest, but the evidence for its protective benefit is still inconclusive.
Vitamins and Minerals . Major clinical studies have found that vitamin and mineral supplements (vitamin E, vitamin C, vitamin D, and selenium) do not prevent prostate cancer. Nutritious foods that are part of a healthy diet are the best sources for vitamins and minerals. A high intake of calcium has been linked to an increased risk of prostate cancer in some studies.
5-ARI Drugs for Prostate Cancer Prevention
Finasteride (Proscar, generic) and dutasteride (Avodart) are drugs used to treat benign prostatic hyperplasia (BPH). They block an enzyme that converts testosterone to dehydroepiandrosterone (DHEA), the form of the male hormone that stimulates the prostate. These medications belong to a drug class called 5-alpha-reductase (5-ARI) inhibitors.
In 2009, the American Society of Clinical Oncology (ASCO) and the American Urological Association (AUA) issued a joint guideline recommending that doctors discuss the pros and cons of the use of 5-ARIs for prostate cancer prevention with men who:
- Have a PSA score of 3.0 or below
- Are being screened yearly for prostate cancer
- Do not yet show signs of prostate cancer
ASCO/AUA also recommended that patients who already take finasteride or dutasteride for controlling urinary symptoms of BPH should talk with their doctors about continuing to take the drug for prostate cancer prevention.
The guideline is the first to recommend drug therapy for preventing prostate cancer. It was based on results of a large 7-year clinical trial that showed that finasteride reduced the overall relative risk of developing prostate cancer by about 25%. However, in this study, a few more men who took finasteride developed a high-grade aggressive form of prostate cancer than the men who did not take finasteride. More recent studies have suggested that 5-ARI drugs may not increase the risk of developing aggressive cancer. It is still unclear if finasteride is an appropriate preventive approach, and not all doctors agree with the ASCO/AUA guideline.
Finasteride and dutasteride may cause reduced sexual drive and problems with erection during the first 1 – 2 years of use. It is not yet known what the long-term effects of 5-ARIs are if they are taken for longer than 7 years.