Friday, October 14, 2011

Should You Get the Test for Prostate Cancer?

Two years ago the United States Preventive Services Task Force stirred up a bit of controversy by stating, after an intensive review of the medical literature, that Mammograms don’t have a good cost/benefit analysis for women under age 50 (see blog November 2009.) Just as the dust was beginning to settle, the Task Force is at it again; it now recommends that asymptomatic men forego the famous PSA, or Prostate Specific Antigen widely used to screen for prostate cancer.

Just as I agreed with the Task’s Mammogram recommendations, I agree that the PSA should no longer be done, unless men are having symptoms in their genitourinary area. But, before you have a cow, please, keep in mind that any man who wants the test may still get it, just as any woman who wishes to have a Mammogram may do so.

I plan to recommend ambivalent asymptomatic men that they forego the PSA. Of course, some men will choose to get the PSA and then ignore a positive finding, or will welcome aggressive follow up testing and treatment if the PSA were to be elevated. Some men may also choose screening to implement the lifestyle changes outlined below. I will gladly do the test for them while I review the Task Force’s reasons for its recommendation stance. It is based on many studies, most of which I have reviewed, that have concluded that any treatment or prostate cancer is not likely to prolong life. While they may make the consequences of cancer less problematic in some cases, the incidence of problems like incontinence and impotence is high enough to question the potential benefits from aggressive therapy. In fact, conservative therapy has better survival.[1]Besides, the PSA leads to over-diagnosing or unwarranted testing and procedures on healthy men.[2]

Whence prostate cancer?

Once we determine why men get prostate cancer we may then be more effective in preventing it. At an Endocrine Society Symposium in 2005 it was posited that estrogen-like chemicals in the environment (plastics, heavy metals, pesticides, dioxins chlorinated compounds, etc) over stimulate growth of the prostate and female sex organs and breasts.[3] This problem is worsened in those who do not eat optimal amounts of plant-based foods, particularly cruciferous vegetables[4] that are redolent with antioxidants to fuel our detoxification pathways.[5] In other words, any amount of over stimulation of those sensitive tissues is “the canary in the coal mine.”[6]

Consequently, poor diets high in alcohol, fats[7] and refined sugars[8] increase the risk of any cancer. In 1931 Dr. Otto Warburg won the Nobel Prize in Medicine by demonstrating that cancers are more common in those whose glucose levels are higher. This is one of the reasons that dairy has been linked to prostate cancer:

High milk consumption has consistently not been associated with lower risk of fractures in large prospective studies, whereas increased risks of advanced or fatal prostate cancer have been observed in many studies.”[9]

How to lower your risk of prostate cancer

Obviously, avoiding estrogen-like toxins (“xenoestrogens”) is the first step. Minimizing processed foods and cutting down on alcohol and dairy products is also recommended. Eating plant based foods may reduce the risk of ANY cancer by 2/3.[10] Changing our lifestyles for only two years as above, while being more active and maintaining good relationships has been shown to significantly reduce the risk of prostate cancer.[11] It seems that the protective changes accrued involve DNA changes, specifically, lengthening the chromosomes’ telomeres,[12] a concept that won the Nobel Prize in 2008.

Details

Vegetables have more zinc[13] and selenium;[14] they help lower the risk of prostate cancer. Herbs like Milk Thistle[15] and Curcumin[16]have shown significant benefits. The following nutrients have also been shown to be helpful, in addition to the ones highlighted in the September 2011 newsletter, like pomegranate juice:

Soy isoflavones, J. Nut and Cancer 2008;60:461

Green tea, J. Nut and Cancer 2008;60:483

Walnuts, J. Clin Cancer Res 2008;14:4491

Fish, J. Nut and Cancer 2008;60:222

Tomatoes, J. Nutrition and Cancer 2008;60:145

Vitamin D J. Carcinogenesis 2005;27:32

Grape seed extract, Int J. Cancer 2004;108:733

Olive oil, Br J. Nut 2002;88:225

The best!

…. Or men would like to think so: frequency of ejaculation is not related to prostate cancer, but it might reduce its incidence![17] Guys always ask me to write that down as a prescription to show their significant others….



[1]Conservative Management on Prostate Cancer,” JAMA 2009;302:1202

[2] J. Natl. Cancer Inst. 2009 :101; 1293

[3]Endocrine-disrupting chemicals probed as potential pathways to illness,” JAMA 2005;294:291

[4] J. National Cancer Institute 2000;92:61

[5] J. National Cancer Institute January 5th 2000

[6]Prostate enlargement: the canary in the coal mine?” Am J. Clin Nut 2002;75:605

[7] American Cancer Society 2005

[8]Prostate cancer prevention [is possible] by nutritional means to alleviate metabolic syndrome,” AJCN 2007;86:889S

[9] Am J. Prev Med 2005;29:320 & British J. Nutrition 2006;95:539

[10] Apoptosis by dietary factors,” J. Carcinogenesis 2007;28:233

[11]Clinical Events in Prostate Cancer Lifestyle Trial: results from 2 years follow up,” J. Urology 2008;72:1319

[12]Increased Telomere Activity and Comprehensive Lifestyle Changes,” J. Lancet Oncology 2008;9:1048

[13]Zinc deficiency alters DNA damage response genes in normal human prostate epithelial cells,” J. Nutrition 2008;138:667

[14] J. Nut and Cancer 2008;60:171

[15] J. Carcinogenesis 2001;22:1399

[16] J. Carcinogenesis 2007;28:1188

[17] JAMA 2004;291:1578

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