Obesity and Prostate Cancer

In this section of the website, we'll look at the different food types and discuss which nutrients are most likely to be "prostate-cancer protective." But before we do, we need to address the most crucial dietary problem of all—the fattening of America.

Over the past 40 years, the rate of obesity has been steadily climbing. In 2002, the last year for which the data are available, a whopping 65% of adults in the United States were classified as overweight or obese, with a body mass index (BMI) over the accepted normal of 25. Even more disturbing is that 31% of children were classified as overweight or obese, placing them well above the 95th percentile for normal growth for their age.

Unfortunately, this increase in weight seems unlikely to be offset by an increase in physical activity, as approximately 40% of adults and teenagers do not exercise regularly. The combination of increased food intake and decreased physical activity has taken its toll on Americans and has resulted in increased rates of a variety of diseases, particularly diabetes.

Although the link between obesity and the risk of developing prostate cancer remains unclear, there is no question that obesity can have a negative effect on disease outcomes. Research has shown that prostate-specific antigen (PSA) test results in obese men can be lower despite the presence of disease, potentially leading to a delay in diagnosis and treatment; recovery from surgery tends to be longer and more difficult; and the risk of dying from prostate cancer can be higher.

Regardless of the nutritional approach that you ultimately choose, weight management must be an essential component of your overall strategy. Increasing your intake of vegetables can be beneficial—but not if they’re swimming in high-fat dressings or sauces. Similarly, nuts can be a great source of some key nutrients but can also be very high in fat and calories.

In addition, it is most important that you be sure to exercise regularly, at least 30 minutes a day at least 3 days each week. Not only will it help to burn off extra calories, but regular stretching exercises will help keep you limber and flexible, while resistance exercises and weight training will help maintain muscle strength and endurance. Walking, jogging, playing tennis or golf, and even gardening can be effective forms of exercise—the key is to stay on the go and stay off the couch.

As you sift through the data on this site and begin to consider what's right for you, don't forget to talk with your doctor or qualified nutritional consultant about how best to incorporate weight management and exercise strategies into your daily routine.

Nutrition & Prostate Cancer

Day after day, the effects of dietary and lifestyle changes on the development and progression of prostate cancer are being discussed and explored by leading researchers in the field.

Which foods and nutrients have been shown to be beneficial for patients with prostate cancer? How reliable are the data for nutritional strategies in prostate cancer? Are there foods or nutrients that might prevent prostate cancer or even prevent or delay a recurrence of the disease?

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Top 10 Considerations for Preventing Prostate Cancer

Top 10 Considerations for Preventing Prostate Cancer

To understand how to prevent prostate cancer, one must first understand what causes it. There are four major factors that influence one's risk for developing prostate cancer, factors which unfortunately cannot be changed.

Age: The average age at diagnosis of prostate cancer in the United States is 69 years and after that age the chance of developing prostate cancer becomes more common than any other cancer in men or women.

Race: African Americans have a 40% greater chance of developing prostate cancer and twice the risk of dying from it. Conversely, Asian men who live in Asia have the lowest risk; however when they migrate to the west, their risk increases.

Family history: A man with a father or brother who developed prostate cancer has a twofold increased risk for developing it. This risk is further increased if the cancer was diagnosed at a younger age (less than 55 years of age) or affected three or more family members.

Where you live: The risk of developing prostate cancer for men who live in rural China is 2% and for men in the United States 17%. When Chinese men move to the western culture, their risk increases substantially; men who live north of 40 degrees latitude (north of Philadelphia, Columbus, Ohio, and Provo, Utah) have the highest risk for dying from prostate cancer of any men in the United States – this effect appears to be mediated by inadequate sunlight during three months of the year which reduces vitamin D levels.
Given the facts above, which are difficult to change, there are many things that men can do, however, to reduce or delay their risk of developing prostate cancer. Why is prostate cancer so common in the Western culture and much less so in Asia, and why when Asian men migrate to western countries the risk of prostate cancer increases over time? We believe the major risk factor is diet – foods that produce oxidative damage to DNA. What can you do about it to prevent or delay the onset of the disease?

1. Eat fewer calories or exercise more so that you maintain a healthy weight.
2. Try to keep the amount of fat you get from red meat and dairy products to a minimum.
3. Watch your calcium intake. Do not take supplemental doses far above the recommended daily allowance. Some calcium is OK, but avoid taking more than 1,500 mg of calcium a day.
4. Eat more fish – evidence from two large studies suggest that fish can help protect against prostate cancer because they have "good fat" particularly omega-3 fatty acids.
5. Try to incorporate cooked tomatoes that are cooked with olive oil which has also been shown to be beneficial, and cruciferous vegetables into many of your weekly meals.
6. Eat more soy.
7. Top off your meal with green or black tea.
8. What about supplements? Although selenium and vitamin E have been shown to reduce the frequency of prostate cancer in smokers, the correct dose is tricky. Too much can be harmful. Until we know more about the value of these supplements, do not take more than you'll find in a multivitamin preparation.
9. Eat an apple a day, or better yet, an apple, an orange, a bowl of vegetable soup, tomatoes, broccoli, and maybe some corn on the cob. Try nature's packaging of phytochemicals instead of the health food store. Studies have shown that simply eating an apple a day gives your body far more antioxidant and cancer fighting help than taking megadoses of vitamins.
10. Finally, eating all the broccoli in the world, though it may make a difference in the long run, does not take away your risk of having prostate cancer right now. If you are age 40 or over, if you have a family history of prostate cancer, or African American, you need more than a good diet can guarantee. You need a yearly rectal examination and PSA test.

The Prevention of Prostate Cancer

The ultimate goal of prostate cancer prevention strategies is to prevent men from developing the disease. Unfortunately, despite significant progress in research over the past 15 years, this goal has not yet been achieved. Both genetic and environmental risk factors for prostate cancer have been identified, but the evidence is not yet strong enough to be helpful to men currently at risk for developing prostate cancer.

By contrast, some success has been seen with strategies that can delay the development and progression of prostate cancer. Studies with finasteride and dutasteride, which are typically used for men with the noncancerous condition BPH, have shown that they might play a role in slowing the development of prostate cancer; ongoing studies will help to define the optimal role of these agents.

In the meantime, diet and lifestyle modifications have been shown to reduce the risk of prostate cancer development and progression, and can help men with prostate cancer live longer and better lives.

Risk Factors of Prostate Cancer

Prostate cancer is the most common non-skin cancer in America, affecting 1 in 6 men. The older you are, the more likely you are to be diagnosed with prostate cancer. Although only 1 in 10,000 under age 40 will be diagnosed, the rate shoots up to 1 in 38 for ages 40 to 59, and 1 in 15 for ages 60 to 69. In fact, more than 65% of all prostate cancers are diagnosed in men over the age of 65.

But the roles of race and family history are important as well. African American men are 61% more likely to develop prostate cancer compared with Caucasian men and are nearly 2.5 times as likely to die from the disease. Men with a single first-degree relative—father, brother or son—with a history of prostate cancer are twice as likely to develop the disease, while those with two or more relatives are nearly four times as likely to be diagnosed. The risk is even higher if the affected family members were diagnosed at a young age, with the highest risk seen in men whose family members were diagnosed before age 60.

Although genetics might play a role in deciding why one man might be at higher risk than another, social and environmental factors, particularly diet and lifestyle, likely have an effect as well.

In fact, research in the past few years has shown that diet modification might decrease the chances of developing prostate cancer, reduce the likelihood of having a prostate cancer recurrence, or help slow the progression of the disease.

More information about how dietary and lifestyle changes can affect the risk of prostate cancer development and progression can be found in the Nutrition and Prostate Cancer guide.

When weighing risk factors for prostate cancer, it’s also important to recognize that there are non-risk factors, or factors that have not been linked to an increase in risk.

What Can Go Wrong With the Prostate: Cancer, BPH, and Prostatitis

For most young men, the prostate falls into the category "obscure body parts" that includes the spleen—that is, it's in there someplace, it probably does something useful, but it's best dealt with on a need-to-know basis.

Unfortunately, most men are going to need to know about the prostate sometime, because this little gland is the source of three of the major health problems that affect men: prostate cancer, the most common major cancer in men; benign enlargement of the prostate (BPH, or benign prostatic hyperplasia), one of the most common benign tumors in men and a source of symptoms for most men as they age; and prostatitis, painful inflammation of the prostate, the most common cause of urinary tract infections in men. Worse, because there's no "statute of limitations" on prostate problems, some men are unlucky enough to endure more than one of these disorders. For example, having BPH or prostatitis doesn't mean a man has "had his prostate trouble" and won't have further difficulty—either a return of symptoms or a new problem entirely, such as prostate cancer. Although this is a book about prostate cancer, when it comes to making the diagnosis and planning treatment, the other prostate disorders must be considered, too. Thus, it's important that men know about all of the "Big Three" prostate problems—what they are, how they are treated, and their telltale symptoms.

Fortunately, effective treatment and relief of symptoms is available for all of these prostate disorders. Even prostate cancer, when caught early, is curable—generally without causing loss of urinary control or sexual function. Better still, for the first time ever, we are very close to understanding how to keep advanced cancer in check, perhaps even for years.

Prostate Symptoms and What They May Mean

(This information is from Dr. Patrick Walsh's Guide to Surviving Prostate Cancer)

Symptoms of urinary obstruction . . .

Weak flow
Hesitancy in starting urination; a need to push or strain to get urine to flow
Intermittent urinary stream (starts and stops several times)
Difficulty in stopping urination
Dribbling after urination
A sense of not being able to empty the bladder completely
Not being able to urinate at all

. . . could be caused by

Benign prostatic hyperplasia (BPH)
Urethral stricture
Prostate cancer
Medication
Neurogenic bladder (bladder trouble caused by a neurological problem, such as Parkinson’s disease)

Symptoms of irritation . . .

Pain or burning during urination
Frequent urination, especially at night
A strong sense of urgency in urination; inability to postpone urination
Sleep disrupted by the need to urinate
Urgency incontinence

. . . could be caused by

Thickened bladder, caused by obstruction from BPH
Infection in the bladder or prostate
Bladder tumor
Bladder stone
Neurogenic bladder

About Prostate

Understanding what happens when prostate cancer begins to grow also helps explain how each of the different treatment options for prostate cancer is utilized.

Normal Anatomy
The prostate is a small, squishy gland about the size of a walnut that sits under the bladder and in front of the rectum. The urethra, the narrow tube that runs the length of the penis and that carries both urine and semen out of the body, runs directly through the prostate; the rectum, or the lower end of the bowel, sits just behind the prostate and the bladder.

Sitting just above the prostate are the seminal vesicles, two little glands that secrete about 60% of the substances that makes up semen; running alongside and attached to the sides of the prostate are the nerves that control erectile function.

Normal Physiology and Treatment-Related Changes
Despite the best efforts of physicians, treatment strategies for prostate cancer can disrupt normal urinary, bowel, and sexual functioning.

Under normal circumstances, the urinary sphincters, bands of muscle tissue at the base of the bladder and at the base of the prostate, remain tightly shut, thereby preventing urine that is stored in the bladder from leaking out. During urination, the sphincters are relaxed and the urine flows from the bladder through the urethra and out of the body.

During prostatectomy, after the prostate is removed, the bladder is pulled downward and is connected to the urethra at the point where the prostate had sat. If the sphincter at the base of the bladder is damaged during this process, or if it is damaged during radiation therapy, some measure of urinary incontinence or leakage will occur.

Solid waste that is filtered out of the body moves slowly down the intestines, and, under normal circumstances, the resultant stool is excreted through the anus following conscious relaxation of the anal sphincter. Damage to the rectum caused by radiation, or, more rarely, by surgery, can result in a number of bowel problems, including rectal bleeding, diarrhea, or urgency.

If the erectile nerves are damaged during prostatectomy, which was standard during this type of surgery up until the mid 1980s, the ability to achieve erection is lost. Sexual desire is not affected, but severing or otherwise damaging the nerves that stimulate the processes by which erection occurs leads to erectile dysfunction.

Finally, because about 10% of men have what is known as seminal vesicle invasion, meaning that the prostate cancer has either spread into the seminal vesicles or has spread around them, the seminal vesicles are typically removed during prostatectomy and are targeted during radiation therapy. The loss of the prostate and the seminal vesicles renders men infertile. (www.prostatecancerfoundation.org)

Why Does Nutrition Matter?

Why Does Nutrition Matter?

When looking at why some people develop cancer and others don't, there are three factors that play a meaningful role and that are unchangeable: age, family history, and race. Depending on the type of cancer, one or more of these can play a pivotal role in increasing or decreasing your risk of developing the disease.

The older you are, the more likely you are to be diagnosed with prostate cancer. Although only 1 in 10,000 under age 40 will be diagnosed, the rate shoots up to 1 in 39 for ages 40 to 59, and 1 in 7 for ages 60 to 79. If you're African-American, you're about 1.5 times as likely as Caucasian patients to be diagnosed, and if you have at least one first-degree relative with prostate cancer—a brother, a father, or even a son—you’re more than twice as likely as the average man to be diagnosed.

But these statistics tell only part of the story. There are countless other factors that can influence your risk—factors over which we do have control; namely, diet and lifestyle.

The old adage of "you are what you eat" might not be completely true, but there is no question that our environment—and particularly our diet—influences the way our body functions. Think about how you felt the last time you ate that third burrito. How long did it take you to get over it? A few hours? A few days? Now think about all of the foods that you've eaten over the past years. How have our bodies managed to survive it all? Because for every extra bite of something not so smart, we also take in a host of nutrients that help our bodies continue running smoothly, and, in the short term, the effects are not usually noticeably harmful.

It's not much different when it comes to cancer: the body has natural defenses against allowing normal cells to become cancerous and allowing cancer cells to grow. But it is a very delicate balance, and it is easily upset by changes in our diet and our environment. For some cancers, the balance is easy to see. Nearly 90% of people in the United States who develop lung cancer are smokers. The longer you smoke, the more damage you cause to your lungs, and the greater your likelihood of developing lung cancer. Take away the cigarettes, and the risk starts to inch its way down.

With prostate cancer, there is not yet evidence of a single causative factor that is likely to dramatically alter your risk. However, research has been showing in the past few years that ingesting certain nutrients might decrease your chances of developing prostate cancer, reduce the likelihood of having a prostate cancer recurrence, or help slow down progression of the disease. Although it will likely take some time before results of these studies conclusively demonstrate the benefits of nutrition in prostate cancer, there is already good evidence that some of these dietary changes are beneficial in other chronic diseases, particularly heart disease. Adoption of these dietary changes can therefore be seen as an important step in a path toward a more healthy lifestyle overall.