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PROSTATE CANCER PREVENTION
AND CONTROL GUIDE
(Revised December, 2008 for the USMA Class of 1958)
We are all at
significant risk for cancer, more so as we age. Our cells are
mutating all the time. It comes with the environment replete with
a multitude of chemical and radiological carcinogens. It only
takes one cell to develop into cancer. The significance to those
of us at our stage of life is that as many as half of us in our 70’s
have latent prostate cancer (PC), the causes of which are not yet fully
understood. But there are at least three factors: lifestyle
choices, genetic propensity and exposure to carcinogens.
Fortunately, we all come equipped with an amazing built-in immune system
that helps keep latent (histological) cancer from becoming symptomatic
(clinical) in any of its many forms. That is unless we fail to
maintain that system properly or we allow it to become overwhelmed with
more carcinogens than it is designed to handle. And fortunately,
while there is still much to learn about PC, we have enough information
to know that there is a great deal we can do to decrease the chance that
it will ever become symptomatic, despite popular beliefs to the
contrary. We can choose to apply that knowledge to modify our
diets and our behavior to help prevent it, or if need be, help reverse
its course after the fact. Fortunately, the
positive effects of doing so also help us to prevail over most other
threats to our wellness, and involve eating right, exercising, avoiding
exposure to toxins, reducing stress, and getting adequate sleep.
Eat Right
Cancer experts estimate that diet
accounts for up to 90% of cancers of the prostate. Between various
clinical trials and studies of diets among diverse populations, a number
of food substances have been shown to inhibit PC cell growth and others
to promote it. Men in Japan
and China,
for example, have up to 90 percent fewer incidences of prostate cancer
than American men. That is until they migrate here and assume our
lifestyle. The best evidence points squarely to a difference in
nutrition as a major factor.
To maximize protection, get your
carbohydrates by consuming a variety of fresh fruits and vegetables.
Broaden your selections. Go for a mix of colors to get a wide
range of different nutrients. Experiment with new choices and
preparations till you find what appeals. If you supplement your
carbohydrate intake with cereals, breads, pastas and rice, then favor
whole grain foods over the refined products. Stick to the
monounsaturated fats like olive and canola oil, and avoid the saturated
fats and the partially hydrogenated oils and trans fats found in
margarines, deep fat fried foods, many commercially prepared foods,
poultry skin, red meat and the like. Avoid animal fat.
Polyunsaturated fats have positive health benefits as well, but we
usually get enough of those in commercially prepared and restaurant
foods. Fulfill your body’s need for protein through lentils,
beans, fish, poultry white meat, small amounts of lean red meat if the
urge persists, egg white/substitute, cheeses that are fat free, skim or
reduced fat, and soy products -- soy milk, tofu, tempeh and soy protein
powder. Soy products have the advantage of containing genistein,
shown to aid in fighting PC. Then wash it all down with a glass of
red wine a day. Add an 81 mg aspirin a day on top of that.
And drink some green tea. But watch your weight. There
is a direct link between obesity and PC. And there are increasing
indications that high levels of cholesterol (a building block of
testosterone) may be associated with PC risk.
There are some other food substances
shown to fight PC cell growth. Lycopene, found in cooked tomato
products, tomato concentrates, watermelon, apricots, guavas and pink
grapefruit, has recently been shown to have little effect on preventing
localized, early stage PC. But once the cancer has formed, high
levels of lycopene (or of carotenoids in general, including lycopene)
may reduce significantly the risk of the tumor progressing to an
advanced stage PC. And that tumor may have started developing well
before you are diagnosed. Pomegranate juice, a strong antioxidant,
has shown promise in lab tests. But like grapefruit juice, it may
interfere with the body’s metabolizing of certain prescription drugs.
Lupeol, an antioxidant found in fruits including strawberries, mangoes
and figs, may kill existing cancer cells and prevent new tumors from
initiating or progressing. Garlic, onions and leeks have more than
30 different enemies of carcinogens. Turmeric or curcumin, the
spice found in curry powder, holds real potential for the prevention and
therapy of PC, especially when combined with PEITC (phenethylisothiocyanate),
a naturally occurring substance particularly abundant in watercress,
cabbage, winter cress, broccoli, Brussels sprouts, kale, cauliflower,
kohlrabi and turnips. IP-6 (inositol hexaphosphate), found in
foods like beans, brown rice, whole-kernel corn, sesame seeds, wheat
bran, cornbread, grape juice and raisins, inhibits the activity of free
radicals in the body, which slows the type of abnormal cell division
associated with tumor and cancer growth. It’s also a big help for
those undergoing chemo and radiation therapy. Cranberries and
their juice have a number of tumor blocking compounds. Whey
protein in powder form or in yogurt is another PC fighting nutrient.
Even mushrooms have significant amounts of cancer fighting antioxidants.
Omega-3 deserves a special mention.
Omega-3 and 6 essential fatty acids, which your body can’t produce, play
key roles in the functioning of your hormonal systems, and should be in
balance with each other. And they were, in our ancestors’ diets
prior to the Agricultural Revolution. Today we get way too much
omega-6 in our diets particularly from commercial foods prepared with
oils from corn, soy, sunflower and safflower, all excessively high in
omega-6. You can increase your omega-3 consumption by eating fatty
fish from the coldest deep seas -- mackerel, anchovies, herring, salmon
and sardines. Be leery of farm raised salmon as a source.
Their feed is often high in omega-6 and PCBs, with food coloring later
added. Enquire about the source. You may still need to
supplement cold water fish with omega-3 fish oil capsules on the order
of 2-3 grams per day. Flax seeds are a good source, ground and
kept refrigerated. Add them to foods or suspend them in thick
juices such as tomato or V-8. But avoid flax seed oil in extract
form. It might actually promote PC cell growth. Walnuts are
another good source of omega-3 and selenium.
Try to get all of your vitamin and
mineral needs directly from whole fresh plant based foods, or in the
case of vitamin D, from moderate exposure to sunlight to allow your body
to manufacture and store it. Where necessary, round out those
needs with supplements. Between the two you should be getting on
the order of 200 mg of vitamin C, 600 IU of vitamin D (if you don’t get
much sun exposure, look for D3 choleciferol vs. D2 ergocalciferol), 400
IU of natural vitamin E with mixed tocopherols (fat soluble, take with
meals), 25,000 IU of mixed carotenes, and 200 mcg (don’t exceed 400 mcg)
of organic yeast bound selenium (take with the E). One caution
though, if you are undergoing chemotherapy or radiotherapy treatment,
antioxidants such as vitamins C and E may reduce its effectiveness.
There is a high correlation between
vitamin D deficiency and incidences of PC. Some 40% of men are
technically deficient in vitamin D. If you are at increased risk
for PC or get very little exposure to sunlight, consider having your
blood level checked for 1,25-dihydroxyvitamin D. It should be on
the order of 30-50 ng/ml.
You need calcium for strong bones and a
long-term hedge against osteoporosis. The RDA is 1,200 mg total.
If you are at high risk for PC, don’t exceed that. If you have PC,
consider cutting back. If you are on hormone therapy, which tends
to accelerate bone loss, consult with your oncologist for the hard
choices. You also need iron. Women need even more. You
normally get enough in your diet. Too much creates too many free
radicals. So do not take an iron supplement. The RDA for
zinc is 15 mg/day. You normally get enough without taking a
supplement. Too much increases PC risk. High doses (>100 mg)
more than doubles the risk for advanced PC. Taking glucosamine to
relieve osteoarthritis symptoms is okay, but avoid chondroitin sulfate
which may encourage cancer cell growth. Excessive selenium may
increase one’s risk for type 2 diabetes.
With supplements, more is not better.
Some have clear toxic levels not to be exceeded. Others are more
obscure. Recent findings show that more than one multivitamin a
day may promote advanced PC, suggesting that some oxidation is important
and too many antioxidants can be destructive. Also bear in mind
that it is difficult to know just how much of a given vitamin or mineral
we are actually getting without measuring our food, which few of us do.
To complicate matters, many prepared foods are fortified with vitamins
and minerals. Be aware and don’t overdo supplements.
Keep in mind that while supplements in
pure extract form may be helpful in rounding out an incomplete diet,
they are generally not as effective as their source found in the
original foods where their effects are enhanced by acting in conjunction
with other nutrients contained in the fresh food. Go fresh where
you can. And remember that supplements are unregulated with regard
to purity and strength. So buy reputable brands from responsible
sources.
Avoid Toxins
On the flip side of dietary intake is the
avoidance of toxins that put unwanted additional stress on your immune
system and in some cases promote and support tumor growth. Avoid
all manner of tobacco smoke. Check your drinking water against EPA
standards and filter it as necessary. Thoroughly wash or peel your
fruits and veggies, and remove pesticide laden outer leaves. Or
better still, buy organic, especially in place of those products
normally known to be high in pesticide content – apples, bell peppers,
celery, cherries, imported grapes, nectarines, peaches, pears, potatoes,
red raspberries, spinach, and strawberries . Organic, naturally
raised, pasture fed meat, poultry and dairy products, free of
antibiotics and growth hormones and containing omega-3 fatty acids are
also available at your local health food stores and farmers’ markets.
They may cost more, but so does cancer, and what price do you put on
your good health? Avoid food preservatives found in many
off-the-shelf food products. In fact, many commercially processed
foods contain a variety of unhealthy ingredients and should generally be
avoided in favor of naturally raised/grown foods prepared at home.
Don’t char your meat on the barbecue. Don’t over-heat cooking oils
to the point of smoking and breaking down into the bad fats.
Wild-caught fatty freshwater fish such as carp, catfish, bass, and trout
are prime candidates for contamination. Removing skin and bones
from all fish should eliminate about half of most contaminants. To
avoid ingestion of low levels of bisphenol A which can cause biochemical
changes in prostate tumor cells that make treatment for prostate cancer
less effective, don’t microwave food in plastic containers or even
“micro-wave able” plastic ovenware.
Exercise Regularly
A good daily exercise regimen is
essential to maintaining your immune system and fine-tuning your myriad
of complex bodily functions. It should include both aerobic,
anaerobic, strength, and stretching/deep-breathing components. If
you don't have the habit, now's the time to acquire it. Regular
exercise is one of the most important things you can do for your health,
and requires a daily investment.
A caveat: the following are suggested
optimal routines. Do what you can without torturing yourself.
Whatever you can do will be beneficial - the more, the better.
(1) Make exercising a priority. Put
it in your daily schedule. Don't make excuses such as "I'm too
tired." or "I don't have time today." Ben Franklin had time for daily
exercise; we do too. It helps if you have a variety of routines, so you
don't get bored. Music helps. A good club with lots of good-looking
women also helps.
(2) Warm up before exercising, and
stretch afterward. Stretching cold muscles is not the best way to
do it.
(3) Lift weights. This is as
important as cardiovascular exercise, and is actually easier. Use
machines or free weights. Exercise all major muscle groups, each
with one set of 8 -12 repetitions, with each repetition taking six
seconds. If you can lift 13 or more times in a set, you need to
add weight in your next session. In short, the last repetition
should be to failure. See anaerobic exercise below, and notice
that this is basically a one minute anaerobic interval - 10 reps x 6
seconds. Lifting weights to failure sends all sorts of good
messages to your muscles: "This guy will kill us if we don't get
strong." Lift 2-3 days per week. Don't punish the same
muscles two days in a row. They need rest.
(4) Do aerobic exercise every day, 20
minutes on weight lifting days and 30-60 minutes on other days.
Take your pulse. Aerobic means your muscles are burning oxygen,
heart rate about 110-120 bpm at our age. Getting your pulse up to
aerobic level should be easy. Running, biking, swimming, dancing,
or machines such as treadmills, steppers, elypticals, rowers and cycles
are all good. To combat boredom when indoors, use music or TV.
Do not, however, just grind away at a steady sub-aerobic or aerobic pace
for an hour or so. That's actually bad - unless you mix in anaerobics!
See Wikipedia for a good discussion of anaerobic exercise. What's
needed are intervals of anaerobic bursts of one minute each at 95%
effort or 140-160 bpm depending on your condition. A good
workout: 10 minute warm-up, then 5 minutes aerobic, then 1 minute
anaerobic, then 4 minutes easy recovery, then another 1 minute
anaerobic, and repeat for the duration of your workout. This does
not have to be torture. It's actually easier than just grinding away -
and much better for you.
(5) Play sports that make you go
anaerobic. Even at age 70+ we can still play sports, if our joints
are OK. Tennis, basketball, volleyball, badminton, squash and
racquetball are good examples.
(6) Spend a few minutes after exercising
to stretch and do deep relaxing breathing.
(7) Consider adding an activity like
yoga, tai chi or Pilates, which incorporates stretching, strengthening,
and balance. If all this seems impossible, remember that lots of
people do it, and enjoy it. Working out with friends helps.
If you want to look good, feel good, and
stay in good health, regular exercise is the ticket. Get the
habit. "Just Do It!" If that seems difficult, just talk to
anyone who has been afflicted with PC. The experience will make
you determined to do everything you can to avoid contracting it. And if
you do get PC, you'll be better equipped to survive if you're in good
shape and stay that way.
If you have been ill or have otherwise
gone a long time without regular exercise, consider first getting a
complete physical exam, including a stress ECG. And if your doctor
(preferably a jock himself!) gives the green light, then force yourself
to get back into it. Take it slowly, one step at time. But
keep at it. Doing what is comfortable is better than doing
nothing.
There are many folks today in their 80's
and 90's who work out every day. More and more research shows that there
is nothing as good for you as physical activity.
Sleep Well
Sleep is critical for maintaining an
effective immune system. It’s our body’s natural mechanism for
restoring its homeostatic balance and recovering from the impact of
daily life on our physical and mental systems and feelings of well
being. Aging takes an added toll on our ability to get adequate,
restorative sleep. BPH gets us up to urinate several times a night
(nocturia). We don’t produce brain chemicals in the same amounts,
and the brain doesn’t respond to these chemicals as effectively.
We have more on our minds, we get stressed out by more complex issues,
and we’re more apt to be depressed.
Here are some helpful suggestions: If you
have trouble falling asleep after about 30 minutes, get out of bed and
do something else until you feel tired. Go to sleep and get up
about the same time every day, varying not more than an hour on
weekends. Put at least two hours between dinner and going to bed,
especially if you are prone to heartburn or indigestion. If you
have nocturia, stop drinking liquids early in the evening. Avoid
caffeinated drinks and alcohol three hours before bed time. Be
cautious about using sleeping pills; older people are at higher risk of
side effects. For example, for those with BPH, the use of
diphenhydramine, an antihistamine (found in brand names like Nytol,
Sominex, Sleepinal, Compoz) as a sleep aid can make it difficult to
urinate. However, if BPH is not an issue, Benadryl, an
antihistamine, is well tolerated, not habit-forming, has no after
effects, and may aid in getting to sleep for most people. Being
tired from a good workout may be helpful, but avoid busy or stressful
activities late in the evening; rather unwind and relax. Get a
short afternoon nap in, but not beyond 3 p.m. If you have a sleep
disorder such as sleep apnea, get it treated. If there are
physical or emotional issues interfering with your developing and
maintaining consistent, effective sleep patterns, learn how to overcome
them, get them resolved, and seek professional help if need be.
Melatonin, the hormone which regulates
the circadian rhythm to determine when we fall asleep, is often found to
be at reduced levels in those with PC and heart disease. It has
also been shown to block PC cell growth in lab studies. If your
melatonin level is low for whatever reason, if you have frequent jet lag
or poor vision, or if you typically operate on a reverse cycle, consider
melatonin supplementation. Dosage levels have not been
established, and too much may cause anxiety and irritability. So
start with a very low dose, follow timing guidance, and check for
interactions with other drugs. Or alternatively, meditation may
cause melatonin levels to rise and can be a valuable addition to the
treatment of PC.
Avoid Chronic Stress
Stress is good—up to a point. It
keys our bodies to perform at higher levels of efficiency, be it the
fundamental fight or flight response to danger or responding to sudden
pressures imposed by the work place or modern day environmental factors,
and it prepares us to meet a tough situation with focus, strength,
stamina, and heightened alertness. Adrenaline and cortisol are
released into the bloodstream to speed up heart rate, breathing rate,
blood pressure, and metabolism. Blood vessels open wider to let more
blood flow to large muscle groups, putting our muscles on alert. Pupils
dilate to improve vision. The liver releases some of its stored glucose
to increase the body's energy. And sweat is produced to cool the body.
All of these physical changes prepare us to react physically in a quick
and effective manner to handle the pressure of the moment.
In today’s environment, however, our
stressors and responses thereto tend to be more emotional than physical.
And ongoing emotional stress and response can produce chronic stress
symptoms, which is bad. The continued low level release of
hormones over time without accompanying physical exertion adversely
affects our immune system and tends to elevate our PSA levels.
Yes, there is a direct correlation between PSA and stress levels.
If chronic stress is a major part of your
life, make a concerted effort to eliminate or attenuate the stressors.
Change your lifestyle where appropriate. Seek control,
information, predictability and solutions. Where these are
elusive, find outlets for relieving stress -- exercise, prayer,
meditation, yoga, psychotherapy, guided imagery, sports, music, and the
like. Exercise has the fastest and most dramatic effect on
reducing stress. Find sources of social affiliation and support.
As the Cadet Prayer encouraged us, “Grant us new ties of friendship…
Kindle our hearts in fellowship with those of a cheerful countenance…”
And the AA prayer pretty well sums it up -- “God, grant me the serenity
to accept the things I cannot change, courage to change the things I
can, and wisdom to know the difference.”
If need be, get professional help through
the many hospitals, medical schools and freestanding clinics offering
programs that help you learn various techniques for stress management.
One of these is therapeutic biofeedback to help develop the ability to
monitor and control certain physiological processes through structured
stress and anxiety reducing interventions. There are interactive
computer software programs that apply biofeedback techniques available
for home computer use.
Know Where You Stand
By all means, get PSA and DRE tests once
a year. Don't be content with being told that "Your PSAT score is
normal." Get your current and previous three year numbers and look
for change or “velocity”. At our age an annual increase of
0.6 ng/ml or more (0.4 for the <60s) is a definite red flag, even if you
are within the so called normal range -- <4.0, or <3.0 with a family
history of PC. But don't panic. An elevated PSAT score could
be caused by a benign infection that a few weeks of antibiotics may
remedy. Or it could be elevated by having had an orgasm within 48
hours prior to the test or by a recent trauma to the prostate such as a
catheter insertion. Or your provider may have switched labs having
differently calibrated instruments. Be aware that to start taking
statins to control cholesterol, or saw palmetto, statins or various
drugs to control BPH may produce a change from your previous baseline
and affect interpretation of your numbers. Consult with your
urologist on that. Beyond the daily 81 mg. of aspirin, taking a
dose of aspirin or other NSAID before a PSAT can reduce the score and
affect interpretation. Seasonal variations too can affect the
score by as much as a 0.5 ng/ml rise in the summer.
If it is determined that a biopsy is in
order, then go for it. Be guided by one of Gen. Creighton W.
Abrams' memorable aphorisms: "I have never known bad news to
improve with age." If PC is caught in its early stages, your
treatment options and likelihood of an effective cure are greatly
enhanced.
For those who have consistently elevated
PSA levels and have had one or more standard transrectal prostate
biopsies (TRPB) with negative results, if yet another biopsy is called
for, ask for the newer stereotactic transperineal prostate biopsy (STPB)
which has shown in a recent study to have a greatly enhanced level of
confidence in detecting the presence or absence of cancer, and more
specifically, the exact location of the cancer within the prostate.
Risk Factors
Risk is a major consideration in testing
for PC and choosing to take preventive measures, and there is a strong
genetic component involved. If you have one or more family members
who have been diagnosed with PC or ovarian or breast cancer, you
probably have a greater risk of contracting PC as well. Being
genetically predisposed does not mean you will get PC yourself.
But it does mean the triggers are more sensitive and you need to take
greater precautions in lifestyle choices and being tested for PC.
Being overweight is not a threat.
However, obesity (a Body Mass Index of 30 or more) not only increases PC
risk, but it tends to distort PSAT score readings downward (lower PSA
concentrations per volume of blood) and increase the possibility of
advanced cancer. Again, look for year to year change.
Mind-Body Connection
If you have been diagnosed with PC, the
above guidance becomes doubly important to follow. But you also
have yet another tool in your arsenal to apply to enhancing your immune
system's performance--your mind. We're not sure how it works, but
there is a definite link between your immune system and your mind.
It's called the mind-body connection, and we are all familiar with one
of its subsets, the "placebo effect." We often hear the terms
"miraculous cures" and "spontaneous remissions." They are
neither miraculous nor spontaneous. Rather they are most often the
result of a sick individual making major life style changes and becoming
convinced in his mind that they will enable him to prevail. Those
changes could be in the form of diet, exercise, the developing of
supportive social relationships, the application of religious faith, the
use of visualization techniques, or implicit faith in one's doctors and
treatments, or a combination thereof. The net result is the mind
triggering that mind-body connection, however it works, to boost the
immune system. It may not always bring about a cure, but it will
certainly help the process. And for the mind to best do its job,
we need to keep it sharp as we age. That means exercising it with
such activities as crossword puzzles, sudoku, learning a foreign
language or musical instrument, problem solving, memorizing a poem or
passage and the like--anything that challenges your intellect.
Reducing stress, expanding social relationships, proper diet to include
antioxidants and omega-3, exercise, and the judicious use of alcohol
(1-2 drinks max per day) have also shown to help keep the mind sharp as
we age.
Making Changes
For most of us, acting on the advice
given here requires a significant degree of behavioral modification.
Change can be scary. It entails giving up that which is known and
comforting to us for the unfamiliar and therefore seemingly difficult
and/or unpleasant. Doing so effectively can only come from doing
your homework, understanding the facts, assessing the risks and rewards
normally associated with alternative behaviors and deciding that change
is in one’s overall best interest. What is the current likelihood
of your contracting PC? What are the probable consequences if you
do? What changes are you willing to make in order to avoid these?
The problem is we don’t really know the answer to that first question
until it’s too late, in which case this guide becomes doubly important
to follow to enhance your chances of survival, when the question then
becomes what changes are you willing to make to survive? Bear in
mind that a diagnosis of PC is a wake-up call, a stark reminder that
your ongoing lifestyle up to that point did not afford you the
protection necessary to avoid contracting the cancer, given whatever
circumstances may have led to the diagnosis.didn’t work for you.
It’s high time for some major changes.
An excellent companion to this guide is
Dr. Dean Ornish’s book “The Spectrum” which provides the “why” and the
“how’ to the guide’s “what”. To paraphrase Ornish, don’t think of
change in terms of deprivation and sacrifice, but rather what we gain is
so much more than what we give up. Be motivated by the joy of
living, not the fear of dying. And remember, it doesn’t have to be
all or nothing. Every little bit helps.
And finally…
We hope this guide will help to point you
in the right direction for achieving and maintaining wellness and
avoiding PC or stopping it in its tracks once diagnosed. Volumes
have been written and exhaustive studies have been conducted on the many
subjects we have touched upon. There are still many unknowns
surrounding the causes, prevention and treatment of PC, and this guide
is a consensus of what we as informed laymen consider to be the best
information available at this time. As new and better information
becomes available, we will do our best to disseminate it, and if you
acquire information that you believe is relevant, please let us know.
If you would like references for further understanding of the subjects
discussed here, or if you have suggestions for improving the utility of
this document, contact the PC list moderator for assistance. The best
thing you can do for yourself, your family and friends is to get
informed and get involved.
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