Lifestyle and Prostate Cancer

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There is increasing evidence, that lifestyle, diet and environment has a major impact on the risk of developing cancer, including the most common in men - prostate. The World Cancer Research Fund recently issued a statement that up to 50% of cancers could be avoided by a long term change in lifestyle. 

Prostate cancer is particularly unique as there is emerging evidence that a healthy lifestyle could reduce the rate of progression and risk of of relapse after radical initial treatments. A review of the published evidence has been sponsored by  Macmillan Cancer Support

Self help lifestyle programme's can also have a significant impact on the severity of adverse side effects and risk following cancer treatments. The most important are summarised in the headings below with links to more comprehensive advice pages:

Physical activity Several large studies link regular exercise with a reduced risk of prostate cancer relapse after radical treatments. It also reduces the rate of PSA progression especially if combined with a healthy diet. Three hours a week is the minimum target, (moderate to brisk walking >3 miles/hour) but up 5-6 hours still confers a benefit. Exercise helps alleviate many of the adverse risks of androgen deprivation therapies (e.g.Zoladex) including weight gain, mood swings, hot flushes, blood clots and  osteoporosis. After radiotherapy it improves risk of urinary urgency, a better urinary stream and better erections. After surgery, particularly if combined with pelvic floor exercises it reduces incontinence risk.

The are numerous exercise programmes available which can suit most needs, abilities and preferences. These range from  from walking groups, dance classes, dragon boat racing  to formal gym classes. There is a national referral scheme for exercise after many illnesses and in some areas this applies to cancer- more about exercise and local facilities

Avoid obesity Being overweight increases the risks of surgery, chemotherapy hormone therapy and radiotherapy. It delays wound healing, increases the risk of infection and blood clots. After radiotherapy it increases the risk of pelvic symptoms particularly urinary and rectal urgency and incontinence. 

Overweight men on hormone therapies have more hot flushes, join pains and risks of blood clots. A variety of studies have linked obesity with and high rate of prostate cancer, more aggressive forms of cancer. A number of published reports have linked obesity with a higher risk of psa progression in men treated with active surveillance. Other studies have shown that obese men are more likely to relapse after radiotherapy or surgery - tips to help control a healthy weight

Healthy sun (vitamin D) Unlike other essential nutrients >80% of our vitamin D is made in the skin following interaction with sunlight. The trouble is, especially in the UK, we do not get enough sun and hence many of us are Vitamin D deficient which is associate with an increased risk of cancer.  A presentation at the NCRI conference 2012 reported the vitamin D of individuals who had bought nutritional tests from the online service established by cancernet. Over 95% of participants had 25 hydroxy Vitamin D levels lower than 75 nmol/l. and 73% had levels less than 50nmol/l.  (See full presentation).

As well say regular sun exposure (without sun burning), try to increase other foods with can help increase Vitamin D levels such as oily fish, nuts and sun dried mushrooms - lifestyle tips to increase vitamin D

Reduced processes sugar

Try to avoid processed foods, pre-packed ready meals particularly those labeled as ‘diet’. Train yourself to resist sweet snacks: cakes, sweets, biscuits and chocolate bars, sweet drinks: such as cola or other fizzy drinks or adding sugar to tea or coffee. Steer clear of restaurants which add sugar to their meals  >>>more

Healthy plant based foods. Regular intake of several  foods  have been linked to a lower risk of prostate cancer intake of vegetables, colourful  fruit, herbs and spices. These foods are rick in nutrients and healthy phytochemicals which have anti-cancer properties; They contain minerals and vitamins essential for  healthy metabolism and immunity; They have anti-oxidants which mop up free radicals before they damage protecting over DNA;  They have phytoestrogenic properties reducing 5 alpha reductase lowering testosterone levels; They contain polyphenols which have been shown to have direct effects on a number hallmarks of cancer proliferation and spread in laboratory studies.

Try to increase intake of   Green tea,  broccoli,  pomegranate,  turmeric as well as green cabbage, spinach, dark green lettuce leaves (rocket), leaks, onions, celery, herbs and spices including garlic, parsley, mint, coriander, thyme, rosemary and turmeric as well as nuts legumes and colourful berries - .tips to increase plant based foods

Smoking  increases the risks of blood clots on hormone therapies, mouth ulcers on chemotherapy and a higher risk of skin damage. After radiotherapy it si associated with a higher risk of erectile dysfunction and pelvic symptoms such as urgency and incontinence. Several cohort trials have also shown that smoker tend to with more aggressive grades of prostate cancers at diagnosis which suggest a worse outcome. Men who continue to smoke after treatment have a higher risk of relapse.

There are many other reasons to quit - making a commitment to quit and sticking to it. Make a time and date. Most people who successfully quit smoking do so by stopping altogether, and not by gradually cutting down. Make a promise to yourself and a punishment if you fail (e.g. give money to you a charity)  - 10 tips to give up smoking

Polyphenol rich supplements There is plenty of good evidence that individuals who eat good quantities of polyphenol rich foods have a lower risk of cancer. Likewise after cancer regular consumption reduces the relapse rate and slows PSA progression. Concentrating foods into a pill may be a convenient way to boost intake but up to now most of the studies involved minerals and vitamins or other extracted chemical such as lycopene or saw palmetto which either have been shown to increase the risk of cancer or have no effect. 

On the other hand, concentrated whole food supplements are showing  promise with laboratory studies reporting reduction in markers of growth and metastasis especially with the polyphenol rich food such as green tea,  broccoli,  pomegranate and  turmeric. A purified combination of these foods known as Pomi-T has been evaluated in men with prostate cancer. The results presented at the ASCO conference 2013 showed a 63% reduced rate of PSA progression compared to  placebo - More about the Pomi-T study

Carcinogens Certain dietary chemicals (carcinogens) can cause normal cells to mutate into cancer cells.  The fundamental mechanism is the formation of super oxide free radicals which are highly damaging to DNA. Splitting and rearranging the DNA can separate the harmful genes (oncogenes) from the suppressor genes, which is the first step in the cancer process. It often takes several different types of mutation for the cancer process to progress, so although people with established cancer already have already sustained the initiate DNA damage in order to mutate from benign to malignant cells, the cancer process can also be fuelled by continuing consumption of foods high in carcinogens encourage the cancer to mutate into a more aggressive types. 

Steer clear of heavily processed foods, containing high concentrations of additives, Avoid fatty foods and particularly those which have been reheated in fats and oil. Avoid super heated snacks such crisps, chips and roasted or baked bars. Reduce aromatic hydrocarbons exposure by avoiding smoked, barbequed or burnt foods. ..more about carcinogens

Excess alcohol Heavy drinking, especially when it's beer, increases the risk for highly aggressive prostate cancer. More specifically >50 grams of alcohol (at least four drinks) daily doubled their risk of high-grade prostate cancer. In one large study, heavy drinking did not influence the risk of low-grade cancer 

  Set yourself an alcohol limit and stick to it, if necessary keep an alcohol diary. Pace your drinks by sipping slowly, don't rush to get the next drink form the bar or top up when your glass in empty. Choose non-premium beers, alternate alcoholic drinks with soft drinks. Try not to drink at home unless socialising, perhaps find something else to do instead - for example, going to the gym, museum arts clubs. Have alcohol-free days to remind yourself you don’t always have to drink. .. more about alcohol and cancer

Unhealthy fatty foods A large analysis of USA health professionals who had a high energy and fat intake subsequently were associated with an increased risk of advanced prostate cancer especially for cases with a young age at diagnosis or had a positive family history of cancer. At a recent conference in the National Institute of Health, a Cambridge University scientist, presented data to show that people who eat more than 90g of fat a day had twice the risk of developing cancer than those eating 40g per day. 

Try to avoid foods which contain hydrogenated or saturated fats such as biscuits, cakes, pastries, meat pies, sausages, hard cheese, butter and processed fatty foods containing coconut or palm oil. Choose lean cuts of meat and chicken without skin. Cut down on deep-fried snacks such as crisps, pakoras, samosas, bhajis, and chips. Cut down on sweets, desserts, creamy foods and milk chocolates. Avoid dishes containing ghee, rather stick to drier (less fatty) dishes such as dry curries, rather than dishes with rich or creamy sauces. >>more

Healthy fats It is a misconception that all fats are unhealthy. In fact, the opposite is true - health fats contain essential fatty acids such as omega  3,6 and 9 important for a healthy metabolism. They also help to reduce the unhealthy saturated fats and cholesterol. A number of trials have linked a lower intake of these fats with an increased risk of cancer. The only negative associate in this area was a retrospective analysis of the SELECT and Health Professionals Study showed that men with high omega three levels in their blood stream had an increased level of prostate cancer - this may actually be a correlation not a causation as men who took high doses of Omega 3 may have taken supplement which we know may increase the cancer risk such as Vitamin E, A and selenium. Nevertheless if taking a fish oil supplement take some days off and never exceed the RDA. 

Aim to increase weekly amounts of oily sea fish - mackerel, herring, tuna, swordfish, salmon, sardine, other white sea fish – cod, sea bass, bream. But also fresh water fish – lake varieties, trout and river salmon. Also increase plant based oils from olive oils (and others rapeseed, soya, sunflower), avocados, nuts – walnuts, almonds, brazil, peanut, pine, cashews, hazel and macadamia nuts;  seeds – dried pumpkin, sunflower and linseeds; leafy green vegetables and hemp >>more

Mineral and vitamin supplements A short course of a multivitamin may well be helpful after an acute illness, recovering form a cold or surgery. A number of well conducted large trials however have shown, in terms of cancer, that they either have benefits or they actually are associated with an increased risk of cancer. For example the SELECT study showed and increased risk for selenium and vitamin E and men in Health Professionals Study showed higher than recommended Zn intake was associated with an increased risk. The CARET and ATBC Trials also showed that Vitamin A and E supplements actually increased the risk of lung cancer and cardiac disease.

If you are concerned about your essential nutrient levels eat a healthy diet rather than  take supplements or otherwise  invest in an essential more about micro nutritional  analysis

Essential nutrient testing Deficiencies of micronutrients such as vitamins, essential minerals, fatty acids and antioxidant enzymes can lead to an imbalance in the immunity and an increase risk of chronic diseases including cancer. The difficulty is that it is also clear from published studies that an excess of vitamins or minerals can also increase the risks of cancer as well as heart attacks and other diseases. As mentioned above, in the west it is not clear whether an individual has an excess, deficiency or optimal levels in their body. 

The most reliable way to ensure you have the correct amounts of vital nutrients in your diet is to measure the body's levels. A measure of these nutrients will empower you with the knowledge to be able to modify your diet, or take specific supplements, which will give you the best possible chance of fighting cancer. - read more about nutritional testing.

 

Side effects influenced by lifestyle and self help strategies:
During treatment:	After treatment (long term):
Fatigue and tiredness Weight loss Weight gain Hand foot syndrome Poor appetite Sickness and vomiting Diarrhoea  Constipation Indigestion and heart burn Deep/superficial vein thrombosis Skin care Hair loss Sleeping Healthy mind	Psychological well-being Post treatment fatigue Incontinence   Bowel adhesions Constipation  Rectal damage   Breast tenderness   Sexual function   Hot flushes Bone health   Second cancers   Skin quality and tone Brain power

References:

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