Prostate Cancer: Can Diet And Lifestyle Make A Difference?

September is National Prostate Cancer Awareness Month, so I thought that a discussion of prostate cancer and preventative measures would be an appropriate topic to write about as the month approaches its end.  As a urologist and a wellness advocate, this subject is very dear to my heart.

Prostate cancer is the second leading cause of cancer-related deaths among men in the USA.  The burden of this disease is felt not only by those men diagnosed with this disease, but also by their partners, relatives and friends who are key elements in their emotional support system.

Prostate cancer is the most common non-skin malignancy among men in most Western populations (240,000 estimated new cases in 2011 in the U.S.), and is the second leading cause of cancer death among U.S. men (34,000 estimated deaths in 2011). To put this in perspective, heart disease causes more than 800,000 deaths per year in American men and is the leading cause of death in men with prostate cancer.  Many more men die of heart disease than of prostate cancer, and even in the population of men with prostate cancer, many more men die with it than of it.

The three major risk factors for prostate cancer are age, race, and family history. The likelihood of developing prostate cancer increases with the aging process, thought to be on the basis of gradual accumulation of DNA mutations due to incremental oxidative damage (literally “rusting”) of prostate cells. With each decade of aging, the incidence of prostate cancer increases appreciably.

In terms of race, African-American men have the highest reported incidence of prostate cancer in the world, with an incidence of 1.6 times that of Caucasian men in the United States; additionally, mortality is 2.4 times higher for African American men. On a worldwide basis, the highest incidence is in North America and Scandinavia and the lowest incidence is in Asia.

Prostate cancer tends to run in families, so it is prudent for male children of those with prostate cancer to be checked on an annual basis starting at age 40 (with a PSA blood test and digital rectal exam). With respect to familial prostate cancer, risk increases according to the number of affected family members (the more affected, the higher the risk), their degree of relatedness (brother and/or father affected confer a higher risk than cousin and/or uncle), and the age at which they were diagnosed (relatives of patients diagnosed younger than 55 years old are at highest risk). Generally speaking, if you have a brother or a father with prostate cancer, your risk of developing it is doubled. If you have three family members with prostate cancer, or if the disease occurs in three generations in your family, or if two of your first-degree relatives have been diagnosed at an age younger than 55 years, then you have a good likelihood for hereditary prostate cancer, which confers a 50% risk of developing the disease.

My father, a retired urologist, was diagnosed with prostate cancer at age 65 and underwent curative surgery and is currently 80 years old and thriving. For this reason, I have been very diligent in seeing my internist annually for a prostate examination and a PSA blood test. Additionally, I have been proactive in taking a medication to decrease my risk of prostate cancer.

Prostate cancer is unique among solid tumors in that it exists in two forms: a latent form (evident on autopsy studies, but not causing an abnormal digital rectal exam or PSA), which is present in 60-70% of men older than 80; and a clinically evident form (causing an abnormal rectal exam or elevated PSA), which affects approximately 1 in 6 men in the United States. Overall, men have an approximately 17% chance of being diagnosed with prostate cancer and a 3% chance of dying from it. This high ratio of prostate cancer incidence to mortality suggests that a portion of the cancers are minimal or indolent, non life-threatening conditions.

Currently, most prostate cancers are detected on the basis of a PSA elevation ranging from 2.5-10 ng/ml. Widespread PSA testing has resulted in the increased diagnosis of prostate cancer and a downward stage migration to non-palpable, organ-confined cancer with a parallel reduction in deaths—as opposed to the pre-PSA era, when most cancers were detected on the basis of a palpably abnormal digital rectal exam and were at a more advanced stage at presentation.

It is very important to know that when detected early, prostate cancer is highly curable. In the USA, more than 90% of men diagnosed with prostate cancer survive at least 10 years after the diagnosis is made. Even when not discovered early, it is a very manageable condition. In general terms, prostate cancer is a relatively slow-growing process.   Although most prostate cancers diagnosed at an early stage often have an indolent course, local tumor progression and metastases may certainly develop in the long term; therefore, early treatment is an important consideration for men with a general life expectancy exceeding 10 years.

Localized prostate cancer typically causes no symptoms and is typically diagnosed by a biopsy done because of a PSA elevation, an accelerated increase in the PSA over time, or an abnormal digital rectal examination. Non-palpable cancers, i.e., those picked up by virtue of a PSA elevation or accelerated PSA velocity, now account for 75% of all newly diagnosed prostate cancers. Although screening for prostate cancer remains somewhat controversial because of a lack of studies demonstrating a decrease in mortality in screened populations, the observed trends in PSA-driven detection of prostate cancer at earlier stages and declining mortality where screening is common provide strong inferential evidence that screening is beneficial.

Wouldn’t it be wonderful if we could prevent the occurrence of prostate cancer? It certainly would make my job a whole lot easier. Unfortunately, we are not there yet—but we do know a thing or two about lifestyle measures that can be pursued to maintain health and wellness in general and to help mitigate the chances of developing prostate cancer.

When Asian men (the ethnic group that has the lowest incidence of prostate cancer) migrate to Western countries, their risk of prostate cancer increases substantially over time.  So it is clear that environment plays a strong role in the genesis of prostate cancer and it is not just a simple matter of genetics.

Unquestionably, a coronary artery-clogging Western diet high in animal fat and highly processed foods and low in fruits, vegetables, legumes and whole grains is associated with a higher incidence of many preventable chronic health problems including cancer.  A heart-healthy, colon-healthy diet is a prostate-healthy and life-healthy diet.  A healthy diet combined with a healthy lifestyle, will afford us our best opportunity at minimizing heart disease, diabetes, and a host of cancers. This means weight management; the avoidance of obesity; healthy eating with abundant fruits and vegetables (chock full of antioxidants, vitamins, minerals and fiber) and real food as opposed to processed foods; consumption of animal fats and dairy in moderation; avoidance of tobacco and excessive alcohol; and plenty of exercise. And if we do develop prostate cancer, we will be in stellar physical shape and will heal that much better from any intervention necessary to treat the prostate cancer. Good nutrition and exercise helps in part by inhibiting oxidation and inflammation, factors that contribute not only to prostate cancer but also to conditions such as heart disease and osteoarthritis.

Michael Pollan, a journalism professor at the University of California, Berkeley and author of The Omnivore’s Dilemma, summarized in a most succinct way the answer to the question of what humans should eat, in his seven words: “Eat food. Not too much. Mostly plants.” By food, he means a nutritional substance that your grandmother would recognize as food, not a food-like highly processed substitute. Not too much is pretty obvious. A mostly plants-based diet will result in the consumption of a moderate amount of calories and plenty of fiber and anti-oxidants.

In addition to recommending a regimen of healthy eating and regular participation in exercise, there are medications that can help prevent the occurrence of prostate cancer. The presence of precursor lesions such as high grade prostate intraepithelial neoplasia (HGPIN) many years before the onset of prostate cancer, coupled with the increasing prevalence of prostate cancer with the aging process, suggest that the process of developing cancer takes place over a protracted interval of time. In fact, it is estimated that it takes many years—often more than a decade—from the initiation of the initial mutation to the time when prostate cancer becomes clinically manifest with either a PSA elevation or an abnormal digital rectal examination. In theory, this provides the opportunity for intervention before the establishment of a cancer.

The Prostate Cancer Prevention Trial was a clinical trial that tested whether Finasteride, which induces a deficiency of the enzyme 5-alpha reductase, would prevent prostate cancer. This trial was based upon the fact that prostate cancer does not occur in the absence of testosterone and that men with a congenital absence of 5-alpha reductase (that functions to convert testosterone to the activated form, dihydro-testosterone) do not develop benign or malignant prostate growth. This 7-year study involved almost 20,000 men who were randomly assigned to Finasteride or placebo. The study was terminated 15 months early because a 25% risk reduction for prostate cancer was achieved on Finasteride. The other finding was that the prevalence of higher-grade cancers was slightly higher in the Finasteride group (6.4% vs. 5.1%); however, Finasteride is known to change the pathological appearance of the prostate in such a way as to make determination of an accurate grade difficult.

A number of years ago, I was given the disheartening news that I had sunburn on my crown!  A balding pate frankly did not appeal to my sense of vanity!   After topical Minoxidil (Rogaine) proved ineffective, I started taking Propecia (a.k.a. Finasteride) every morning. Lo and behold, my thinning crown filled in and ultimately I had a full re-growth of hair.  When the Prostate Cancer Prevention Trial report came out revealing a 25% risk reduction for prostate cancer associated with the use of Finasteride, this cinched it—particularly insofar as my father had been diagnosed with prostate cancer.  Finasteride is a drug that fixes my bald spot, shrinks my prostate, and helps prevent prostate cancer, for which I have a family history. It seemed like a win-win situation, a no-brainer!

Bottom line:  Prostate cancer is very prevalent in men, involving one in six men in the USA.   When picked up on a timely basis via screening with the digital rectal exam and blood PSA test, it is eminently treatable and has an excellent prognosis, with only 3% of deaths in the USA attributable to prostate cancer.  There are both genetic and environmental factors at work in the genesis of prostate cancer.  We are not in control of our genetics, but we are in command of our lifestyle.  Maintaining a healthy lifestyle—including rational food choices—can help mitigate our chances of developing prostate cancer.

Andrew Siegel, M.D.

September 30, 2011

www.PromiscuousEating.com

For more information on prostate cancer:

American Cancer Society: www.cancer.org

American Urological Association Foundation: www.auafoundation.org

Cancer Care: www.cancercare.org

National Cancer Institute: www.cancer.gov

National Prostate Cancer Coalition: www.pcacoalition.org

Prostate Cancer Foundation: www.prostatecancerfoundation.org

Prostate Cancer Research and Education Foundation: www.pcref.org

Us TOO Prostate Cancer Education and Support Network: www.ustoo.org

“Elective” Male Sexual Dysfunction: How We Are Eating Ourselves Limp

“It is like a firstborn son—you spend your life working
for him, sacrificing everything for him, and at the
moment of truth, he does just as he pleases.”

Gabriel Garcia Marquez, Love In The Time Of Cholera

 

Two weeks ago, my blog dealt with the relationship between overeating/obesity and urinary incontinence/pelvic organ prolapse in females. In fairness to the male gender, today’s essay will be how overeating/obesity affects our manhood and vitality. What we eat—or don’t eat—can directly affect our sex lives! While the achievement of good sexual function is predicated upon many factors, it must be recognized that the particular diet we choose plays a definite role in its attainment.

Sexuality is a very important part of our human existence, both for purposes of procreation as well as pleasure. Healthy sexual function involves a satisfactory libido, the ability to obtain and maintain a rigid erection, and the ability to ejaculate and experience a climax. Although not a necessity for a healthy life, the loss or diminution of sexual function can result in loss of self-esteem, embarrassment, a sense of isolation and frustration, and even depression. Therefore, for many of us, it is vital that we maintain our sexual health.
On a functional level, sexuality is a very complex event dependent upon a number of systems, including the endocrine system (which produces sex hormones); the central and peripheral nervous systems (which provide nerve control); and the vascular system (which conducts blood flow). A healthy sexual response is, at its physical essence, largely about adequate blood flow to the genital and pelvic area. Increased blood flow to the genitals from sexual stimulation is responsible for the penis going from a flaccid to an erect state. Blood flow to the penis is analogous to air pressure in a tire: if there is not enough air, thereby causing the tire to be improperly inflated, the tire works less optimally and may even suffer a flat!
The penis is a rather amazing, multifunctional organ that has a role as a urinary organ allowing directed urination that permits men to stand to urinate, and a sexual and reproductive organ that when erect, allows the rigid penis the ability to penetrate the vagina and function as a conduit for release of semen into the vagina. No other organ in the body demonstrates such a great versatility in terms of the physical changes between its “inactive” versus “active” states! The penis has an abundant supply of vascular smooth muscle, and like every other muscle in the body, “use it or lose it” is relevant when it comes to the sexual domain. Disuse atrophy can occur if the penis is not used the way it was designed to be, and this often results in patients complaining of penile shrinkage.
Erectile dysfunction is a common problem, occurring in millions of American men. About one-third of the male population over age 60 is unable to achieve an erection suitable for intercourse. However, erectile dysfunction is NOT an inevitable consequence of the aging process as there are many elderly men who have intact sexual function.
Diminished blood flow occurs most commonly on the basis of an accumulation of fatty plaque deposits within the walls of blood vessels. As we age, physiological and lifestyle factors combine to increase this plaque build-up, causing a significant narrowing of many of the body’s blood vessels. The resultant decrease in blood flow to our organs negatively affects the functioning of all of our systems, since every cell in our body is dependent upon the vascular system for delivery of vital oxygen and nutrients and removal of metabolic waste products. Pelvic atherosclerosis, the accumulation of fatty deposits within the walls of the arteries that bring blood to the penis, will compromise blood flow to the genitals and incite sexual dysfunction.
The presence of erectile dysfunction can be considered the equivalent of a genital stress test and may be indicative of a cardiovascular problem that warrants an evaluation for arterial disease elsewhere in the body (heart, brain, aorta, peripheral blood vessels). In other words, the quality of erections can serve as a barometer of cardiovascular health and those who can get hard attacks are unlikely to get heart attacks. The presence of sexual dysfunction is as much of a predictor of cardiovascular disease as is a strong family history of cardiac disease, tobacco smoking, or elevated cholesterol. The British cardiologist Graham Jackson has expanded the initials E.D. (Erectile Dysfunction) to mean Endothelial Dysfunction (endothelial cells being the type of cells that line the insides of arteries), Early Detection (of cardiovascular disease), and Early Death (if missed). The bottom line is that heart healthy is sexual healthy.

Many adults in the USA are beset with Civilization Syndrome, a cluster of health issues that have arisen as a direct result of our poor dietary choices and sedentary lifestyle. Civilization Syndrome can lead to obesity, high blood pressure, elevated cholesterol, and can result in such health problems as diabetes, heart attack, stroke, cancer, and premature death. The diabetic situation in our nation—often referred to as “diabesity” has become outrageous and it probably comes as no surprise that diabetes is one of the leading causes of sexual dysfunction in the United States.
Obesity (external fat) is associated with internal obesity and fatty matter clogging up the arteries of the body including the pudendal artery, which supplies blood to the penis. Additionally, obesity can have a negative effect on our sex hormone balance (the balance of testosterone and estrogens), further contributing to sexual dysfunction. The fatty tissue present in our obese abdomens contains abundant amounts of the enzyme aromatase—functioning to convert testosterone to estrogen—literally emasculating us! High blood pressure will cause the heart to have to work harder to get the blood flowing through the increased resistance of the arteries. Blood pressure lowering medications will treat this, but as a result of the decreased pressure, there will be less blood flow through the pudendal arteries. Thus blood pressure medications, although very helpful to prevent the negative affects of hypertension—heart attacks, strokes, etc.—will contribute to sexual dysfunction. High cholesterol will cause fatty plaque buildup in our arteries, compromising blood flow and contributing to sexual dysfunction. Tobacco constricts blood vessels and impairs blood flow through our arteries. Smoking is really not very sexy at all! Stress causes a surge of adrenaline release from the adrenal glands. The effect of adrenaline is to constrict blood vessels and decrease sexual function. Hence, the physiologic explanation for the common occurrence of performance anxiety. Interestingly, men with priapism (a prolonged and painful erection) are often treated with penile injections of an adrenaline-like chemical to bring down the erection.
Obesity is stealing away one of our most precious resources—the ability to obtain and maintain good quality erections. Remember the days when you could achieve a rock-hard erection—majestically pointing towards the sky—simply by seeing an attractive woman or thinking some vague sexual thought? Chances were that you were young, active, and perhaps had an abdomen that somewhat resembled a six-pack. The loss in function is often so gradual and insidious that it barely gets noticed. Maybe it takes a great deal of physical stimulation to achieve an erection barely firm enough to be able to penetrate. Maybe penetration is more of a “shove” than a ready, noble, and natural access. Maybe you need “daddy’s little helper”—a little blue pill (Viagra), or yellow pill (Cialis), or orange pill (Levitra), to get the blood flowing.

If this is the case, it is probable that you are carrying extra pounds, have a soft belly, and are not physically active. When you’re soft in the middle, you will probably be soft down below. A flaccid penis is entirely consistent with a flaccid body and a hard penis is congruous with a hard body. Perhaps when you are standing naked in the shower and you gaze down towards your feet, all you see is the protuberant roundness of your large midriff, obscuring the glorious sight of your manhood. Perhaps you’re wondering where your penis is hiding. In most cases, the abundant pubic fat pad that occurs coincident with weight gain obscures the penis, what I like to refer to as the “turtle effect.” If your pubic fat pad makes your penis difficult to find, your man-boobs are competitive with your wife’s breasts, and your libido and erections are just not performing up to par, it may be just time to rethink your lifestyle habits!
So, where does this leave us? It leaves us with what should by now be obvious: a healthy lifestyle is of paramount importance towards the endpoint of achieving an optimal quality and quantity of life. Intelligent lifestyle choices, including proper eating habits, maintaining a healthy weight, engaging in exercise, adequate sleep, alcohol in moderation, avoiding tobacco and stress reduction are the initial approach to treating many of the diseases caused by poor health decisions. Sexual dysfunction is in the category of a medical problem that is brought on by unwise lifestyle choices. It should come as no surprise that the initial approach to managing it is to improve lifestyle choices. By simply improving one’s daily habits, Civilization Syndrome can be ameliorated or even prevented, and the various medical problems that often follow, including sexual dysfunction, can be mitigated.
In terms of maintaining good cardiovascular health—and thus healthy sexual function—eating properly is incredibly important, obviously in conjunction with other smart lifestyle choices. Maintaining a healthy weight and fueling up with wholesome and natural foods will help prevent the build-up of harmful plaque deposits within blood vessels that can lead to compromised blood flow to the penis as well as every other organ. Poor dietary choices with a meal plan replete with calorie-laden, nutritionally-empty selections (e.g., fast food or processed or refined anything), puts one on the fast tract to clogged arteries that can make your sexual function as small as your belly is big!
If you want a “sexier” lifestyle, first start with a “sexier” style of eating that will help you feel better, look better and optimize your sexual, emotional and psychological well-being. Smart nutritional choices are a key component of sexual fitness. Exercise is a fundamentally important component of maintaining good sexual health and partners well with healthy eating. At times, even with the achievement of a very healthy lifestyle, erectile dysfunction can still persist. Under these circumstances, there are numerous excellent treatment modalities available, and the reader is referred to the following links below for more information.

 

 

I have done a number of educational videos on the subject of erectile dysfunction. These are intended for mature adults only as they contain language and images of a graphic and sexual nature and viewer discretion is advised.

Introduction to erectile dysfunction: http://www.youtube.com/watch?v=AQW1HFwBuPc

Anatomy: http://www.youtube.com/watch?v=zPwaXTTfnd8

Penis size: http://www.youtube.com/watch?v=g65bq7CuUyI

Causes of erectile dysfunction: http://www.youtube.com/watch?v=f6N34G11Saw

Treatment part 1: http://www.youtube.com/watch?v=fuhPGharax0

Treatment part 2: http://www.youtube.com/watch?v=Rd47zIQEGcA

This is just a taste of what you will find in Promiscuous Eating: Understanding and Ending Our Self-Destructive Relationship with Food. The website for the book is: www.PromiscuousEating.com. It provides information on the book, a trailer, excerpts, ordering instructions, as well as links to a wealth of excellent resources on healthy living. It is also available on Amazon Kindle.

Andrew L. Siegel, M.D.