Strategies to reduce prostate cancer risk

Wellness Factsheet

Prostate Cancer is the second most common cancer in men worldwide and the fourth most common cancer overall. It develops when abnormal cells in the prostate gland grow more quickly than is normal, forming a malignant tumour. Of the known prostate cancer risk factors, the most important are age, ethnicity, genetic factors and possibly dietary factors. Considering that factors such as age and ethnicity cannot be changed, knowing how to prevent this cancer remains the best choice.

Did you know?

In 2020, it was estimated that over 145,000 new cases of cancer would be diagnosed in Australia. This equates to an average of just under 400 people per day receiving a cancer diagnosis, with more than half of these cases being in males [1].

The number of new cases of diagnosed Prostate Cancer increased from 3,606 in 1982 to 19,305 in 2016. This figure was projected to drop to 16,741 in 2020 [2].

In 2020, in Australia, prostate cancer was the most commonly diagnosed cancer in males and the second most commonly diagnosed cancer overall [2][3].

In 2020, in New Zealand, prostate cancer was the most commonly diagnosed cancer both in males and overall [4], with more than 650 deaths from prostate cancer each year [5].

Prostate cancer incidence increases with age. Although it is very unusual in men younger than 40 years, rates increase after the age of 50 years; or 40 years in black men and men with a family history of prostate cancer [6]. 

Men with a family history of prostate or breast cancers had a greater risk of prostate cancer than those who didn’t. Men with a family history of prostate cancer had a 68% greater risk of developing prostate cancer, those with a family history of breast cancer had a 21% greater risk; and men with a family history of both prostate and breast cancers had a 61% higher risk of prostate cancer than men with family history of either [7]. 

It is estimated that 42 percent of all cancer cases and nearly 50% of cancer deaths are preventable [8]. Lifestyle factors have been linked to a variety of malignancies, including prostate cancer [9]. 

The Facts

Prevention of Prostate Cancer includes many lifestyle and nutritional strategies, and genetic counselling for patients with a family history is recommended.

Genetic counselling should include a discussion of the risks and benefits of genetic testing, as not all individuals who inherit a gene mutation that predisposes them to prostate cancer will go on to develop it. Rather, they have inherited a greater risk of developing the disease [10].

Diet can influence the development and progression of prostate cancer:

Milk and dairy products:

The evidence is mixed, with studies showing some association between prostate cancer and milk and dairy products. 

  • A systematic review and meta-analysis showed that high intake of dairy products, including milk, cheese and dairy calcium, increased the risk of prostate cancer by 3-9% [11,12]. Milk and dairy increases levels of insulin-like growth factor 1 (IgF-1), which has been associated with an increased risk of prostate cancer [13].
  • The Adventist Health Study-2 found that people who ate a vegan diet had a 35% lower prostate cancer risk [14],suggesting that higher intakes of fibre, soy and antioxidant-rich fruits and vegetables, and the reduced intake of saturated fat, animal protein and IGF-1 from dairy products, may help reduce risk [15].
  • A review of 47 studies showed that a high intake of dairy foods increased the risk of prostate cancer, while plant foods decreased the risk [16].
  • A comprehensive analysis of World Cancer Research Fund literature found some evidence for higher prostate cancer risk with higher intake of dairy products and diets high in calcium, particularly among people who were overweight/obese and/or tall [17].

A number of studies have shown either no association or even a negative association between dairy products and prostate cancer risk:

  • A recent Australian study found that being overweight or obese increased the risk of aggressive prostate cancer, yet the consumption of dairy products, particularly milk, decreased risk [18].
  • While some studies examining the role of a combination of milk and dairy products in prostate cancer have not shown a statistically significant increase in risk, different results were found when milks were broken up into subgroups of different fat content and analysed separately. In general, whole milk and high-fat dairy products were more strongly associated with increased prostate risk than low-fat milks and dairy products [19-23].
  • Until high-grade evidence on the role of dairy in prostate cancer is available through RCT studies, it may be prudent to reduce intake, especially of high-fat dairy products. 

Animal fat and meat:

  • A diet high in fat, particularly saturated fat, may be an important factor in the development of prostate cancer and in its metastasis [24,25].
  • Cooked red meat and poultry are associated with an increased risk of prostate cancer [26].

Polyunsaturated fatty acids:

  • The intake of alpha-linolenic acid (omega-3 fatty acid) appears to decrease the risk of prostate cancer while the intake of linoleic acid (omega-6 fatty acid) increases the risk [27]. In addition to this, the higher the ratio of omega-6 to omega-3, as found in a processed food diet, the higher the risk [28].

Fruits and vegetables:

  • A diet low in vegetables may be another risk factor for prostate cancer [29-31]. Various studies have shown an inverse relationship between fruit and vegetable intake and prostate cancer [27].
  • EPIC, a large European study, only found a reduced risk with fruit intake, not vegetables [32].

Lycopene:

  • Lycopene is a bright red carotenoid found in tomatoes and other red fruits and vegetables, such as red carrots, watermelons and papayas, but not in strawberries or cherries [33].
  • Dietary intake of lycopene is associated with a lower incidence of prostate cancer and a decreased risk of lethal prostate cancer [34,35].

Brassicas (broccoli, cauliflower, cabbage, choy sum, swede, turnip):

  • Studies of prostate cancer cells provide evidence that isothiocyanates, found in cruciferous vegetables, may act as epigenetic modulators, thus affecting the initiation and progression of cancer. Their effects can help restore cells to a more normal state [36,37].

Supplements:

Vitamin E Supplements

  • Men should avoid taking vitamin E supplements at doses that exceed the recommended dietary intake, as vitamin E supplementation significantly increases the incidence of prostate cancer [38-40].

Vitamin D Supplements suppresses cancer cell growth, inhibits cancer from spreading, and look more like normal cells, tending to spread slower

  • Preclinical studies indicate that vitamin D and its analogs may help suppress prostate cancer cell growth, slow or inhibit cancer from spreading, and help cells to look and behave more like normal cells, suggesting a potential role in prevention [41,42].
  • When given vitamin D supplements for a year, 55% of men with low-grade prostate cancer had lower Gleason scores (a measure of cancer aggressiveness) compared to their initial biopsies, or even complete disappearance of their tumours [43].
  • Another trial found that men who received 4000IU of vitamin D showed improvements in their tumours and down-regulation of genes that express for inflammation, while men who received a placebo stayed the same or got worse [44].
  • Vitamin D also plays an important role in optimising bone health [45].

Exercise:

  • An inactive lifestyle has been linked to a higher PSA (prostate-specific antigen) level, which is a marker of prostate disease [46].
  • At least 3 hours per week of physical activity, including brisk walking and jogging, may decrease mortality rates for prostate cancer [47].
  • Physical activity, particularly vigorous activity, also lowers the risk of prostate cancer developing, progressing to a more advanced stage or reoccurring (in survivors) [48].

Smoking:

  • Smoking increases the risk of developing primary and advanced (metastasised) prostate cancer, recurrence after successful treatment with surgery or radiotherapy, and poorer prognosis (mortality) [49-51].
  • Regular smoking increases the risk of developing another primary cancer by 59% [52]. However, having stopped smoking 10 years before diagnosis reduces the risk of prostate cancer recurrence and mortality [53].

Lifestyle changes and gene expression:

  • A pilot study of 30 men with low-risk prostate cancer who participated in an intensive nutrition and lifestyle intervention which found that the lifestyle intervention up-regulated 48 and down-regulated 453 genes involved in prostate cancer. This suggests that lifestyle choices may interfere with cancer cells at a genetic level [54].

Infections:

  • About 20% of cancers are thought to be due to chronic inflammation caused by infectious organisms, environmental factors, dietary factors and hormonal changes [55]. Potential links between urinary tract infections, sexually transmitted diseases and bacterial prostatitis have been found but the research is not consistent [56].

Occupational and external exposure:

  • Some jobs have a higher risk of prostate cancer due to exposure to harmful or carcinogenic substances. One example is firefighters, who have a 20% greater risk [57].

Endogenous hormones:

  • Estrogens were once considered protective for prostate cancer; however, more recent evidence shows them to be pro-carcinogenic, increasing the risk of prostate cancer in males who have had early exposure to high intakes of estrogen-containing foods, such as milk and animal fat [58].

What can we do about it

Maintain a healthy weight 

Keep your body moving with plenty of exercise

Avoid vitamin E supplements. Obtain Vitamin E naturally from your diet [59]

Wisely expose yourself to sunshine or take vitamin D supplements

Limit or avoid red meat and dairy products

Eat lots of vegetables, including broccoli, Brussels sprouts, radish and bok choy

Quit smoking

Discuss prostate cancer screening options with your GP

Be alert to early signs and symptoms:

It is important to be aware that in its early stages, prostate cancer may not show any symptoms. Some symptoms of early prostate cancer may include:

  • having difficulty passing urine
  • having a slow, interrupted flow of urine
  • frequent passing of urine, including incontinence at night.

There are some additional symptoms that can be associated with advanced prostate cancer, but also with benign prostate cancer hyperplasia, a non-cancerous enlargement of the prostate gland. These symptoms may include:

  • blood in urine or semen
  • pain during urination
  • lower back or pelvic pain.
  • If you experience these symptoms, you should visit your doctor.

Your genes do not fully determine your destiny. You can choose to adopt healthy habits to minimise your risk of developing prostate cancer, or if it is already present, to minimise the progression of your prostate cancer.

References

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2. Australian Insitute of Health and Welfare. Cancer Data In Australia Internet. Canberra, Australia: Australian Insitute of Health and Welfare; 2020.

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36. Wong CP, Hsu A, Buchanan A, Palomera-Sanchez Z, Beaver LM, Houseman EA, et al. Effects of sulforaphane and 3,3'-diindolylmethane on genome-wide promoter methylation in normal prostate epithelial cells and prostate cancer cells. PLoS One. 2014;9(1):e86787.

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39. Klein EA, Thompson IM, Jr., Tangen CM, Crowley JJ, Lucia MS, Goodman PJ, et al. Vitamin E and the risk of prostate cancer: the Selenium and Vitamin E Cancer Prevention Trial (SELECT). JAMA. 2011;306(14):1549-56.

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43. Marshall DT, Savage SJ, Garrett-Mayer E, Keane TE, Hollis BW, Horst RL, et al. Vitamin D3 supplementation at 4000 international units per day for one year results in a decrease of positive cores at repeat biopsy in subjects with low-risk prostate cancer under active surveillance. J Clin Endocrinol Metab. 2012;97(7):2315-24.

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46. Loprinzi PD, Kohli M. Effect of physical activity and sedentary behavior on serum prostate-specific antigen concentrations: results from the National Health and Nutrition Examination Survey (NHANES), 2003-2006. Mayo Clin Proc. 2013;88(1):11-21.

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48. Cormie P, Zopf EM, Zhang X, Schmitz KH. The Impact of Exercise on Cancer Mortality, Recurrence, and Treatment-Related Adverse Effects. Epidemiologic Reviews. 2017;39(1):71-92.

49. Prostate Cancer UK. Your diet and physical activity: Prostate Cancer UK; 2018 [updated 2018 Jun. Available from: https://prostatecanceruk.org/prostate-information/living-with-prostate-cancer/your-diet-and-physical-activity

50. Skolarus TA, Wolf AM, Erb NL, Brooks DD, Rivers BM, Underwood W, 3rd, et al. American Cancer Society prostate cancer survivorship care guidelines. CA Cancer J Clin. 2014;64(4):225-49.

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54. Ornish D, Magbanua MJ, Weidner G, Weinberg V, Kemp C, Green C, et al. Changes in prostate gene expression in men undergoing an intensive nutrition and lifestyle intervention. Proc Natl Acad Sci U S A. 2008;105(24):8369-74.

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57. Mehlum I, Johannessen H, Kjærheim K, Grimsrud T, K N. 546 Risk of prostate cancer among firefighters: a review and meta-analysis of studies published after 2007. Occup Environ Med. 2018;75:A388.

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