Prevention of Prostate Cancer

Prevention of Prostate Cancer

Due to high morbidity and economic cost associated with the malignancy of the prostate gland, investigators have explored various preventive strategies to reduce the incidence of prostate cancer in susceptible male population. It is believed that patient awareness, identification of danger signs, knowledge of screening modalities and necessary lifestyle modifications can help a great deal in the prevention of prostate cancer in the susceptible popualation.

Identification of risk factors

Most statistically significant risk factors that are associated with prostate cancer are:

• Age: In the United States, most men develop prostate cancer after 40 years of age. The peak age of diagnosis is 60 years.
• Race: African American men are more susceptible to develop prostate cancer than Caucasians and Asians. Additionally, African-Americans develop more severe disease and have a much higher mortality (more than double) owing to aggressive disease or delayed diagnosis.
• Family History: Positive family history of prostate cancer (especially in the index relatives) can make you more susceptible to prostate malignancy.

It is logical to assume that these risk factors are non-modifiable; which also means that these individuals require more intensive and periodic screening for prostate malignancy.

Addressing modifiable risk factors to prevent prostate cancer

Certain risk factors such as diet and occupations are modifiable. In other words, adopting healthy lifestyle and dietary choices can help in reducing the risk of developing prostate malignancy. Various research studies suggests that oxidative damage caused by poor lifestyle or dietary choices can lead to prostate cancer (1). Therefore following preventive strategies may help in improving the overall outcomes.

• Obese males are more likely to develop aggressive disease. Moderate reduction in the intake of calories and incorporation of daily exercise can help in improving the overall health and maintenance of body weight; while reducing the risk of prostate cancer; according to the results of a study reported in the Cancer Epidemiology Biomarkers & Prevention journal (2).
• Red meat intake can promote carcinogenesis. Research indicates that minimizing the amount of animal fat and red meat intake can reduce the risk of prostate malignancy. Same is true for dairy products (1).
• Avoid excessive intake of calcium. Based on the latest recommendations, intake of high calcium (in doses higher 1500 mg per day) can aggravate the risk of prostate cancer.
• Increase the intake of fish and other sources of omega fats; as it helps in fighting against prostate cancer cells.
• Maximize the consumption of tomatoes cooked in olive oil due to high content of lycopene and other high quality antioxidants that prevents free radical induced damage. Other dietary components that can help against prostate cancer include cauliflower and broccoli.
• Avoid smoking and limit the consumption of alcohol. Likewise, any type of stress (emotional or physical) is associated with high risk of morbidity and mortality. It is therefore suggested to live a stress-free lifestyle by incorporating healthy habits such as meditation, yoga, breathing exercises and other stress-relieving therapies.
• If you are suffering from medical or psychiatric issues (such as persistently high levels of stress, depression, hypertension or cholesterol problems); make sure to seek appropriate medical help to control your health issues; this also helps in reducing the risk of prostate cancer.
• Avoid excessive or unnecessary medication due to potential risk of adverse effects. For example, even nutritional or dietary supplements such as Vitamin E supplementation (that is considered helpful in the prevention of cardiovascular and inflammatory disorders) can aggravate the risk of prostate malignancy in healthy males, according to the result of Selenium and Vitamin E Cancer Prevention Trial that was conducted in over 35, 533 males, across 427 locations (3).
• The prognosis of prostate cancer is excellent if the disease is identified in the early stages. Therefore, it is highly recommended to opt for periodic screening (PSA and rectal examination at least once each year). In addition, if you have certain risk factors (such as non-modifiable risk factors discussed above); you may need more frequent screening.

Pharmacological preparations for the prevention of prostate cancer

Investigators are also developing pharmacological and hormonal analogues to control/ prevent the growth of malignant prostate cells. For example, it has been observed that controlling the abnormal hormonal activity can help in preventing the abnormal cell divisions. Most recommended pharmacological preparations include; finasteride and dutasteride (4,5). It is imperative to mention that these agents are ideally use for the management of the symptoms of BPH.

According to the extensive, multi-center clinical trial that was conducted in over 18,000 participants over a 10 year period; investigators identified that controlled intake of pharmacological agents like finasteride can help in reducing the risk of prostate cancer by 25% (4). However, according to a new study reported in the peer reviewed New England Journal of Medicine (6), suggested that agents like finasteride (the 5-alpha reductase inhibitor) is only effective at minimizing the risk of less-invasive cancers (with Gleason score under 6). The report also suggested that these drugs have little to no role in the prevention of more aggressive cancers (Gleason score 8 -10).

Speak to your healthcare professionals to learn more about the viable preventive strategies.

References

1. Wilson, K. M., Giovannucci, E. L., & Mucci, L. A. (2012). Lifestyle and dietary factors in the prevention of lethal prostate cancer. Asian J Androl, 14(3), 365-74.

2. Barrington, W. E., Schenk, J. M., Etzioni, R., Arnold, K. B., Neuhouser, M. L., Thompson, I. M., … & Kristal, A. R. (2015). Associations of Obesity with Prostate Cancer Risk Differ Between US African-American and Non-Hispanic White Men: Results from the Selenium and Vitamin E Cancer Prevention Trial. Cancer Epidemiology Biomarkers & Prevention, 24(4), 765-765.

3. Klein, E. A., Thompson, I. M., Tangen, C. M., Crowley, J. J., Lucia, M. S., Goodman, P. J., … & Baker, L. H. (2011). Vitamin E and the risk of prostate cancer: the Selenium and Vitamin E Cancer Prevention Trial (SELECT). Jama, 306(14), 1549-1556.

4. Thompson, I. M., Goodman, P. J., Tangen, C. M., Lucia, M. S., Miller, G. J., Ford, L. G., … & Coltman Jr, C. A. (2003). The influence of finasteride on the development of prostate cancer. New England Journal of Medicine, 349(3), 215-224.

5. Andriole, G. L., Bostwick, D. G., Brawley, O. W., Gomella, L. G., Marberger, M., Montorsi, F., … & Rittmaster, R. S. (2010). Effect of dutasteride on the risk of prostate cancer. New England Journal of Medicine, 362(13), 1192-1202.

6. Theoret, M. R., Ning, Y. M., Zhang, J. J., Justice, R., Keegan, P., & Pazdur, R. (2011). The risks and benefits of 5α-reductase inhibitors for prostate-cancer prevention. New England Journal of Medicine, 365(2), 97-99.