47th Annual Scientific Assembly Islamic Medical Association of North America Arusha, Tanazania August 9th & 10th, 2014
PROSTATE CANCER: Its Prevention and the Role of Nutrition Mahmood Abdul Hai, M.D., F.I.C.S. President & Executive Director, The Surgical Institute of Michigan Westland, Michigan, USA.
Disclosure “IMANA
is committed to providing CME activities that are fair, balanced and free of bias.
Full and specific disclosure information is provided in your handouts.” I have no relevant financial relationship with any of the commercial interests.
Cancer Statistic: 2013 Cancer New Cases
Cancer Statistics: 2013 Cancer Deaths
Worldwide Incidence of Prostate Cancer
Risk Factors in Prostate Cancer 1.
Age
2.
Family History & Genetic factors
3.
Race
4.
Diet
5.
Life style & Overweight
6.
Hormonal Status
7.
Enviornment & Sun exposure
8.
Alcohol & Smoking
Relation of Age to Prostate Cancer
Race and Prostate Cancer
Role of Diet in Prostate Cancer ď‚—
Diet is clearly implicated in the origin of many cancers
ď‚—
Higher incidence with:
1.
Increase consumption of red meat and animal fat
2.
Reduced consumption of vegetables, fiber and starch
Mechanism of diet effect ď‚— Low fat diet reduces Prostate cancer risk by reducing androgen levels ď‚— Ingestion of simple glycemic carbohydrates stimulates high level of insulin production promoting increased risk of prostate cancer ď‚— Prostate tumors grow faster in animals fed a high fat diet
Effect of Diet in Prostate Cancer Foci of Prostate cancer exist in 30% men >50 & 75%>80 These are consistent worldwide Most of these foci remain latent and do not grow or spread Diet may be a crucial factor in the transformation into a more aggressive form These facts are confirmed by epidemiological, laboratory, intervention and migration studies. These factors make prostate cancer an ideal target for prevention It can help proactively to prevent and also slow or reverse the progression of premalignant lesions
Diet and Prostate Cancer Risk
Current Theories about Prevention 1.
Blocking the effects of hormones
Drugs: Finasteride,Dutasteride
2.
Eating a healthful diet
Limiting red meat and dairy products
Including Antioxidants in moderation
Soy products
3.
Exercise and Life style changes
ASC Report on Cancer Survivors: 2014 Current # of cancer survivors in US:14.5m Estimated survivor growth by 2024: 19 m Among males living with cancer:Prostate43% 64% of these were diagnosed in 5yrs or more 62% of PCa survivors are 70 or older Factors responsible for better survival: 1.Awareness & early detection 2.More effective treatment 3.Cancer rate decreasing in the last 10 years
Role of Nutrition in PCa Role of nutrition in PCa is very complex Nutrients modify genetic susceptibility Strongest dietary factor is obesity Randomoized and carefully controlled studies are required Awareness of patients, physicians and dietetians is needed
Principal message from nutritional studies ď‚— Benefits of diet consisting mainly of vegetables, fruits, grains and fish combined with restricted caloric intake and regular exercise. ď‚— Adopt diet when young ď‚— Nutrients contained in food is better and more easily absorbed than synthetically produced supplements.
American Institute of Cancer Research 1/3rd of PCa can be prevented by avoidance of tobacco and alcohol 1/3rd of PCa deaths can be prevented by dietary changes, adequate physical activity and control of body weight High intake of red meat makes a person three times more susceptible to PCa High fat diet stimulated cancer growth in animals High intake of saturated fats caused higher incidence, more aggressive form and more deaths from PCa.
Carotenoids Risk of PCa reduced in men using caotenoids Lycopene is considered most efficient Common sources of Lycopene: Tomato (more in cooked form), pink grapefruit, watermelon, apricot, guava, papaya A high intake of tomato products was associated with 35% decrease risk of PCa.
Cruciferous vegetables ď‚— Broccli, cauliflower, cabbage, Brussel sprout, bok choy and kale prevent Pca ď‚— They contain high levels of anticarcinogenic phytochemicals which produce antioxidant enzymes which in turn protect cell damage
Selenium It is an essential non-metallic trace metal Found in Brazil nuts, walnuts, fish, shell fish, beef, turkey, eggs, whole grains, garlic, onions, broccoli, cabbage mushroom Nutrition Prevention of PCa Trial: High selinium levels confer a 50% reduction in the risk of PCa
Vitamin E Lipid-soluble antioxidant found in veg. oils,nut oils, hazel nut, whole grain and leafy vegetables. Benefits only in smokers Cleveland Clinic found a significant increase in the risk of PCa among healthy men who took a dietary supplement of Vitamin E (Klein)
Vitamin D Most important source is sunlight but also contained in dairy products, eggs, fatty fish like salmon & Tuna Many men are Vitamin D deficient Adequate levels of Vit D significantly reduce the incidence and mortality of PCa Strengthens the immune system in general Specially important in pts. on Androgen Deprivation Therapy(ADT) to treat PCa
Calcium and Zinc Higher consumption of whole milk has been consistently shown to be associated with an increased risk of developing advanced PCa. This is due to the high fat content Calcium is good in moderation specially from natural sources Excessive use of calcium supplements to prevent/treat osteoporosis has lead to marked increase in urinary stone disease. High doses of Zinc have been shown to promote PCa
Testosterone Therapy in 2014 American Society of Clinical Oncology Long term testosterone supplement in hypogonadal men does not increase the risk for Pca Most researches have shown that testosterone replacement therapy(TRT) is not harmful in PCa pts. Pt. with metabolic syndrome have 54% greater risk of developing Pca Stress and lack of family support is associated with higher PCa mortality.
Dietary advice to pts. Diagnosed with PCa Vegan diet supplemented with antioxidants, aerobic exercises and stress management can lower PSA levels Dietary modifications coupled with exercise and life style changes may decrease PCa growth rate Should be used in concert with accepted therapy Relying on diet and supplements alone to cure PCa is unrealistic and often fatal
Specific Foods and Herbs Pomegranate
Saw palmetto
Lycopenes
Flaxseed
Soy
Medicinal mushrooms
Green tea
Baikal scullcap
Ginseng
Hu zhang
Holy Basil
Pao pereira
Tumeric
Rauwolfia vomitoria
Ginger
Lignans
Soy(Isoflavones) and Green Tea(Polyphenols) Soy has been shown to have a beneficial effect in the prevention and reduction in growth rate of PCa Effects the production and metabolism of androgens and estrogens in the body Polyphenols are present in green tea, red wine, grape juice, fruits and vegetables. Inhibits cancer cell growth which has been proven in several human PCa sudies.
Superfoods in Chemoprevention of Prostate Cancer Spinach, Broccoli, Brussels sprout, cauliflower and cabbage Wild caught salmon, Fish oils Pomegranate and Blueberries Soy foods Oats and oat products Green tea
BREAKING NEWS FROM AUA Study suggests adding Broccoli to weekly diet may change gene activity linked with Prostate Cancer First study in which gene expression in a target tissue has been studied after a dietary intervention Men with low-risk Prostate Cancer showed profound changes microscopically
Life style Changes to prevent PCa Heart healthy is prostate healthy Monitor Cholesterol and Blood pressure Maintain a healthy weight: Body Mass Index (BMI) Waist-to-hip ratio (WHR) Exercise and move more Decrease Total calories not just fat content Above all : LIVE IN MODERATION
Ideal Prevention for Prostate Cancer CASTRATION AT BIRTH
OUCH !!!!
AUA Guidelines for PCa screening Begin PSA screening for Prostate Cancer at age 40 Consideration should be given to overall health, family history, age, race and risk Screening should include DRE Increases in PSA velocity of greater than 0.4 ng/ml/yrare associated with 50% higher likelihood of significant disease
Screening Tools for Prostate Cancer
Digital Rectal Examination (DRE)
Yearly total PSA: If high it may be repeated or a Free PSA done Transrectal Ultrasound (TRUS) If any abnormal areas seen, Transrectal ultrasound guided needle biopsies Saturation biopsies if indicated MRI/Ultrasound Fusion image guided Bx
Recent Advances in Detection and Staging of PCa ď‚— New Diagnostic Blood Tests: 1.
Onko cell MDX
2.OPKO 4K score ď‚— Special Tissue Diagnostic test to assess the aggressive nature of the cancer: 1.Polaris 2. Oncococyte gene testing
Joint Guidline (AUA,ASCO) recommends 5-alpha reductase inhibitors for preventing Ca P – 25% better than placebo It recommends benefits in asymptomatic younger men with PSA of 3ng/ml or higher It may be considered in patients with higher risk factors like family history, race Increase in erectile dysfunction, decrease in libido and ejaculate volume and gynecomastia are known side effects
CONCLUSIONS Prostate Cancer has a very high prevalance in men in the US The risk factors have been well studied Diet and Lifestyle have a definite impact Prostate cancer can be successfully prevented by changing lifestyle, diet and chemoprevention.
General Advice Reduce intake of white bread,meats and saturated fat. Increase fruits,vegetables,fiber & Fish oil Eliminate smoking and excess alcohol Reduce stress,sleep well,regular exercise Increase soy,Vitamin D & Green tea Avoid unnecessary hormones especially Androgens
Suggested Reading PROMOTING WELLNESS Guide for Cancer Patients Mark Moyad, M.D.,M.P.H. Director of Preventive & Alternative Medicine University of Michigan Medical Center
Disclosure “IMANA
is committed to providing CME activities that are fair, balanced and free of bias.
Full and specific disclosure information is provided in your handouts.” I have no relevant financial relationship with any of the commercial interests.