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Men's health: Prostate Cancer

Prostate cancer is the second most common cancer in men worldwide with an estimated 1.1 million cases and 307,000 deaths during 2012. In the US there will be an estimated 233,000 new cases and 29,500 deaths during 2014. Lifetime risk is estimated to be as high as one in six men with a lifetime risk of dying from prostate cancer at about one in 34. In over 90% of the cases, prostate cancer is identified in a localized or local-regional state that can be managed/treated successfully. The prostate is a gland in males that is involved in the production of semen. It is located between the bladder and the rectum. The normal prostate gland is the size of a walnut and surrounds the urethra, the tube that carries urine from the bladder.

Regular screening of men over age 40–50 with an annual digital rectal exam and PSA level has led to early diagnosis. Since prostate cancer can progress very slowly, many cases are identified while clinically indolent and would never have become clinically apparent during the person’s lifetime. Some of these patients are subjected to confirmatory biopsy and treatment modalities that may result in psycho-social harm, anxiety and complications of treatment that may have been unnecessary. The impact of early treatment on survival remains controversial. Approximately 10% of prostate cancers become rapidly progressive and advancing to a widely metastatic phase that can cause great morbidity and subsequent death. There has been a recent call to reduce screening concerned with "over-diagnosis" doing "more harm than good". A study has reported that 27 men need to be diagnosed with prostate cancer (at least 60% of them received surgery or radiation) to prevent one prostate cancer death with its apparent related quality-of-life issues. Perhaps a more judicial approach would be to continue regular screening, but keep the results in proper perspective related to relative risk.

These decisions are often best made by an experienced primary care physician who knows the relative risk status of the patient, together with a highly skilled and experienced urologist with good clinical judgment. An approach of "Active Surveillance" sometimes combined with chemo suppression may be an appropriate alternative to more aggressive surgical or radiation intervention with its increased co-morbidity issues. Fortunately new MRI imaging techniques and less invasive robotic surgery has significantly reduced morbidity in cases where more aggressive approach is necessary.

We have less specific validated information regarding the prevention of prostate cancer compared to some other cancers, but diet, physical activity, smoking cessation and management of co-morbidities are of paramount importance. The pursuit of generally excellent health significantly improves risk reduction. Eating a diet with an emphasis on adequate fresh fruits and vegetables and fish and limiting salty foods, sugar and saturated fats facilitates adequate needed vitamins and minerals including the antioxidants. Several studies have suggested that diets high in certain vegetables including tomatoes, cruciferous (cabbage, broccoli and cauliflower), soy, beans and other legumes as well as fish are beneficial. Diets high in calcium tend to have a negative effect. Studies have suggested that taking supplements of antioxidants has not produced a favorable clinical response. Vitamin E and selenium where once promoted to be of benefit and have subsequently been been found to suggest a slightly higher risk for prostate cancer. Drinking pomegranate juice, taking flaxseed and having frequent ejaculations have been studied with inconclusive results for significant benefit.

More than 2.3 million American men take a supplement testosterone product. It is unlikely that taking testosterone is a primary cause of prostate cancer, but it tends to contribute to increasing the cancer growth when present and contributes to risk concerns. Increasing age is clearly the greatest risk for developing prostate cancer. Family history with certain inherited genes create a predisposition in some. Racial and ethnic group risks are also a consideration with a dramatically higher incidence among blacks and lowest among native Japanese, while intermediate among white men.

In summary it can be stated that there are perhaps 7 factors that men can do to reduce the risk of prostate cancer.

1) Don't smoke or use tobacco products.

2) Eat a healthy diet including plenty of fruits and vegetables and other foods from sustainable plant sources. Limit saturated fats. Use alcohol in moderation.

3) Maintain a healthy weight.

4) Regular physical activity - studies show that men who exercise 30 minutes most days have a reduced risk.

5) Vaccinations - Get an annual flu shot - stimulates an active immune system.

6) Regular medical screening.

7) Awareness of risk concerns related to testosterone usage.

Paul Block, MD, FACP, FCCP

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