How to prevent prostate cancer

You're leading a happy, healthy life. Why should you be concerned about prostate cancer? My husband, Allan, and I weren't either, until we received the devastating news from his doctor. Out of town at an antique music box convention, our future appeared uncertain as we clung to each other in shock. But our initial bewilderment and emotion faded as we counted our blessings. His cancer was diagnosed at an early stage. In our opinion, consistent healthy lifestyle choices had delayed this diagnosis more than 10 years.

Allan has been very conscientious about getting regular screenings for prostate cancer, following a healthy diet and exercise program, taking selected supplementation, and not smoking. When he was in the Army, doctors had told him that he was at increased risk for prostate problems because of the surgeries he required then.

Allan explained the health issues that he was concerned about before we got married and added, "I can't change heredity or past health problems, but I certainly have a choice about prevention steps to lower my odds for disease, avoid new problems, and improve the quality of my life. We have each other, and there's so much that makes life worth living." This optimistic attitude encourages me to continue following a healthy lifestyle also, as we work together to maintain and enhance our well-being.

Most men don't have such advance warning.

"I think a common misconception is that prostate cancer has a low threat potential and that more men will die with the disease than of it," says Dr. James M. Kozlowski, chief of urologic oncology at Northwestern University Medical School in Chicago.

"Although this is generically true, we know that prostate cancer is a leading cause of cancer death in men ... it's a common disease; it's a pervasive disease. When detected in relatively young men who have a significant amount of their life span ahead of them, their chances of dying from it decrease dramatically," he says.

The prostate is a walnut-sized male sex gland under the bladder whose secretions help form the seminal fluid. It surrounds the upper part of the urethra. The American Cancer Society estimates that 198,100 new cases of prostate cancer will be diagnosed and that 31,500 American men will die of this cancer in the year 2001. That's one diagnosis every three minutes and one prostate cancer death every 13 minutes. The incidence of prostate cancer is higher among Black men, and may be linked to higher levels of the male hormone testosterone.

Get Regular Testing

Debate continues among experts about the benefits of the PSA (prostate-specific antigen) screening test. Some physicians have raised objections, believing it leads to needless biopsies and treatment of a very slow-growing cancer. But since 1991, when PSA testing became prevalent, prostate cancer death rates have dropped by 16 percent (while there's been an increase in prostate cancers detected).

"Curative windows of opportunity that are lost are never retrieved," says Dr. Kozlowski. "You may live a normal life span with the disease, but it may be one adversely impacted by disease-related complications that could have been avoided if optimal treatment were provided earlier on." He agrees with the American Urological Association and the American Cancer Society's policy that both a PSA blood test and the digital rectal examination (DRE) should be offered annually to men beginning at age 50, and to younger men who are at higher risk.

Your internist can provide these tests, and may refer you to a urologist. If you have a family history or think you may be at high risk, it's probably best to see a urologist for testing. It's best not to ejaculate 48 hours before the test, as it can raise PSA levels. Since a rectal exam can also raise PSA levels, have your blood drawn for the PSA test first. It's also been suggested that it is best not to ride a bicycle beforehand.

Many urologists now do a "PSA profile." This consists of utilizing both the traditional PSA test and the percent-free PSA, which measures the percentage of free PSA in the blood. Then a ratio of free to total PSA in the blood is considered.

Inform your doctor of your medical history, including all supplements and medications you take. Dr. Kozlowski says it's wrong to assume anything over the counter is simple and safe, and if not helpful, at least neutral.

Some physicians are also concerned about the "fountain of youth" hormone supplements DHEA (dehydroepiandrosterone) and andro (androstenedione) and the possibility that they may increase risk for prostate cancer by raising testosterone levels. Dr. Kozlowski advises patients to discuss any over-the-counter dietary supplements or herbs they are utilizing or considering with their physician, rather than come to them later with many complications that could have been avoided had they been more open at the outset.

Men are not as conscientious as women about getting suggested routine health screenings. Eighty-five percent of women over 40 have had a mammogram (the recommended screening test for breast cancer), while only 30 percent of men over 50 have had a PSA test. Prostate cancer strikes as many men, and causes almost as many deaths annually, as breast cancer does women.

Dr. Kozlowski says wives should encourage their husbands to have routine screening for prostate cancer--especially if they haven't seen a physician in a long time.

"I think it's important to have other members of the family, perhaps at a younger age, nudged in the direction of surveillance, if there are a number of first- or second-degree relatives in that family who have been afflicted with the disease," he says.

Richard Sutera, 51, of Centerville, Ohio, was diagnosed with prostate cancer at the age of 46. There's no history of prostate cancer in his family, but he first sought testing at age 45 after experiencing lower back pain and noticing blood in his urine. Thinking he had a bladder infection, he saw his family physician (who did only a digital rectal exam the first time). He was treated with antibiotics for an enlarged prostate (benign prostatic hyperplasia--BPH or prostatitis), a noncancerous condition very common in men over 40.

After no improvement, further testing showed he had cancer. Because of his experience, he is a believer in early testing. "A high PSA doesn't necessarily mean cancer, but I think men should get their PSA at 40 (definitely no later than 45)," Sutera says.

Keep Your Own Records

Ask for test results from your urologist, including any percentage figure. Chart these numbers next to the date of testing (or get a copy of the actual test report). Ask your doctor questions and seek additional testing if you (or your spouse) notice increases in your PSA level over time, notice some other trend, or have a concern. No one cares about your health more than you and those who love you.

Allan kept a detailed chart of the date of his test, the number of the PSA, and when he last ejaculated prior to testing. He noticed a change in the PSA figures if he ejaculated prior to the test, and was told not to by his physician only after asking him. He keeps an updated list of all medication and supplements, and brings a copy to his doctor(s).

Allan also charted changes in urinary function in response to dietary supplements. He noticed an improvement in urinary function and a lower PSA level after supplementing his diet with lycopene. Although the United States Pharmacopeia concluded last April that there is "moderate evidence of effectiveness" for saw palmetto in men with BPH, it didn't seem to help Allan. A lack of effect could be because not all brands contain the same amount of active ingredients.

Can Prostate Cancer Be Prevented?

Since we don't know exactly what causes prostate cancer, we don't know what will prevent it. However, according to the American Cancer Society, existing scientific evidence suggests that about one third of the cancer deaths in the U.S. annually are caused by dietary factors. Cigarette smoking accounts for another third. Although genetics is a factor, heredity doesn't explain all cancer occurrences. So for most Americans who don't smoke, "dietary choices and physical activity become the most important modifiable determinants of cancer risk, at all stages of its development," says the American Cancer Society.

Lynn Danford, M.S., C.D.E., L.D., a nutritionist who works with a urologist at Weiss Memorial Hospital in Chicago, believes a low-fat, plant-based diet can help men who have already undergone treatment, aiding in their recovery and slowing the growth of any other cancer cells. She adds that happiness and social interaction also enhance health, such as eating out, dining with friends, and celebrating with food. She says, "As an aspect of complete wellness, no person should ever be expected to forgo the enjoyment that comes from eating."

"I Have Prostate Cancer! What Should I Do Next?"

1. Stay positive