Review article
Lifestyle recommendations to prevent prostate cancer, part I: time to redirect our attention?

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Lifestyle change #1: patients should know their lipid profile and other cardiovascular risks and markers as well as they know their prostate-specific antigen values and other results from their prostate exam

In the authors' experience, many patients are aware of their prostate-specific antigen (PSA) values, but either have not had a cholesterol test, or are unaware of their cholesterol levels or their meaning. This is frustrating because cardiovascular disease is the primary or secondary cause of death in these patients [1], [6], [7], [10]. This incomplete knowledge is common not just among prostate patients. Surveys of the general population indicate that most people either do not know their

Lifestyle change #2: encourage patients to maintain a healthy weight; the body-mass index or waist-to-hip ratio should become a part of the clinical record

The negative effects of overweight or obese on overall health and mortality are well known. Less known is the effect of weight on prostate cancer risk, but its impact may be as profound [28]. Body-mass index (BMI) is a reliable and fast method of diagnosing overweight or obese [29]. BMI is the weight (in kg) divided by the square of the height in meters (kg/m2). Another method to calculate BMI is to divide weight in pounds by height in square inches and multiply the quotient by 704

Lifestyle change #3: emphasize to patients that there is no ideal weight loss diet or intervention; the primary goal is motivation and action to maintain a healthy weight; help patients choose diet or lifestyle changes that suit them; most diets and interventions consist of several related healthy messages

Low-fat, low-carbohydrate, drug therapy, surgery: the list of ways to reduce weight continues to grow, confuse, and frustrate many individuals [29]. Losing sight of the ultimate goal is a potential risk for patients attempting to lose weight. A similar analogy exists in smoking cessation, where many credible methods are available, rather than a single intervention [46]. Some dietary interventions that reduce dietary fat involving men with prostate cancer have produced favorable PSA-level

Lifestyle change #4: replace saturated, trans-fatty acids, and cholesterol with unsaturated fat; types of dietary fat consumed may matter more than total fat intake; the use of commercial plant sterol/stanol products may be heart- and prostate-healthy

Saturated fat (SF) or hydrogenated fat reduces LDL receptor expression and increases LDL serum levels [19]. LDL levels increase by 2% for every 1% increase in total calories from SF. The NCEP Adult Treatment Panel III recommends reducing SF to less than 7% of total calories to reduce the risk for cardiovascular disease. In the United States, the average adult intake of SF is 11% of total calories. Some nonlean meats, high-fat dairy products (whole milk, butter, cheese, ice cream, and cream),

Summary

This article provides a foundation for clinicians willing to provide lifestyle change recommendations for the prevention of prostate cancer. In part II, more general and specific lifestyle recommendations will be provided. It is imperative to provide patients with realistic and practical recommendations that are not only consistent in the medical literature, but will improve overall compliance.

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