Review articleLifestyle recommendations to prevent prostate cancer, part I: time to redirect our attention?
Section snippets
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.
References (104)
- et al.
Mortality by cause for eight regions of the world: Global Burden of Disease Study
Lancet
(1997) Atherosclerosis gene increases susceptibility to prostate cancer
Lancet
(2002)- et al.
Relation of erectile dysfunction to angiographic coronary artery disease
Am J Cardiol
(2003) Is obesity a risk factor for prostate cancer, and does it even matter? A hypothesis and different perspective
Urology
(2002)Osteoporosis: a rapid review of risk factors and screening methods
Urol Oncol
(2003)- et al.
Portion size of food affects energy intake in normal-weight and overweight men and women
Am J Clin Nutr
(2002) - et al.
Association of energy intake with prostate cancer in a long-term aging study: Baltimore Longitudinal Study of Aging (United States)
Urology
(2003) - et al.
Calorie restriction and aging: review of the literature and implications for studies in humans
Am J Clin Nutr
(2003) - et al.
Mortality in vegetarians and non-vegetarians: detailed findings from a collaborative analysis of 5 prospective studies
Am J Clin Nutr
(1999) - et al.
Hyperlipidemia
Prim Care
(2000)
Dietary fat intake and risk of type 2 diabetes in women
Am J Clin Nutr
Do trans fatty acids increase the incidence of type 2 diabetes?
Am J Clin Nutr
Plasma lipoprotein and Lp[a] changes with substitution of elaidic acid for oleic acid in the diet
J Lipid Res
Trans (elaidic) fatty acids adversely affect the lipoprotein profile relative to specific saturated fatty acids in humans
J Nutr
Metabolism of trans fatty acids with emphasis on the effects of trans, trans-octadecadienoate on lipid composition, essential fatty acid, and prostaglandins: an overview
Am J Clin Nutr
Intake of conjugated linoleic acid, fat, and other fatty acids in relation to postmenopausal breast cancer: the Netherlands Cohort Study on Diet and Cancer
Am J Clin Nutr
Dietary fat reduction to reduce prostate cancer risk: controlled enthusiasm, learning a lesson from breast or other cancers, and the big picture
Urology
The effect of shellfish in the diet upon the plasma lipid levels in humans
Metabolism
Effect of shellfish consumption on cholesterol absorption in normolipidemic men
Metabolism
Hypocholesterolaemia and increased elimination of low-density lipoproteins in metastatic cancer of the prostate
Lancet
Efficacy and safety of plant stanols and sterols in the management of blood cholesterol levels
Mayo Clin Proc
Lipoproteins, nutrition, and heart disease
Am J Clin Nutr
Cholesterol reduction by different plant stanol mixtures and with variable fat intake
Metabolism
Effects of 2 low-fat stanol ester-containing margarines on serum cholesterol concentrations as part of a low-fat diet in hypercholesterolemic subjects
Am J Clin Nutr
The international burden of cardiovascular disease: responding to the emerging epidemic
Circulation
Mental health: new understanding, new hope
Burden of disease: implications for future research
JAMA
Effects of selenium supplementation for cancer prevention in patients with carcinoma of the skin. A randomized controlled trial. Nutritional Prevention of Cancer Study Group
JAMA
The influence of finasteride on the development of prostate cancer
N Engl J Med
The prevention of prostate cancer-the dilemma continues
N Engl J Med
Prostate cancer prevention trial yields positive results, but with a few cautions
J Natl Cancer Inst
Causes of death in elderly prostate cancer patients and in a comparison nonprostate cancer cohort
J Natl Cancer Inst
Association between coronary heart disease and cancers of the breast, prostate, and colon
Cancer Epidemiol Biomarkers Prev
Tumor angiogenesis inhibition by prostaglandin synthetase inhibitors
Anticancer Res
Cardiovascular risk factors correlate with prostate size in men with bladder outlet obstruction
BJU Int
Alzheimer disease: current concepts and emerging diagnostic and therapeutic strategies
Ann Intern Med
Emphasizing and promoting overall health and nontraditional treatments after a prostate cancer diagnosis
Semin Urol Oncol
Contemporary awareness and understanding of cholesterol as a risk factor: results of an American Heart Association National Survey
Arch Intern Med
Executive summary of the Third Report of the National Cholesterol Education Program (NCEP). Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III)
JAMA
C-reactive protein-to screen or not screen?
N Engl J Med
Homocysteine and risk of ischemic heart disease and stroke. A meta-analysis
JAMA
Lipoprotein(a): still an enigma?
Curr Opin Lipidol
Lp(a) lipoprotein, vascular disease, and mortality in the elderly
N Engl J Med
Effects of the amount and intensity of exercise on plasma lipoproteins
N Engl J Med
Hyperinsulinaemia as a risk factor for developing benign prostatic hyperplasia
Eur Urol
National Heart, Lung, and Blood Institute. National High Blood Pressure Education Program Coordinating Committee
Hypertension
Effect of aerobic exercise on blood pressure: a meta-analysis of randomized, controlled trials
Ann Intern Med
Current methods used for defining, measuring, and treating obesity
Semin Urol Oncol
Risks and benefits of estrogen plus progestin in healthy postmenopausal women: principal results from the Women's Health Initiative randomized controlled trial
JAMA
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2011, European Journal of CancerCitation Excerpt :In addition, patients receiving statins are also advised to implement lifestyle changes pointing towards cardiovascular disease (CVD) prevention, such as exercise, reducing animal-lipid food and consuming low-calorie products such as fish, soy and vegetables. This lifestyle might also relate to reduced PCa risk and reduced progression of well-differentiated malignancies, thus introducing another potential bias in the aforementioned studies.132 Intriguingly, published data support that lifestyle modifications do not seem to impact PCa if the cholesterol profile remains unchanged.133
Prostate-Specific Natural Health Products (Dietary Supplements) Radiosensitize Normal Prostate Cells
2010, International Journal of Radiation Oncology Biology PhysicsCitation Excerpt :The results of epidemiology studies have strongly supported a relationship between the incidence of prostate cancer and lifestyle factors such as diet (1–4).
Clinical Events in Prostate Cancer Lifestyle Trial: Results From Two Years of Follow-Up
2008, UrologyCitation Excerpt :Finally, the experimental patients had greater improvements in cardiovascular health parameters than did control patients, as shown by lowered total and low-density lipoprotein cholesterol levels, which might translate into a reduction in cardiac events over the long term. This is especially important because, in general, men with prostate cancer are more likely to die of cardiovascular disease than of prostate cancer.28 The results of our study have shown that participating in an intensive lifestyle program might allow patients choosing active surveillance to delay conventional treatment.