Prostate cancer is the most common cancer, other than skin cancers, in American men, according to the American Cancer Society (ACS). ACS estimates that 192,280 new cases of prostate cancer will be diagnosed in the United States in 2009.

What men eat strongly influences prostate cancer risk, and consuming dairy products can contribute to an increased risk of this disease.

Men who consume low-fat and nonfat milk face an increased risk of prostate cancer, according to two studies in the American Journal of Epidemiology. One study included 82,483 men in the Multiethnic Cohort Study, 4,404 of whom developed prostate cancer over an average follow-up of eight years. Researchers found no association between prostate cancer risk and calcium and vitamin D intake, whether in the form of food or supplements. But the study did find a positive association between consuming 1 cup or more per day of low-fat or nonfat milk and developing prostate cancer.

The other study included 293,888 participants in the National Institutes of Health (NIH)-AARP Diet and Health Study. Consuming two or more daily servings of skim milk was associated with an increased risk of advanced prostate cancer.

Several previous studies—including two large Harvard studies—have shown that milk-drinking men have a significantly higher risk of prostate cancer. Researchers offer two possible reasons for the association: Milk drinking increases blood levels of insulin-like growth factor, which is associated with cancer risk. It also decreases activation of vitamin D precursors. Vitamin D helps protect the prostate against cancer.

Men who have prostate cancer can increase their chances of survival by following a low-fat vegan diet. By increasing consumption of cancer-fighting vegetarian foods and avoiding foods that feed tumor growth, such as dairy products and meat, men may significantly increase chances of living longer after prostate cancer diagnosis, according to a review in Nutrition Reviews in 2007.

Researchers found that low-fiber diets raise circulating testosterone, estradiol, and insulin levels, which in turn may fuel prostate cancer cell growth. Among men with the highest intake of saturated fat, the risk of dying from prostate cancer is three times higher than among men with the lowest intake.

Men with prostate cancer who follow a low-fat vegetarian diet benefit from increased quality of life and slowed PSA doubling time, according to a study in Urology. PSA doubling time is the amount of time it takes for levels of prostate-specific antigen, a biological marker for prostate cancer, to increase by 100 percent.

The study, led by Dean Ornish, M.D., focused on 36 men who had been diagnosed with prostate cancer, had undergone primary treatment for more than six months, and had continuous increases in PSA levels. The men were assigned to attend vegetarian nutrition and cooking classes or to a control group. Those in the vegetarian intervention group consumed significantly less saturated fat, more vegetable protein, and less animal protein, including fewer dairy products. The mean PSA doubling time at the three-month follow-up was substantially longer for the intervention group compared with that of the control group, meaning that the diet slowed cancer growth.

Men who want to avoid prostate cancer should follow a low-fat vegetarian diet. Which foods should men focus on? Building a balanced diet from whole grains, beans, fruits, and vegetables is the best way to go. But a few foods stand out as powerful fighters in the battle against prostate cancer.

Black, pinto, small red, and kidney beans are high in fiber, which helps the body rid itself of excess testosterone, and are among the 20 most antioxidant-rich foods. Beans are also rich in inositol pentakisphosphate, a known cancer-fighter.

Tomatoes and other lycopene-rich foods, such as watermelon and pink grapefruit, are associated with a reduced risk of prostate and other cancers. Studies from the Harvard School of Public Health have shown that men who frequently consume lycopene-rich foods cut their prostate cancer risk by one-third.

Broccoli and other cruciferous vegetables, including kale and cauliflower, are rich in sulforaphane, a cancer-fighting phytochemical that helps rid the body of excess testosterone and reduces the risk of prostate and other cancers.

Soy, nut, and rice milks are a healthy alternative to cow’s milk, which is known to increase the risk of prostate cancer. According to two major Harvard studies, men who avoided dairy products cut their prostate cancer risk by as much as 25 to 40 percent. Soy foods are also associated with a lower risk of cancer. Excellent plant sources of calcium are broccoli, brussels sprouts, kale, mustard greens, and fortified products such as orange juice and soymilk, and these foods will also provide your body with important cancer-fighting nutrients.

Need more information on prostate cancer and or making the transition to a vegetarian diet? Visit http://www.CancerProject.org for delicious recipes, information on nutrition and cooking classes, fact sheets on nutrition and cancer, DVDs, videos, books, and a free copy of The Cancer Project’s booklet Healthy Eating for Life: Food Choices for Cancer Prevention and Survival.

By Jennifer K. Reilly, R.D.
The Cancer Project

Doctors are unsure whether to treat, and those that do take positive action are uncertain about the type of treatment.

This mass uncertainty, based on inadequate trials, came to light in a survey of 270 British urologists. The research team was so concerned by its findings that it is calling for established standards of practice to be decided upon, but this is hard to implement without proper research.

“For the foreseeable future, recommendations for managing prostate cancer will rely more on dogma than data,” says Albert Mulley from Harvard Medical School in an accompanying comment.

Urologists who favour early intervention are divided over what form it should take. Of the urologists who participated in the survey, most recommended radiation for men under the age of 70 with early prostate cancer, some preferred radical prostatectomy and a sizeable minority opted for hormone treatment. For men over 70, 30 per cent of urologists favoured active treatment, usually radiation.

Although 90 per cent of urologists favoured active treatment among younger men, few of them thought that early detection had any benefits.

This indecision may be fuelled by the understanding that any benefit is only likely to be realised long after treatment, while the patient still had to contend with the immediate side effects of incontinence and impotence among the few aspects of treatment that have been well researched (Br J Urol 1997; 79: 749-55; BMJ 1998; 316: 1919-20).

Impotence was suffered by 98 of 112 men after surgery for prostate cancer, an Australian study has discovered. Impotence was the most reported worry, well ahead of fears about cancer and incontinent. Unsatisfactory golf club toilets was a more unexpected item on the list (Med J of Australia 1998; 168: 483-6).

* In a recent study, one third of 773 individuals involved in a road accident as a driver, bicycle rider or pedestrian experienced some level of anxiety, depression, fear of travel or post traumatic stress disorder (PTSD) 3 to 12 months later and, in most cases, persisted. After one year, about half the group had phobic travel anxiety, nearly 60 per cent had general anxiety, and half were diagnosed with PTSD (Am J Psychiatry, 2001; 158: 1231-8).

* New research in nearly 1300 men suggests that, during a severe asthma attack, men are less likely than women to notice the symptoms of the attack. The reason for this is unclear, but it may be that men perceive less discomfort because of greater lung size and muscle strength, or because they generally develop asthma at an earlier age than women. Men also tend to only seek medical attention when symptoms are too severe to ignore, the researchers noted (Ann Emerg Med, 2001; 38: 123-8).

* What’s lurking in that paddling pool? Physicians in Canada have found the first outbreak of a new type of Pseudomonas infection called ‘hot foot syndrome’. This discovery was made when 40 children, aged 2 to 15, developed intense pain in the soles of their feet within 40 hours of using the same wading pool. A hot, red swelling began after a few hours, along with pain so severe that the children were unable to stand up. Three children were given oral cephalexin (an antibiotic) while the others were treated with cold compresses, analgesics and foot elevation. In all cases, the condition resolved within 14 days, although it recurred in three children after they revisited the same pool (N Engl J Med, 2001; 345: 335-8).

A 10 year follow up study of men with early prostate cancer left untreated showed that 10 years later only 8.5 per cent of the 223 patients had died from prostate cancer. The survival rate of 86.8 per cent in the untreated group was nearly identical to a subgroup who met all the conditions for radical prostatectomy.

In two thirds of some 76 patients, after a decade the tumour had only undergone local growth, and had not spread to other organs. In these patients, hormonal treatment was usually successful. Only six of the entire study group of 223 had substantial local problems arising from the tumour.

The study also found that after an initial surge of deaths among the 8 per cent who died, disease progression and death from prostate cancer decreased during the last years of the decade long follow up.

Other studies of survival rates after irradiation or radical prostatectomy have been reported as 65 to 83 per cent demonstrating that the more radical treatment offers no benefit (and possibly a disadvantage) to patients over leaving well alone particularly for patients of an advanced age.

The study compared 60 men with prostate cancer with 197 healthy controls. Nineteen of the cancer patients had received hormone therapy. The total BMD and BMD at selected sites were significantly lower in the hormone treated group compared with the others, and there was a significant association between the duration of hormone therapy and reduction in total BMD.

The authors comment that, in treating men with hormonal therapy earlier and for longer periods of time, doctors are creating a menopause equivalent condition, causing severe osteoporosis a disease that may have more serious consequences than early stage prostate cancer (J Clin Endocrinol Metab, 2001; 86: 2787- 91).

A vasectomy is a minor 15- to 30-minute operation usually carried out under local anaesthesia. It involves cutting the tubes that carry the sperm (vas deferens), and sealing them off with sutures or surgical clips. Recovery usually takes about two days, though patients are advised to avoid strenuous exercise for a week. There is normally a two-month wait after the surgery before the vasectomy can be confirmed, usually by a negative sperm result.

Vasectomies are free under the UK’s National Health Service, but can cost up to $1000 in the US. And changing your mind may be even more of a pain – costing up to £2200 in the UK and around $13,000 in the US.

What doctors tell you

* Inflammation of the testicles (orchiepididymitis), in one study, affected 4 per cent of vasectomy patients (Actas Urol Esp, 2004; 28: 175-214), and some 1 per cent also have bruising and swelling of the epididymis (Contracept Technol Update, 1990; 11: 185).

* Sperm granulomas, or pea-sized lumps of scar tissue in the scrotum, were seen in three of 30 vasectomised men (J Clin Ultrasound, 2004; 32: 394-8). They are usually not serious or painful, but they may require surgical removal.

* Chronic scrotal pain affects around one in seven (14.2 per cent) patients after vasectomy (BJU Int, 2004; 93: 571-4).

* Scrotal haematoma, a blood blister, is the most common immediate complication seen with vasectomy (Rajast Med J, 1972; 11: 51-61). It can affect up to 2 per cent of vasectomy patients (Contracept Technol Update, 1990; 11: 185), but should disappear within seven to 10 days.

* Impetigo is a contagious skin infection caused by bacteria – usually Staphylococcus aureus and/or group A beta-haemolytic streptococci (GABHS). Although infections are possible with any type of surgical trauma or skin wounds, it is unusual, especially in young fit men.

* Be aware of the psychological implications that may accompany sterilisation. It needs to be understood that the operation will prevent a man from fathering children, and the prospective patient needs to consider whether this fact will have a negative impact on his attitude towards his sexuality. In some cases, the patient is left feeling incomplete as a man after the operation. This can lead to unhappiness and a loss of libido.

What doctors don’t tell you
The risks of these complications may be higher than doctors like to admit. One study involving 300 patients who had undergone a vasectomy concluded that the procedure was safe, despite reporting adverse effects in up to 18 per cent of the men. The reported problems included bleeding (ecchymoses, or little haemorrhagic patches), inflammation, gangrene (as a complication of infection), sepsis (infection) and endocarditis (an inflammation/infection of the endocardium – the inner lining of the heart and its valves – requiring antibiotics) (Actas Urol Esp, 2004; 28: 175-214).

* Chronic scrotal pain is the most common vasectomy complication: it may affect a third of patients – in one follow-up, four years after surgery (Br J Urol, 1992; 69: 188-91) – and have an adverse effect on the quality of life (J Urol, 1996; 155: 1284-6).

* Impetigo sepsis occurred in one out of the 300 vasectomised men in the study mentioned earlier and required hospitalisation (Actas Urol Esp, 2004; 28: 175-214).

* A possible link with prostate cancer is inconclusive, although vasectomised men may have an increased risk (Prostate Cancer Prostatic Dis, 2002; 5: 193-203). An expert panel recommended no changes in clinical practice due to inconsistent results across 16 reports (Contracept Technol Update, 1993; 14: 69-73). However, two studies found that sterilised men were almost twice as likely as their unsterilised counterparts to have prostate cancer (Consum Rep Health, 1994; 6: 8-9) and, more recently, Canadian retrospective data have suggested that such a risk is likely to increase after 10 years (Health Place, 2001; 7: 131-9).

* Post-vasectomy pain syndrome is recognised by some medical professionals, and involves epididymal congestion, tender sperm granuloma and/or nerve entrapment. Vasectomy reversal may be a possible cure (J Urol, 2000; 164: 1939-42).

* Erectile dysfunction (impotence) was put down to vasectomy in around 10 per cent of men in a Swiss study, with a reduced libido reported during the first two postoperative years in a further 22 per cent of cases (J Psychosom Res, 1994; 38: 759-62).

* Death, albeit rare, can result from vasectomy surgery. One study found that, out of 160,000 such operations, two resulted in death – one due to a scrotal haematoma, with death occurring as a result of infection; the other due to general anaesthesia (Contracept Technol Update, 1990; 11: 185).

Deaths from cancer of the prostate in Japan and other Asian countries are low, despite the same incidence of latent or small “non infiltrative” prostatic cancers as among Western men. It seems that the Japanese life long soya rich diet may act to prevent these latent cancers from advancing.

Researchers compared the level of isoflavonoids plant estrogens found in soya products in the blood plasma of the two groups of men, both with an average age of 54.9.

They found that although the plasma concentrations among the Japanese men varied greatly, their levels were seven to 110 times higher than among those eating an ordinary Finnish diet.

Earlier laboratory studies have shown that isoflavonoids can inhibit the growth of several types of cancer cells, say the researchers.

Researchers at the Netherlands Cancer Institute reviewed 27 randomised trials comparing methods of androgen suppression in the treatment of prostate cancer.

The five year survival rate in those whose treatment regime consisted of androgen suppression, using surgical castration or drugs to control testicular hormone secretion, plus an antiandrogen to block hormones of adrenal origin referred to as maximum androgen blockade, or MAB was 25.4 per cent.

This was little different from the 23.6 per cent five year survival rate of those who had only surgery or drugs to control testicular hormone secretions.

MAB is a very extreme regime in the treatment of prostate cancer. While no comment was made on the adverse effects caused by MAB, the experience of women with breast cancer suggests that hormone manipulation can produce a wide range of unpleasant effects which substantially reduce quality of life.

What is more, the results of this analysis suggest that the improvement in survival rates is minimal. According to their data, the MAB regime will only improve survival by an average about 2-3 per cent (Lancet, 2000; 355: 1491-8).

Similarly, caution is now being advised in prostate cancer regimes that involve radiotherapy. Men who have received high dose radiotherapy are now reporting side effects, including rectal bleeding, pain and mucus discharge, the possibility of which they may not be informed about at the time of receiving therapy.

The warning comes after research showing that moderate doses of conformal radiotherapy (in which the radiation strikes only the prostate and not the surrounding tissues) produces fewer rectal symptoms (Lancet, 1999; 353: 267-72).

The authors of this trial concluded that, on the basis of their findings, the radiation dose could be safely increased. However, other researchers are warning that such a recommendation cannot be drawn from the data and that routinely increasing the intensity of irradiation could end up producing just as many rectal symptoms as conventional high dose radiation (Lancet, 353; 1999: 1443).

Garlic, onions, shallots, leeks and scallions are all cancer-fighting foods, and they’re all found in Chinese food. Not surprisingly, then, a study among men in Shanghai found that those who ate small amounts of these foods every day cut their risk of developing prostate cancer by a third. Of all the foods mentioned, the most powerful were scallions, which alone could reduce the risk of prostate cancer by 70 per cent (J Natl Cancer Inst, 2002; 94: 1648-51).

There are three stages of prostate cancer: In the overwhelming majority of cases prostate cancer is localized, where low-grade, cancerous cells reside within the prostate gland and the patient may not even know he’s got cancer until it’s detected during, say, a routine, investigation for some other problem, or possibly picked up by screening. In the majority of cases, this will probably never grow to give you any problems during the rest of your life. Treatment is mainly wait-and-see and shouldn’t affect your quality of life. Ironically, this is the only stage where surgery can be successful at a point where it may not be necessary. If you have a much longer expected life span than 10 years, the “watchful waiting ” approach is supposedly associated with a higher probability of living with cancer that spreads or dying from prostate cancer (New Eng J Med, January 27, 1994). In the locally advanced type, medium-grade cancer cells spread outside the prostate gland. In this instance, surgery usually won’t help, so radiotherapy and hormone treatment is usually prescribed. Reducing hormone levels with drugs or surgery can help to control the cancer for several years. With advanced prostate cancer, high-grade cancer cells have spread out from the prostate into the adjoining tissue and bone. Although by this stage, prostate cancer can’t really be treated effectively with drugs, hormone therapy can slow down the disease for a couple of years, after which chemotherapy can help for while, according to conventional medicine. Radiotherapy is used to relieve the pain caused by the cancer spreading to the bones.One of the most important ways of detecting prostate cancer is to know thyself. By the time you reach 50 you may well be showing some clinical signs of benign prostatic hyperplasia (BHP), where the prostate’s cells increase in size and number. In this condition the prostate grows from the size of a walnut to about the size of a lemon. This expansion of the prostate then constricts the urethra through which urine flows out of the bladder.

If, for example, you’re having to get up several times in the night to pass urine, you feel discomfort or pain, you may wish to get medical help, particularly If the prostate feels unusually firm or uneven, of if symptoms are very severe and inconvenient. An early visit can often mean a non-surgical treatment of the prostate if it is enlarged.