Risk Factors

Prostate cancer is the most common non-skin cancer in America, affecting 1 in 6 men. The older you are, the more likely you are to be diagnosed with prostate cancer. Although only 1 in 10,000 under age 40 will be diagnosed, the rate shoots up to 1 in 38 for ages 40 to 59, and 1 in 14 for ages 60 to 69. In fact, more than 65% of all prostate cancers are diagnosed in men over the age of 65.

But the roles of race and family history are important as well. African American men are 61% more likely to develop prostate cancer compared with Caucasian men and are nearly 2.5 times as likely to die from the disease. Men with a single first-degree relative—father, brother or son—with a history of prostate cancer are twice as likely to develop the disease, while those with two or more relatives are nearly four times as likely to be diagnosed. The risk is even higher if the affected family members were diagnosed at a young age, with the highest risk seen in men whose family members were diagnosed before age 60.

Although genetics might play a role in deciding why one man might be at higher risk than another, social and environmental factors, particularly diet and lifestyle, likely have an effect as well.

In fact, research in the past few years has shown that diet modification might decrease the chances of developing prostate cancer, reduce the likelihood of having a prostate cancer recurrence, or help slow the progression of the disease.

Prostate Cancer Symptoms

If the cancer is caught at its earliest stages, most men will not experience any symptoms. Some men, however, will experience symptoms that might indicate the presence of prostate cancer, including:

• A need to urinate frequently, especially at night;
  Difficulty starting urination or holding back urine;
  Weak or interrupted flow of urine;
  Painful or burning urination;
  Difficulty in having an erection;
  Painful ejaculation;
  Blood in urine or semen; or
  Frequent pain or stiffness in the lower back, hips, or upper thighs.

Because these symptoms can also indicate the presence of other diseases or disorders, men who experience any of these symptoms will undergo a thorough work-up to determine the underlying cause of the symptoms.

Early Detection

The purpose of screening for cancer is to detect the cancer at its earliest stages, before any symptoms have developed.

Some men, however, will experience symptoms that might indicate the presence of prostate cancer. Because these symptoms can also indicate the presence of other diseases or disorders, these men will undergo a more thorough work-up. Typically, men whose prostate cancer is detected through screening are found to have very early-stage disease that can be treated most effectively.

Screening for prostate cancer can be performed quickly and easily in a physician’s office using two tests: the PSA (prostate specific antigen) blood test, and the digital rectal exam (DRE).

The PSA Blood Test
PSA is a protein produced by the prostate and released in very small amounts into the bloodstream. When there’s a problem with the prostate, such as when prostate cancer develops and grows, more and more PSA is released, until it reaches a level where it can be easily detected in the blood.

During a PSA test, a small amount of blood is drawn from the arm, and the level of PSA is measured. PSA levels under 4 ng/mL are usually considered "normal," results over 10 ng/mL are usually considered "high," and results between 4 and 10 ng/mL are usually considered "intermediate."

However, PSA can also be elevated if other prostate problems are present, such as BPH or prostatitis, and some men with prostate cancer have "low" levels of PSA. This is why both the PSA and DRE are used to detect the presence of disease.

The Digital Rectal Exam
During a DRE, the physician inserts a gloved, lubricated finger into the rectum and examines the prostate for any irregularities in size, shape, and texture. Often, the DRE can be used by urologists to help distinguish between prostate cancer and non-cancerous conditions such as BPH.

Should I Be Screened?
The American Cancer Society recommends that both the PSA and DRE should be offered annually, beginning at age 50, to men who have at least a 10-year life expectancy. Men at high risk, such as African American men and men with a strong family history of one or more first-degree relatives diagnosed at an early age, should begin testing at age 45.

However, there is no unanimous opinion in the medical community regarding the benefits of prostate cancer screening. Those who advocate regular screening believe that finding and treating prostate cancer early offers men more treatment options with potentially fewer side effects. Those who recommend against regular screening note that because most prostate cancers grow very slowly, the side effects of treatment would likely outweigh any benefit that might be derived from detecting the cancer at a stage when it is unlikely to cause problems.

Because a decision of whether to be screened for prostate cancer is a personal decision, it’s important that each man talk with his doctor about whether prostate cancer screening is right for him.

Why Nutrition Matters
• When it comes to the risk of developing prostate cancer, there are three factors that are unchangeable: age, family history, and race. But there is also no question that our environment—and particularly our diet—influences the way our body functions.

• Regardless of the nutritional approach you ultimately choose, weight management and exercise should be a core part of your overall strategy.

Nature’s Bounty: Fruits and Vegetables
• Lycopene, a naturally occurring chemical found mostly in tomatoes, and to a lesser degree in watermelons, pink grapefruits, papaya, and guava, acts as a powerful antioxidant, and helps protect the body against cancer.

• Because processing and cooking foods change the way that lycopene is absorbed and used in the body, lycopene supplements may not provide the same benefits as cooked tomato products. If possible, you should get your lycopene from regular consumption of cooked tomatoes or tomato products.

• A very large and long-term study has shown that consuming at least two servings of tomato sauce per week confers a significantly lower risk of developing organ-confined prostate cancer, locally advanced disease, and metastatic disease.

• Sulforaphane, a compound found in cruciferous vegetables such as broccoli and cauliflower, helps the body to repair the damage caused by cancer-causing substances, thereby helping to slow down the cancer growth process.

• In a large, long-term study, men who consumed five or more servings of cruciferous vegetables each week showed a lower risk of developing prostate cancer.

• Polyphenols found in green tea as well as isoflavones found in soy-based foods have both shown anti-cancer effects in laboratory studies, but it has been difficult to confirm these effects in human clinical studies.

The Building Blocks: Vitamins and Minerals
• Data from a large, long-term study showed that beta-carotene supplementation in men with low levels of the vitamin in their bloodstreams can decrease the risk of developing prostate cancer; vitamin E supplementation can decrease the risk of developing and dying of prostate cancer, but seems to be most effective in men who are smokers.

• In one large, long-term study, consumption of selenium was associated with a lower risk of developing prostate cancer, but the benefits might differ depending on each person’s PSA levels.

• Although high levels of certain vitamins and minerals can increase the risk of developing prostate cancer, they can also be beneficial in preventing or delaying development of other diseases or disorders. Discussion with your doctor or qualified nutrition consultant about your particular risk factors for one disease or disorder over another will help you find the nutritional approach that’s right for you.

Dietary Fats and Red Meat: Rethinking the American Way
• Although the role of saturated fats in prostate cancer remains unknown, a number of studies have shown that different types of omega-3 fatty acids can affect the risk of developing prostate cancer: ALA (alpha-linolenic acid), an omega-3 fatty acid found in dairy products and red meat, increases the risk of developing advanced prostate cancer, while DHA (docosahexaenoic acid) and EPA (eicosapentaenoic acid), two omega-3 fatty acids found mostly in fatty fish, lowers the risk of developing prostate cancer.

• Exposure to high levels of a cancer-causing substance known as PhIP, which is found in grilled meats, has been associated with the development of prostate cancer in laboratory animals. In humans, lowering the grill temperature and minimizing char on the meat resulted in lower absorption of PhIP, as did an increase in cruciferous vegetable intake.

• Further research in this area is needed to help define the optimal strategy for reducing exposure to cancer-causing substances such as PhIP. In the meantime, flipping the meat more frequently while grilling to avoid char can help play a role in minimizing their effect on cancer risk.

Charting a Course for the Road Ahead
• Any attempt to combat the trend of the increase in obesity in the United States is important, but extreme or fad diets don’t teach people how to make smart choices over the long term -- those enrolled in programs that could be more easily adaptable to everyday life tend to stick to their diets for a longer time.

• Planning ahead before shopping for food will help you identify the healthiest options, and make it easier to incorporate smarter choices into your life.

• It’s rare that there are no smart choices available at a restaurant, but finding them might require some creativity and persistence—two qualities that are essential to your goal of slowing the development and progression of prostate cancer.

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