Prostate cancer is the second most commonly occurring cancer in men. A healthy diet including right foods and supplements such as whole grains, legumes, tomatoes and their active compound lycopene, garlic, mushrooms, fruits such as cranberries, and Vitamin D, may be beneficial for reducing the risk of prostate cancer or for improving the treatment outcomes in prostate cancer patients. However, factors such as obesity and diet including foods such as sugary foods and dairy products, and supplements such as stearic acid, Vitamin E, Vitamin A and excess Calcium may significantly increase the risk of prostate cancer. Also, consuming random supplements while undergoing treatment can interfere with the treatment and cause adverse effects. A personalized nutrition plan will help with finding the right foods and supplements to complement the prostate cancer treatment rather than interfere with it.
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Prostate Cancer Incidence
Prostate cancer is the fourth most commonly occurring cancer and the second most common cancer in men. (World Cancer Research Fund/American Institute of Cancer Research, 2018) It is more common in men who are aged over 50 years. About 1 out of 9 men will be diagnosed with prostate cancer during his lifetime. The American Cancer Society estimated about 191,930 new cases and 33,330 deaths from prostate cancers in the United States in 2020.
Prostate cancer often grows extremely slowly and the patients might not realize that they have cancer. It can also spread to different parts of the body, away from the prostate including areas such as bones, lungs, brain and liver. It can be detected early by testing for prostate-specific antigen (PSA) levels in the blood. Prostate cancers detected at a very early stage are more treatable.
There are different treatment options available for prostate cancer including surgery, radiation therapy, hormone therapy, chemotherapy, immunotherapy, targeted therapy and cryotherapy. The treatment for prostate cancer is decided based on various factors such as the stage and grade of cancer, age and expected life span and other medical conditions.
Signs and Symptoms
Prostate cancer detected at a very early stage might not necessarily show any symptoms. According to the American Cancer Society, advanced prostate cancers may lead to certain symptoms such as:
- Problem in urinating, increased frequency of urination, especially at night
- Blood in the urine or semen
- Erectile dysfunction
- Pain in the back (spine), hips, chest (ribs), or other areas when the cancer has spread to the bones
- Weakness or numbness in the legs or feet
- Loss of bladder or bowel control if the cancer presses the spinal cord
The most common risk factors of Prostate cancers include:
- Age : 6 out of 10 prostate cancer cases are found in men older than 65.
- Family History
- Genetic Risk : Inherited mutations of the BRCA1 or BRCA2 genes; Lynch syndrome- also known as hereditary non-polyposis colorectal cancer, a condition caused by inherited gene changes
- Exposure to chemicals
- Inflammation of Prostate
- Sexually Transmitted Infections
- Unhealthy diet
A healthy and well-balanced diet that provides the right nutrition is important to stay away from cancer as well as support and improve the cancer treatment outcomes. Proper nutrition provides patients the strength to handle the treatments, get the best out of the therapies as well as improve their quality of life. In this blog, we will highlight the studies which evaluated the association between different foods and supplements that we add to the diet, and prostate cancer risk as well as the treatment outcomes.
Foods and Supplements to Reduce the Risk of Prostate Cancer
In a study published in 2020, the researchers from the Loma Linda University in California and the Arctic University of Norway evaluated the association between the intake of tomatoes and lycopene and the risk of prostate cancer based on data from 27,934 Adventist men without prevalent cancer who participated in the Adventist Health Study-2. During a mean follow-up of 7.9 years, 1226 incident cases of prostate cancer with 355 aggressive cancers were identified. The study found that the intake of canned and cooked tomatoes may reduce the risk of prostate cancer.(Gary E Fraser et al, Cancer Causes Control., 2020)
Lycopene is the key active compound found in tomatoes. Researchers from Zhongnan Hospital of Wuhan University, China evaluated the association between lycopene consumption and the risk of Prostate Cancer based on data from 26 studies, with 17,517 prostate cancer cases from 563,299 participants, obtained through literature search in Pubmed, Sciencedirect Online, Wiley online library databases and manual search till April 10, 2014. The study found that higher lycopene intake may be associated with a reduced risk of prostate cancer, with the dose-response meta-analysis showing that higher lycopene consumption was linearly associated with a reduced risk of prostate cancer, with a threshold between 9 and 21 mg/day. (Ping Chen et al, Medicine (Baltimore)., 2015)
Researchers from the Tohoku University School of Public Health and Tohoku University Graduate School of Agricultural Science in Japan and Pennsylvania State University and Beckman Research Institute of the City of Hope in the United States evaluated the association between mushroom consumption and prostate cancer incidence based on dietary data from the Miyagi Cohort Study in 1990 and the Ohsaki Cohort Study in 1994, which involved 36,499 men who were aged between 40-79 years. During a follow-up period of 13.2 years, a total of 1204 cases of prostate cancer were reported. (Shu Zhang et al, Int J Cancer., 2020)
The study found that compared to the participants who consumed mushroom less than one servings per week, those who consumed 1-2 servings of mushrooms per week were associated with a 8% decreased risk of prostate cancer and those who consumed ≥3 servings per week were associated with a 17% decreased risk of prostate cancer. This association was found to be more predominant in middle-aged and elderly Japanese men.
- Researchers of China-Japan Friendship Hospital in China evaluated dietary data from six case-control and three cohort studies obtained through a systematic literature search up to May 2013 in PubMed, EMBASE, Scopus, Web of Science, Cochrane register, and Chinese National Knowledge Infrastructure (CNKI) databases and found that garlic intake significantly decreased the risk of prostate cancer; however, the study didn’t find any significant association for onions. (Xiao-Feng Zhou et al, Asian Pac J Cancer Prev., 2013)
- In another study, the researchers in China and the United States evaluated the association between intake of allium vegetables, including garlic, scallions, onions, chives, and leeks, and the risk of prostate cancer based on data obtained from face-to-face interviews to collect information on 122 food items from 238 prostate cancer patients and 471 male controls. They found that men with the highest intake of total allium vegetables, approximately >10.0 g/day, had a significantly lower risk of prostate cancer compared to those with lowest intake of <2.2 g/day. They highlighted that the risk reduction was significant in the highest intake categories for garlic and scallions. (Ann W Hsing et al, J Natl Cancer Inst., 2002)
In a study published in 2012, the researchers evaluated the dietary data from 930 African Americans and 993 European Americans in a population-based, case study named the North Carolina-Louisiana Prostate Cancer Project or PCaP Study and found that whole grain intake may be associated with a reduced risk of prostate cancer in both African Americans and European Americans. (Fred Tabung et al, Prostate Cancer., 2012)
Researchers from Wenzhou Medical University and Zhejiang University in China carried out a meta-analysis of data from 10 articles, with 8 population based/cohort studies involving 281,034 individuals and 10,234 incident cases, obtained through literature search in the PubMed and Web of Science databases till June 2016. They found that every 20 grams per day increment of legume intake was associated with a 3.7% reduced risk of prostate cancer. (Jie Li et al, Oncotarget., 2017)
Foods and Supplements to be avoided to Reduce the Risk of Prostate Cancer
Stearic Acid Intake may Increase the Risk of Prostate Cancer
Analysis of dietary data of 1903 men without a history of cancer from a large, multi-ethnic, population-based cohort study called the SABOR (San Antonio Biomarkers of Risk) Study, done by the researchers from the University of Texas, University of Kansas and CHRISTUS Santa Rosa Medical Center in the United States, found that every 20% increased intake of stearic acid (with the intake increasing from one quintile to the next quintile) was associated with a 23% increased risk of prostate cancer. However, the study did not find any significant association between omega-3 fatty acids, polyunsaturated fatty acids (PUFAs) or any other individual polyunsaturated fatty acids and the risk of prostate cancer. (Michael A Liss et al, Prostate Cancer Prostatic Dis., 2018)
Vitamin E Supplement Intake may Increase the Risk of this Cancer
In a study published in 2011, the researchers from the Glickman Urological and Kidney Institute, Cleveland Clinic in the United States examined data from a very large Selenium and Vitamin E Cancer Prevention Trial (SELECT) which was conducted in 427 sites in the United States, Canada and Puerto Rico on over 35,000 men who were 50 years or older and had low prostate specific antigen (PSA) levels of 4.0 ng/ml or less. The study found that compared to men who did not consume Vitamin E supplements, there was a 17% increased risk of prostate cancer in men who took vitamin E supplements. (Eric A Klein et al, JAMA., 2011)
High Sugar Intake may Increase the Risk of Prostate Cancer
A study published in 2018 analyzed dietary data of 22,720 men from the Prostate, Lung, Colorectal, and Ovarian (PLCO) Cancer Screening Trial who were enrolled between 1993-2001, of which, 1996 men were diagnosed with prostate cancer after a mean follow-up of 9 years. The study found that increased consumption of sugars from sugar-sweetened beverages was associated with an increased risk of prostate cancer. (Miles FL et al, Br J Nutr., 2018)
Excessive Intake of Calcium Supplements and Dairy Products may Increase the Risk of Prostate Cancer
- In a 24 year follow-up study called the Health Professionals Follow-Up Study done by the researchers of the Harvard School of Public Health in Boston, based on dietary information from 47,885 men, it was found that high consumption of phosphorus was independently associated with an increased risk of advanced stage and high-grade prostate cancer, approximately 0-8 years after consumption. The researchers also found that excessive Calcium intake of >2000 mg/day was associated with an increased risk of advanced-stage and high-grade prostate cancer, about 12 to 16 years after consumption. (Kathryn M Wilson et al, Am J Clin Nutr., 2015)
- In another study, as part of the WCRF/AICR Continuous Update Project, the researchers from the Norwegian University of Science and Technology in Norway, Imperial College in London and University of Leeds in UK evaluated the association between the intake of calcium and dairy products and prostate cancer risk. The analysis used data from 32 studies which were obtained through literature search in Pubmed till April 2013. The researchers found that the consumption of total dairy products, total milk, low-fat milk, cheese, and dietary calcium were associated with an increased risk of total prostate cancer. They also found that supplemental calcium intake was associated with an increased risk of fatal prostate cancer. (Dagfinn Aune et al, Am J Clin Nutr., 2015)
High Vitamin A intake may Increase the Risk of Prostate Cancer
- In a pooled analysis of 15 clinical studies published in the American Journal of Clinical Nutrition in 2015, the researchers looked at over 11,000 cases, to determine the association between the levels of vitamins and cancer risk. In this very large sample size, high levels of retinol (Vitamin A) were associated with an increased risk of prostate cancer. (Key TJ et al, Am J Clin Nutr., 2015).
- In another observational analysis of over 29,000 samples from the alpha-tocopherol, beta-carotene cancer prevention study conducted by National Cancer Institute (NCI), National Institute of Health (NIH), in the United States, the researchers reported that at the 3 year follow-up, men with higher serum retinol (Vitamin A) concentration had an increased risk of prostate cancer (Mondul AM et al, Am J Epidemiol, 2011).
Diet / Foods and Supplements which may be beneficial for Prostate Cancer Patients
Including Lycopene in the Diet may Improve the Treatment Efficacy of a Specific Drug in Prostate Cancer
A phase I study of docetaxel plus synthetic lycopene in metastatic, castration-resistant and chemotherapy-naïve prostate cancer patients, conducted by researchers from the University of California, who in a previous pre-clinical study demonstrated the synergistic effect of lycopene on the drug DTX/DXL to inhibit the growth of human prostate cancer cells, found that lycopene improved the effective dose of DTX/DXL, with the combination resulting in very low toxicities. The study also found that lycopene may significantly enhance the antitumor efficacy of this drug/treatment by approximately 38%. (Zi X et al, Eur Urol Supp., 2019; Tang Y et al, Neoplasia., 2011).
Including Tomato-Products in the Diet may Reduce Prostate Specific Antigen (PSA) levels
In a study published in 2017, researchers from the University of Oslo, Norway evaluated data from 79 patients with prostate cancer and found that three week dietary intervention with tomato-products (containing 30 mg lycopene) alone or in combination with selenium and n-3 fatty acids may reduce Prostate Specific Antigen/PSA levels in non-metastatic prostate cancer patients. (Ingvild Paur et al, Clin Nutr., 2017)
Including White Button Mushroom (WBM) Powder may Reduce Serum Prostate Specific Antigen (PSA) levels
Researchers from the City of Hope National Medical Center and Beckman Research Institute of the City of Hope in California carried out a study involving 36 patients with continuously rising Prostate Specific Antigen (PSA) levels and found that after 3 months of white button mushroom powder intake, PSA levels reduced in 13 out of 36 patients. The study reported that the overall PSA response rate was 11% with no dose limiting toxicities post using white button mushroom powder. 2 of the patients who received 8 and 14 gm/day of white button mushroom powder had a complete response related to PSA, with the PSA declined to undetectable levels for 49 and 30 months and 2 other patients who received 8 and 12 gm/day had a partial response. (Przemyslaw Twardowski, et al, Cancer. 2015)
Including Lycopene in the Diet May Reduce Treatment-induced Kidney Damage in Prostate Cancer Patients
In a double-blinded randomized trial involving 120 patients, the researchers from the Shahrekord University of Medical Sciences in Iran evaluated the effects of lycopene found in tomatoes on a CIS chemo-induced kidney damage in patients. They found that lycopene may be effective in decreasing the complications due to CIS treatment-induced nephrotoxicity in prostate cancer patients by affecting different markers of renal function. (Mahmoodnia L et al, J Nephropathol. 2017)
Including Mushroom Mycelium Extracts in the Diet may Reduce Anxiety in Prostate Cancer Patients
A study done by the researchers of Shikoku Cancer Center in Japan which included data from 74 prostate cancer patients found that, in patients who had strong anxiety before consuming mushroom mycelium extracts, the dietary administration of these extracts significantly alleviated anxiety. (Yoshiteru Sumiyoshi et al, Jpn J Clin Oncol., 2010)
Including Vitamin D in the Diet may Improve Muscle Weakness
The European Palliative Care Research Centre Cachexia Project evaluated dietary information from 21 publications obtained through literature search in CENTRAL, MEDLINE, PsycINFO, ClinicalTrials.gov, and a selection of cancer journals until 15 April 2016 and found that vitamin D supplementation has the potential to improve muscle weakness in patients with prostate cancer. (Mochamat et al, J Cachexia Sarcopenia Muscle., 2017)
Including Cranberry in the Diet may reduce Prostate Specific Antigen (PSA) Levels
In a double blind placebo controlled study, the researchers evaluated the effects of cranberry consumption on prostate specific antigen (PSA) values in men with prostate cancer before radical prostatectomy. They found that the daily consumption of powdered cranberry fruit reduced serum PSA levels in prostate cancer patients by 22.5%. (Vladimir Student et al, Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub., 2016)
Following a diet including the right choices of foods and supplements such as whole grains, legumes, tomatoes and their active compound lycopene, garlic, mushrooms, fruits such as cranberries and Vitamin D, and a healthy lifestyle along with doing regular exercises and being physically active may help reduce prostate cancer risk and improve treatment outcomes. However, factors such as obesity and a diet including foods such as sugary foods and dairy products, and supplements such as stearic acid, Vitamin E, Vitamin A and excess Calcium may significantly increase the risk of prostate cancer.
Right nutrition may help reduce the risk of developing prostate cancer, improve the treatment outcomes and quality of life of the patients, reduce the rate of progression of the disease and may also help prevent the cancer. However, all dietary supplements should be used only after consultation with your healthcare provider to avoid any undesirable interactions with your ongoing treatment.
Cancer patients often have to deal with different chemotherapy side effects which affect their quality of life and look out for alternative therapies for cancer. Taking the right nutrition and supplements based on scientific considerations (avoiding guesswork and random selection) is the best natural remedy for cancer and treatment related side-effects.