CaPLESS & Prostate Cancer

The Anti-Cancer Benefits of Curcumin

Along with ginger and garlic, curcumin is one of my favorite herbs to prevent and even treat health problems naturally.

This potent herb does not only have potent anti-inflammatory properties, which in at by itself is worth taking, but it also has anti-cancer abilities.

I am not exaggerating.

Now, to be clear, I am not saying just taking curcumin that will cure cancer. It’s not that simple.

But taking ample amounts of this botanical should be part of any anti-cancer arsenal.

That is why when I formulated ImmunoPCTN, it was a no-brainer to add ample amounts of curcumin to the formula.

What is Curcumin

Curcumin is a component in the Indian spice turmeric, and it’s a cousin of ginger – another highly protective herb. Curcumin causes the yellow color in your curry dish. Tumeric is a member of the ginger family (Zingiberaceae). Turmeric’s other two curcuminoids are desmethoxycurcumin and bis-desmethoxycurcumin. Ideally, when consuming curcuminoids, you would want all three health-promoting curcuminoids: curcumin, bisdemethoxycurcumin, and dimethoxy curcumin. I know, it’s getting a little technical, but the bottom line is to get enough of this yellow staining compound from spicing your food and from supplementation.

There are over three hundred research papers suggesting curcumin’s protective effects against prostate cancer and more than to four thousand scientific documents showing its inhibitory results against almost all cancer.

While curcumin can be consumed in food, I recommend have my patients take additional curcumin daily from dietary supplements.

How curcumin protects Prostate cells

Chronic inflammation can cause all kinds of health problems in men from heart disease to certain cancers. Regarding prostate cancer, however, chronic inflammation elevates PSA in the prostate gland, which can build up and eventually leads to tumor formation. A clinical trial examined the effect of curcumin on men and showed a drop in PSA numbers.

Curcumin does not falsely lower PSA. In other words, prostate cancer is not hidden while PSA lowers when taking this herg.

How Curcumin protects against prostate cells

Curcumin protects prostate cells (and breast cells) by slowing down the overproduction of inflammatory chemicals called cytokines.

A particular molecule in the body that promotes cytokine production is Nuclear Kappa Factor –b (NFkB). This ancient yellow spice has shown to inhibit progression of excess prostate cell replication by interrupting the action of NFkB in mice.

Curcumin is an excellent herb to take during radiation therapy for cancer.

That’s right. Curcumin actually helps destroy cancer cells during radiation treatment. This is a big deal because virtually all radiation oncologists would recommend against taking supplements during radiation treatment. This recommendation is based on the flawed theory that anti-oxidant supplements are taken during radiation treatment, it may protect cancer cells from the radiation treatment.

But now we know that curcumin makes cancer cells more radiosensitive to radiation therapy. Indeed, taking curcumin can help cancer cells be more vulnerable to radiation therapy.

Lastly, Curcumin has shown to stop spreading of aberrant prostate cells in the body.

The Takeaway on Curcumin and Prostate cells

Here’s the bottom line: spices of all kinds should be consumed daily with food. The scientific community now realizes that the best pharmacy is indeed in the kitchen. Rosemary, Oregano, garlic, turmeric all have anti-cancer properties.

Smart and judicious use of dietary supplements should be an essential part of any health routine if the interest is in preventing or slowing the development of abnormal prostate and breast cells.

Optimal amounts ranges of curcumin vary from 400mg to 4000mg a day. Science daily has suggested up 8 grams a day (8000mg) is safe. Typically, the more aggressive the health challenge, the more curcumin should be consumed.

I consume about 1000 to 2000 mg curcumin from this formula for maximal protection, reduce soreness from workouts and for prostate health. And you should too.

 

 

 

BREAKING NEWS: USPTSF Position on Prostate Cancer Screening

The United States Preventive Service Task Force (USPSTF) on PSA screening

The United States Preventive Services Task Force (USPSTF)  is a government supported panel composed of national medical experts in primary care and researchers (no urologist or oncologist on the panel) who collectively review the evidence for what screening tools and treatments are most useful for patients.

The USPSTF has a grading system ranging from grade A, where the task force recommends for a service (screening or treatment) to grade D where the recommendation is against a service, and everything else in between. (see below chart).

In 2012 the United States Preventive Services Task Force (USPSTF) issued a report opposing the use of PSA in screening for prostate cancer and gave a grade “D” recommendation, discouraging physicians to screen for prostate cancer and that there is more harm than good with the use of the PSA test.

Then two years later after further data review, the USPSTF graded PSA screening to a “C,” suggesting that the decision on whether or not to screen for prostate cancer with PSA test should be shared between the physician and patient and it should be used selectively in a case by case basis.

Today, published in the Journal of American Medical Association (JAMA), the USPSTF concludes that there is a small overall benefit with the use of PSA in screening for prostate cancer, but continues to note that damages may occur during this screening process.

There is still a major age-related problem in this current recommendation because studies have predominantly included patients aged 55-70 years. Thus, the new USPSTF will not recommend PSA for men over 70 years nor for those under 55 years, which seems inadequate, given that it does not take into account clinical characteristics nor individual volition.

This new screening grade is important because the task force has an influence on how clinicians practice on what health insurance companies pay for.

Now Three Studies Driving Prostate Cancer Screening Controversy

Initially, the two main trials influencing the USPSTF’s grading on prostate cancer screening are The European Prostate Cancer Screening Trial (ERSPC) and The American Prostate Cancer Screening Trial (PLCO) study. Now there is a more recent study, the Cluster Randomized Trial of PSA Testing for Prostate Cancer (CAP) that reinforces the task force position on screening.

The Cluster Randomized Trial of PSA Testing for Prostate Cancer (CAP)

This British study was conducted in the United Kingdom, where about five hundred primary care practices in the United Kingdom were offered to screen men aged 50 to 69 years an invitation to a single PSA test (271 practices) and a control group that did not offer PSA testing (302 practices).

In an average of ten years follow-up, there was no all-cause mortality difference between the screened and the non-screened group.

In other words, men who were screened for prostate cancer died from any cause, not just prostate cancer as much as men who were not screened at all. As one would expect, there was an increase in low-risk prostate cancer detection in the screening group in the CAP study.

The European Prostate Cancer Screening Trial (ERSPC)

The ERSPC randomized trial of about 160,000 men between 55 and 69 years for PSA screening or control without PSA where the PSA average to indicate a prostate biopsy is ≥ 3.0 ng/ml. The PSA test was taken, on average, only every four years. After monitoring for 11 years, screening reduced the risk of metastases by 41% and the chance of death from prostate cancer by 21%.

More recently, the European ERSPC study, now with almost 14 years of follow-up, confirmed that prostate cancer mortality in PSA screened patients decreased by 32% suggesting that as time goes on study subjects continued to be followed, there will be more benefit from PSA screening.

On the other hand, ERSPC trial continues to show a major problem with over diagnosing for prostate cancer screening with PSA of clinically insignificant tumors.

In fact, in the ERSPC study, the finding of low-risk tumors (PSA less than10 ng/mL and Gleason score less than 6) was almost three times higher in the screened group than the control group.

The American Lung, Colorectal, and Ovarian Cancer Screening Trial Trial (PLCO) study

Lastly in the American Lung, Colorectal, and Ovarian Cancer Screening Trial Trial (PLCO) study randomized over 76,000 men aged 55 to 74 years for annual screening with PSA and rectal exam or control group with the “usual urological care,” that is, at the discretion of the urologist.

The PSA value used to indicate biopsy was ≥ 4.0 ng/mL. This study initially showed no mortality benefit for men who received PSA screening in comparison with those who did not.

The problem in the PLCO trial was the control group. Since “usual care” in the USA includes PSA, in this case almost 90% of the patients in the “usual care” group did the test compared to the randomized group. Therefore, it is no surprise that the rates of prostate cancer death were similar to the screening arm.

When researchers combined all the major prostate cancer screening studies, they did not find a significant decrease in prostate cancer-specific mortality except in the ERSPC which screening did indeed lower prostate cancer mortality.

They concluded that “Harms associated with PSA-based screening and subsequent diagnostic evaluations are frequent, and moderate in severity. Overdiagnosis and overtreatment are common and are associated with treatment-related harms.”

The Takeaway from the USPSTF on Prostate Cancer Screening

The task force grade recommendation for prostate cancer screening stays at a “C” which mostly means that you, the patient, can dictate whether or not you want to be screened for prostate cancer. If you do not want a PSA test taken, then you can decline, and in theory, your physician should be fine with it.

Essentially, there is no grand change in the USPSTF recommendation from 2014, other than they are doubling down on their “C” grade reinforced by the CAP study.

The Dr. Geo’s Guide to Prostate Cancer Screening & Protection

I am all for patient empowerment and for men partnering with physicians to improve his health. Furthermore, many of my patients, naturally, since I am a holistic practitioner, want to avoid biopsies.

I don’t blame them. I don’t know anyone who gets excited about having their prostate poked 12+ times and had blood come out their urine and semen for up to two weeks.

The evidence is clear that most men with high PSA scores who get biopsied, do not have prostate cancer (what we call a false positive). It is also obvious, based on volumes of research that there is overtreatment of prostate cancer, meaning, most men with prostate cancer will not die from it making prostate cancer treated with either surgery or radiation obsolete.

Why not screen for prostate cancer and not treat if the outcome is low-grade disease?

Because that diagnosis is daunting to your brain. It’s the “cancer” word. In other words, the problem in many cases is the diagnosis itself – it provokes anxiety and unease – so rather than letting those feeling linger “taking it out” is what many men opt for.

The problem is not the PSA test. And ignorance is not bliss. Before the late 1980’s most men diagnosed with prostate cancer had advanced disease, and those numbers went down drastically after the commercial use of PSA test.

The problem is how the PSA number is used (or abused). As the CAP study revealed, just one PSA number that is relatively high does not dictate you have prostate cancer or that a biopsy is needed.

When I partner with patients to determine if avoiding a prostate biopsy is the right for them, we look at:

  • Age of the patient
  • Family history
  • Race
  • PSA relative to age
  • PSA free percentage
  • PSA density
  • the blood test 4K score
  • the urine test Select MDx.

If most of the results from testing indicate suspicious prostate cells, then we look into getting a 3-Tesla MRI. Still, no biopsy needed up to this point.

If the MRI highly suggested suspicious cells, typically of Gleason 7 or higher, then I would recommend a biopsy, but not a random ultrasound guided one, a targeted MR fusion biopsy.

The bottom line is how a physician uses a PSA test matters most, as imperfect of a biomarker for prostate cancer screening as it is, it saves lives.

At a minimum, an elevated PSA can tell you if something wrong in the prostate, even if it’s not cancer, maybe inflammation or other benign development.

The ultimate goal of prostate cancer screening is this:

• Find a cost-efficient method of locating tumors that have the most life-threatening potential.

• Leave tumors that are not deadly alone, or better yet, not find them in the first place.

• Have a treatment that can remove the possibly deadly cancer without sacrificing quality of life.

The methods of the screening I highlight above provide the best chance of accomplishing the ultimate goal for prostate cancer screening.

Also, prevention is the best medicine.

When I say prevention, I also mean prostate cancer recurrence prevention or, if it returns, preventing spreading of cancer.

Nutrition and Lifestyle is real medicine.

My recommendations:

  • Eat protective foods. A plant-based, Mediterranean method of eating is protective, and it’s the cornerstone of the CaPLESS method of eating.
  • Exercise four hours a week with moderate intensity.
  • Consume selected, targeted supplements from companies that exceed governmental quality manufacturing practices. My favorite supplements for ultimate protection are what I call my one-two punch: ImmunoPCTN and GDtoxSel.

Your Smartphone May Cause Prostate Cancer

There’s no question that modern technology has improved our lives.

If wasn’t for the Internet and your electronic device we would not be connected right now. Of course, there’s also inaccurate content online that can misguide us. And that’s not good.

Another aspect of technology that is imperfect and can cause health problems is excess exposure to the type of light coming out of your technological devices.

A recently published study associates nighttime exposure to blue light with an increased risk of prostate cancer and breast cancer.

Study details on Blue light connection with Prostate & Breast Cancer:

  • Evaluating the Association between Artificial Light-at-Night Exposure and Breast and Prostate Cancer Risk in Spain” was published in the journal Environmental Health Perspectives on April 23.
  • About 4,000 men and women were studied in Spain.
  • All the participants were enrolled in 2008–2013 and were between 20 and 85 years of age.
  • According to results for both the cities, those exposed to higher levels of blue light had a 1.5 times higher risk of developing breast cancer and a two times higher of developing prostate cancer when compared to the less-exposed population.
[Link to study]

What is Blue Light?

Blue light is a form of visible light we get from smartphones, computers, televisions, and lights. Anyone using modern devices is exposed to blue light. Other forms of light include, yellow, red, purple, etc. and each is labeled based on their wavelength.

Exposure to blue light during the day is not a problem and improves alertness, but reading from your smartphone, for example, at night, as many of us do, can contribute to health problems and interfere with quality sleep.

Simply, we have a circadian rhythm in our bodies that is regulated by our exposure to light (also regulated by when we eat).

Naturally, when our eyes are exposed to light, we create hormones and chemicals than we do a night when there should be more darkness. The main hormone that helps us sleep and restore at night, only in darkness is melatonin. If there is blue exposure at night, say, working late night on your computer, melatonin is shut off.

The Association between night workers and Prostate cancer (CaP)

While I am empathic to prostate cancer patients who work the night shifts, ironically also known as graveyard shift, I strongly prescribe them to change their work hours to daytime.

In over 2.5 million individuals studied from this meta-analysis, a significantly increased risk of prostate cancer was associated. The reason for such a strong association may be due to the inability for the body to release melatonin when eyes are exposed to light at night.

A prospective study of over 900 men in Iceland who did not have CaP and measured first-morning void urinary levels of 6-sulfatoxymelatonin (6-STM), a melatonin metabolite. During the study period, about one-hundred men were diagnosed with prostate cancer, including 24 with advanced disease. Men with low morning 6-STM levels had a 4-fold increased risk for advanced prostate cancer compared with men with levels above average. The average follow-up time from urine collection to CaP diagnosis was 2.3 years.

Researchers from another older but relevant study observed less CaP in men with higher nighttime melatonin secretion with longer sleep duration.

While I clinically don’t see nearly as much breast cancer patients as I do men with prostate cancer, the breast cancer research is appealing because it is known for the two cancers to be “cousins.” In other words, both breast and prostate cancer are formed and progress in similar ways.

Also, the nutrition habits and lifestyle behaviors that work for one works for the other

A study looking at 13 studies noticed a with a significant increase of breast cancer risk among nighttime female workers, mostly airplane workers and another showed a link between light exposure at night and breast cancer among nurses who worked night shifts.

What is Melatonin and how it works?

Melatonin is a hormone released from an area in the middle of your brain called the pineal gland only when the eyes detect no light. In other words, the darker the environment, the more melatonin produced. This super hormone has many protective qualities including protection against cancer development through several pathways, including antioxidation, stops excess replication of cells (apoptosis), interfering with new blood vessels in cancer cells (anti-angiogenesis), and the strengthening of the immune system.

Changes associated with shift work, including sleep disruption, circadian disruption also causes melatonin disruption. There is plenty of evidence in animal and human models to suggest the carcinogenicity of artificial light during the night, which causes circadian, sleep, and melatonin disruption.

In prostate and other cancers, shift work shows an increased the risk of diagnosis among pilots and airline occupations, in support of a potential effect of circadian and melatonin disruption.

My Take and Suggestions on the Link between blue light exposure and Prostate cancer

I tell my teenage kids all the time, “you have to control your phone. Your phone can’t control you.” That might be good advice for adults to practice as well.  Come to think of it, I often suggest to them things I need to improve on. Hmmm.

About three months ago I turned off all notifications and alerts from my phone.

Now, I don’t get instant notices of the news or updates in sports. And I am much happier and more productive. You’d be surprised how much time you have when you are less distracted with things that are less important.

The grand majority of time should be spent improving your health, taking care of your business and finances, improving relationships with people you love, and connecting spiritually with God, the universe or nature (some would say it is all the same but I’m no expert here.)

 

The other deleterious habit I discontinued was reading from my iPad or smartphone at night. As a dad, I know the use of electronic gadgets at night is contributing to poor quality sleep in kids causing them disruption in school and likely the cause of excess diagnosis of ADHD (Attention Deficit Hyperactivity Disorder). Kids need to sleep for better cognition, productivity and lowering the risk of disease. And so do we.

Data shows subjects reading light-emitting devices (e.g., eBook) before sleeping compared with a printed book, took longer to fall asleep, had reduced evening sleepiness, reduced melatonin secretion, later timing of their circadian clock, and reduced next-morning alertness.

 

I firmly believe that prostate cancer prevention and management is successfully improved by better lifestyle, nutritional and behavioral habits. And there is plenty of scientific evidence to prove it.

 

By improving lifestyle, nutritional and behavioral habits, one can optimally live longer – even if after a prostate cancer diagnosis.

Here are suggestions to improve your health with managing blue light exposure:

  • Sleep in a completely dark room. If there is fear of falling when going to the bathroom at night, place a small night light far from your bed.

 

  • Resist the urge of Fear of Missing Out (FOMO). We are easily hooked to our gadget with the FOMO. I recently learned I don’t need to know the score of my New York favorite teams in real time anymore.

 

  • Get into the habit of leaving your smartphone far away from your bed. Control your FOMO.

 

  • If your work hours are late nights, do your best to change your schedule to daytime hours.

 

  • If working nights is what you have to do, consider taking melatonin supplement before going to sleep. About 3mg is good a day, before bedtime is goo.

 

  • If sleep is poor and you have cancer, you may benefit from 20mg of melatonin, but best to see an integrative, functional or naturopathic medicine doctor when increasing the dose of melatonin.

 

  • Give yourself one to two hours of technological shut off time before bedtime. If poor sleep is an issue, consider two to three hours of no blue light before bedtime.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Part Three: PSA use for Prostate Cancer Screening

This is part three of a four-part series on the PSA test in an attempt to demystify the most feared blood marker in men.

 

Part one: What is PSA and what it does

Part two: Benign reason’s why PSA goes up

Part three: PSA use for Prostate Cancer Screening 

Part four: PSA after prostate cancer treatment

 

The Prostate Specific Antigen (PSA) test is the number one used biomarker for prostate cancer screening. In other words, the PSA blood test starts the unpleasant process of biopsies, prostate cancer treatment when malignant cells are found and side effect treatment from the cancer treatment. Many people think PSA is an expensive waste. One of those people is Dr. Richard Ablin, the discoverer of PSA who called this test in a New York Times article, The Great Prostate Mistake. He also wrote the book the Great Prostate Hoax condemning the PSA test for prostate cancer.

Should we stop PSA testing for prostate cancer screening?

No. I will explain. Stay with me.

How does PSA work?

As we learned in the previous article of this series, PSA breaks through the wall of the glandular portion of the tissue and seeps into the bloodstream for many malignant and mostly benign reasons. Ideally, the PSA molecule is only found in the semen. In fact, there are one million times more PSA in the semen than in the blood.

PSA in men before Prostate Cancer diagnosis

The “normal” range of 0.0ng/ml – 4.0ng/ml you see in lab reports is absurd.

Anything under 4ml/ng does not mean you don’t have prostate cancer. In fact, 15% of men with a PSA under 4 develop prostate cancer (Thompson et al. 2004)

Generally speaking, PSA is age-related. For example, a 40-year-old “should” have a PSA well under 1.0ml/ng (exception to the rule, this individual may have an infection of his prostate or other non-cancer causes to his PSA to be above 4).

A 60-year-old with a PSA of 2 may be fine.

A steady trend upward, even if the number is under 4, after three or four PSA tests may be more connected to prostate cancer once prostatitis or other benign conditions are ruled out.

On the previous article, we spoke about non-cancer reasons why PSA is elevated, but there are also numerous reasons why PSA is falsely low, meaning, one can have cancer while there PSA is “low.”

There are two things that cause a false lower PSA:

  1. The meds Finasteride (Proscar) and Dutasteride (Avodart) – falsely lowers PSA up to 50%.

2. Obesity: estrogen activity (which big men have more of) causes a decrease in PSA.

FYI: Obese men typically have worse cases of prostate cancer and higher changes of prostate cancer relapse after treatment. (Cao, 2011) Yet another motive for overweight men to get in shape.

The Good with PSA Screening for Prostate Cancer

Over the past 28 years, since the introduction of prostate-specific antigen (PSA), the incidence of metastatic prostate cancer and dying from this disease has significantly decreased. Although it is hard to connect the cause of prostate cancer decline to PSA, the five-year cancer-specific survival increased from 69% in the 1970s to now more than 95%, associating longer survival in diagnosed men to PSA examination.

 

The United States Preventive Service Task Force (USPSTF) on PSA screening

The United States Preventive Services Task Force (USPSTF) is a group of non-urologists or oncologists; mostly experts in primary care and researchers who collectively review the evidence for what screening tools and treatments are most effective for patients.

The USPSTF has a grading system ranging from grade A, where the task force recommends for a service (screening or treatment) to grade D where the recommendation is against a service, and everything else in between. I stand for insufficient evidence to recommend for or against a service.

In 2011 the United States Preventive Services Task Force (USPSTF) issued a report opposing the use of PSA in screening for prostate cancer and gave a “D” grade recommendation, meaning that existing scientific data demonstrate that there is more harm than good with the use of this test.

Then two years later after further data review, the USPSTF graded PSA screening to a “C,” suggesting that the decision on whether or not to screen for prostate cancer with PSA test should be shared between the physician and patient and it should be used selectively in a case by case basis.

The USPSTF concludes that there is a small overall benefit after a decade with the use of PSA, but continues to note that damages may occur during this screening period. However, there is still a major age-related problem in this current recommendation, because studies have predominantly included patients aged 55-70 years. Thus, the new USPSTF will not recommend PSA for men over 70 years nor for those under 55 years, which seems inadequate, given that it does not take into account clinical characteristics nor individual volition.

The Two Main Studies Driving PSA controversy

The two main humongous trials influencing the USPSTF where the PSA controversy is derived from is The European Prostate Cancer Screening Trial (ERSPC) and The American Prostate Cancer Screening Trial (PLCO) study.

The ERSPC randomized trial of about 160,000 men between 55 and 69 years for PSA screening or control without PSA where the PSA average to indicate a prostate biopsy is ≥ 3.0 ng/ml. The PSA test was taken, on average, only every four years. After monitoring for 11 years, screening reduced the risk of metastases by 41% and the chance of death from prostate cancer by 21%.

More recently, the European ERSPC study, now with almost 14 years of follow-up, confirmed that prostate cancer mortality in PSA screened patients decreased by 32% suggesting that as time goes on and study subjects continued to be followed, there’s benefit from PSA screening.

On the other hand, ERSPC trial continues to show major problem with over diagnosing for prostate cancer screening with PSA of clinically insignificant tumors.

In fact, in the ERSPC study the finding of low-risk tumors (PSA less than10 ng/mL and Gleason score less than 6) was almost three times higher in the screened group than the control group.

The other influential study on prostate cancer screening is the American Lung, Colorectal, and Ovarian Cancer Screening Trial Trial (PLCO) study randomized over 76,000 men aged 55 to 74 years for annual screening with PSA and rectal exam or control group with the “usual urological care,” that is, at the discretion of the urologist.

The PSA value used to indicate biopsy was ≥ 4.0 ng/mL. This study initially showed no mortality benefit for men who received PSA screening in comparison with those who did not.

There is a major problem in the PLCO trial, however.

The “usual care” subjects ( the control group) in the USA includes PSA, in this case almost 90% of the patients in the “usual care” group did the test compared to the randomized group. Therefore, it is no surprise that the rates of prostate cancer death were similar to the screening arm.

This is a multi-million dollar study with a major flaw in it that influence how physicians practice.

That’s freaking insane!

When another group of researchers combined all the major prostate cancer screening studies, they did not find a significant decrease in prostate cancer-specific mortality except in the ERSPC which screening did indeed lower prostate cancer mortality.

They concluded that “Harms associated with PSA-based screening and subsequent diagnostic evaluations are frequent, and moderate in severity. Overdiagnosis and overtreatment are common and are associated with treatment-related harms.”

Other Big Studies on Prostate Screening to Note

Other studies on prostate cancer screening that I find valuable but do not get the attention of PLCO and ERSPC are these two Swedish trials:

In the Gothenburg, in Sweden, 20,000 men were randomized 1:1 for PSA screening every two years or control without PSA. Their average age of participants were 56. The PSA value used to indicate the biopsy was between 3.0 and 4.0 ng/mL. After a 14-year follow-up, there was a relative decrease in prostate cancer mortality of 44%. Prostate cancer was diagnosed in 12.7% of the patients in the screening group and 8.2% of those in the control group.

Again, there was a high rate of overdiagnosis and overtreatment in this trial as well.

Researchers concluded that 293 cases needed to be screened and 12 treated for prostate cancer to prevent one tumor-related death.

[These figures are similar to those for breast cancer screening by the way]

Lastly, this study from Malmo Sweden of over 21,000 patients demonstrated that PSA levels in patients around 45 years of age with no family risk factors could provide data on the chance of developing aggressive prostate cancer and risk of death from the tumor in the coming decades.

When the baseline PSA values were below the population median according to the different age ranges:

  • up to 42 years: ≤ 0.6 ng/mL the chance of death from prostate cancer in 25 years was estimated at 0.1%
  • up to 50 years: ≤ 0.7 ng/mL the chance of death from prostate cancer in 25 years was estimated at 0.5%
  • up to 55 years: ≤ 0.9 ng/mL the chance of death from prostate cancer in 25 years was estimated at 0.8%

These authors suggest that only three PSA measurements, the first performed at around 45 years, the second at the beginning of the fifth decade of life, and the third at 60 years may be sufficient for a safe risk assessment for half of the population.

My Take on the Science of PSA use on Prostate Cancer Screening

There’s no question that the majority of men screened for prostate cancer will not die from it. In other words, there is indeed over-diagnosis and over-treatment of prostate cancer from PSA screening. No one will argue that.

However, many lives have been saved from prostate cancer screening since the beginning of clinical use in the early 1990’s.

If I am the one in the unfavorable percentage of developing aggressive prostate cancer, I want to know as early as possible and do something about it.

The idea of beginning PSA testing at the age of forty as suggested by the Swedish trial is appealing as I have seen many men in their forties with aggressive prostate cancer.

Prostate cancer screening is a case-by-case process. Every case is different, and the approach has to be individualized to the one patient in the office, not only to what researchers conclude as there are design flaws in all studies.

The Dr. Geo’s Guide to Prostate Cancer Screening

Many of my patients, naturally, since I am a holistic practitioner, want to avoid biopsies.

I don’t blame them. I don’t know anyone who gets excited about having their prostate poked 12+ times and have blood come out in their urine and semen for up to two weeks.

When I partner with patients to determine if avoiding a prostate biopsy is the right for them, we look at:

If most of the results from testing indicate suspicious prostate cells, then we look into getting a 3-Tesla MRI.

If the MRI highly suggest aberrant cells, then I would recommend a biopsy, but not a random ultrasound guided one, a targeted MR fusion biopsy.

Additionally, I recommend men to get a PSA reading at forty years of age, regardless of family history and use that as their baseline. If there is no family history and PSA is normal relative to age, do a PSA every five years. If there is a family history (father, brother, etc) then PSA should be taken once a year.

The PSA number is not the problem. What you do with that number is what matters. 

Not all elevated PSA requires a biopsy.

The bottom line is that PSA is decent, though imperfect marker for prostate cancer screening and have saved lives.

At a minimum, an elevated PSA can tell you if something is going on in the prostate, even if it’s not cancer, maybe inflammation or other benign reasons.

The ultimate goal of prostate cancer screening is this:

Find a cost-efficient method of locating tumors that have the most potential to be deadly. Leave tumors that are not deadly alone, or better yet, not find them in the first place. (The “C” word diagnosis, even for indolent tumors prokes anxiety and unnecessary worry). Have a treatment that can remove the potentially deadly tumor without sacrificing quality of life.

Well, maybe one exception, some tests like the MRI are expensive, and health insurances don’t always cover it despite evidence indicating that MRI testing reduces the risk of overdiagnosis.

Yep, that frustrates me too. HERE is what I found to work to get your prostate MRI covered.

The methods of the screening I highlight above are not perfect by themselves but better collectively in providing the best chance of accomplishing the goal of better screening practices to finding and treating deadly prostate cancer.

Last 3 Blog Posts:

[Not part of this series]

ADT, Apalutamide, Exercise in the treatment of prostate cancer

Traditional Chinese Medicine treatment for Erectile Dysfunction

Why I am into Intermittent Fasting 

 

Part Two: Benign, Non-Cancerous Reason’s why PSA rises

Part one: What is PSA and what it does

Part two: Benign reason’s why PSA goes up

Part three: PSA as a screening tool for prostate cancer

Part four: PSA after prostate cancer treatment

 

More often than not, PSA rises for reasons other than cancer. Still, this biomarker continues to stress men all over the world who get tested for it.

Here are non-cancer reasons why PSA goes up:

  • Ejaculating about 48 hours before the blood draw can cause a false increase in PSA by up to 1.3ng/ml.

 

  • PSA may be higher in smokers compared to non-smokers.

 

  • Inflammation of the prostate, or prostatitis, may cause an elevation in PSA. Symptoms of prostatitis include; pain or discomfort in the perineal area (between the scrotum and the anus), feeling of “sitting on a golf ball,” lower abdominal pain, lower back pain, burning, pain or discomfort after urination and/or ejaculation. Urinary frequency and urgency also appear in men with prostatitis. Treating prostatitis lowers PSA by close to 40%.

 

  • A digital rectal exam (DRE) before the PSA blood draw can increase PSA by 0.4ng/ml, which many physicians think it’s not a big deal. However, when a biomarker like PSA cause so much anxiety when elevated, anything you can do to keep the number low is a good idea, don’t you think? Also, the more vigorous the exam, PSA can go higher than 0.4 points.

 

  • Needle biopsy of the prostate raises the PSA level by seven times its normal value and stay elevated for up to 4 weeks.

 

  • Benign Prostatic Hyperplasia (BPH) or enlarged prostate cause an increase in PSA. One of the best methods to determine if PSA is high from BPH and less likely from prostate is by doing a PSA density. This is a simple calculation where the prostate size, best measured by an MRI, second best by ultrasound, is divided over PSA value. If the result of that calculation is higher than 0.15, the elevated PSA is likely from an enlarged prostate. If it’s less than 0.15, it is likely from prostate cancer. PSA density should not be the only determining factor for prostate cancer diagnosis. Lastly, a group of pharmaceutical drugs called, 5-alpha reductase inhibitors (5-ARI), falsely reduces PSA by about 50%, meaning, that one can harbor prostate cancer and have a low PSA when being on these drugs. Finasteride and Dutasteride 5-ARI’s are the two main drugs used for BPH.

 

  • Riding a bicycle for long distance can increase PSA score by up to 10% by putting pressure on the perineum area close to where the prostate is located. Cycling for short distances may not make a difference. Similar to after ejaculating, it is best to abstain from riding for at least 48 hours before the blood draw.

 

  • Any form of vigorous exercise a day or two before a blood draw may result in a false increase in PSA.

Next week you will learn the use of PSA as a screening tool for prostate cancer and uncover the confusion associated with it.

Last 3 Blog Posts:

What is PSA and what it Does

ADT, Apalutamide, Exercise in the treatment of prostate cancer

Traditional Chinese Medicine treatment for Erectile Dysfunction

 

Part One: What is PSA and What it Does

Part one of a four-part series on the PSA test to demystify the most feared blood marker in men.

 

Part one: What is PSA and what it does

Part two: Benign reason’s why PSA goes up

Part three: PSA as a screening tool for prostate cancer

Part four: PSA after prostate cancer treatment

 

No blood test provokes more anxiety than the PSA test.

Not cholesterol, not fasting glucose and, not Triglycerides make a man shake his knees more than the P – S -A test.

What is PSA?

For many, PSA stands for Patient Stimulated Anxiety.

All kidding aside, PSA is for Prostate Specific Antigen, a misnomer since it is not prostate-specific. PSA molecule is also found in a women’s blood who have cervical, uterine and breast cancer (Pummer et al. 1992, Mohajeri et al. 2011).

How Does PSA Work?

PSA is a protease. Any suffix ending with –ase is an enzyme and breaks things down or digests something. For example, lipase digests lipids (fats), sucrase digests sucrose (sugar), etc., like PSA, break a specific protein in men called seminogelin.

Seminogelin is what causes semen to clump up after ejaculating, causes the sperm to immobilize, thus interfering with conception.

You may have noticed that semen clumps up initially after ejaculation. Within a few minutes, it liquefies due to the function of the molecule PSA. This “anti-clumping” aspect is essential for procreation. Sperm cells swim better when they are loose and free.

The purpose of PSA (other than to get you nervous) is for making babies.

 

References:

Pummer K, Wirnsberger G, Pürstner P, Stettner H, Wandschneider G. False positive prostate specific antigen values in the sera of women with renal cell carcinoma. J Urol. 1992 Jul;148(1):21-3.

Mohajeri A, Zarghami N, Pourhasan Moghadam M, Alani B, Montazeri V, Baiat A, Fekhrjou A.Prostate-specific antigen gene expression and telomerase activity in breast cancer patients: possible relationship to steroid hormone receptors. Oncol Res. 2011;19(8-9):375-80.

ADT, Apalutamide and Exercise in the Treatment of Prostate Cancer

Hormone Deprivation therapy, also known as Androgen Deprivation Therapy (ADT) is a common long-term treatment for men with more serious prostate cancer or short-term therapy before undergoing radiation therapy. Either way, when a man’s testosterone levels go down to nearly zero, life is experienced differently.

My partner, David at XY Wellness recalls when he was on short-term ADT  before radiation nearly fifteen years ago;

“ ADT materially alters how you interpret and engage with the world around you. It taught me that there is far more than a mind-body connection by suggesting that they are one in the same.”

He continues;

“While undergoing ADT, it is not so much that the man is disinterested in sex but that it simply does not cross his mind.”

Recently, Apalutamide, trade name Erleada was approved for treating men with rising PSA (recurrence) after treatment for prostate cancer without metastasis. Currently, this is the first standard treatment for a scenario for a rapidly rising PSA without metastasis after a study was published in the New England Journal of Medicine.

Study Details

  • A total of 1207 patients underwent randomization: 806 were assigned to the Apalutamide group(240 mg per day) and 401 to the placebo group in the phase 3 SPARTAN (Selective Prostate Androgen Receptor Targeting with ARN-509) trial

NOTE: It is common for there to be funky names to large trials like this and other ADT studies, i.e, LATITUDE, CHAARTED, etc. It helps physicians (especially when lecturing) and lay people alike mention the studies with ease. Of course, SPARTAN has a warrior kind of implication… as in, are you ready to fight? Clever.

  • Follow up was for close to two years.

 

  • Study participants had confirmed prostate cancer that was castration-resistant and was at high risk for the development of metastasis, which was defined as a PSA doubling time of 10 months or less during continuous androgen-deprivation therapy.

 

  • Patients with evident bone metastasis were excluded from the study.

 

  • RESULTS: Time to metastasis, progression-free survival, and time to symptomatic progression were significantly longer (70% better) with Apalutamide than with placebo

 

  • Apalutamide was associated with higher rates of rash, fatigue, joint pain, weight loss, falls, and fracture than placebo.

(Study Link)

 

My Take on the Use of Apalutamide (Erleada is the trade name) non-metastatic Castrate Resistant Prostate Cancer

Apalutamide is an anti-androgen agent, meaning it lowers testosterone and Dihydrotestosterone (DHT) to almost zero, similar to other forms of Androgen Deprivation Therapy (ADT) except this new drug blocks the genetic formation of androgen receptors.

The study was paid for by Janssen Pharmaceutical, the developer of the drug. I say this because when studies funded by the company that makes the drug questioned, the results are often favorable to the company sponsoring the product. Thus, there seems to be some bias playing a role in such scenario.

That said, the design of the study was good, and it was published on one of the most respectable journals, New England Journal of Medicine (NEJM), so I will proceed with a small air of caution.

Seventy percent improvement from cancer worsening in two years compared to placebo is darn good. Of course, no drug that works well comes without downside (excuse the pun).

Men on Apalutamide showed higher rates of rash, fatigue, joint pain, weight loss, falls, and fracture than placebo.

Long-term treatment of ADT is associated with side effects, such as fatigue, reduced bone mineral density, increased fracture risk, decrease in skeletal muscle mass (muscle wasting), associated with the development of metabolic syndrome/insulin resistance, increase in adverse cardiovascular events effects and increases the risk of anemia, hot flashes, gastrointestinal tract disturbances, loss of libido, impotence, osteoporosis, gynecomastia, deep vein thrombosis, congestive heart failure, myocardial infarction, pulmonary edema, cognitive decline and psychological changes.

As I continue to monitor the well being of many prostate cancer patients on ADT, I can say with very little doubt that men can live long and strong while undergoing hormone therapy.

With one caveat…

You must follow a lifestyle and exercise regimen that supports your body.

Many of my patients on ADT are “crushing it” by practicing a prescribed exercise and nutritional regimen gathered from the science I’ve researched.

Not only is prostate cancer successfully managed when combining ADT with lifestyle, but the quality of life is also exceptional. I am not exaggerating.

Should I be on ADT? What would you do if you were me?

I’m often asked by patients, “What would you do if you were in me? Would you go on ADT?”

Such question reminds me of a line in one of the few books I read from cover to cover in high school (I wasn’t a big reader then), To Kill a Mockingbird by Harper Lee…

“You never really understand a person until you consider things from his point of view, until you climb inside of his skin and walk around in it.”

In other words, I am not you. And I have not been diagnosed with PSA recurrence after initial treatment for prostate cancer with curative intent.

That said, I do read many scientific papers on prostate cancer, have extensive clinical experience with patients battling this disease, and have opinions about prostate cancer treatments and quality of life.

Here’s what I’d say…

I am a sucker for a good quality of life. I’d choose the quality of life over longevity in most cases. Much would depend on the severity and length of time of adverse effects from ADT.

Thus, every case is different.

If God forbid, I am diagnosed with aggressive, stage 4 lung cancer; it is likely that I will choose no medical treatments as experience and data show not a significant survival rate and poor quality of life with the available treatments for such disease and numerous others alike.

But I digress. We are talking about prostate cancer.

Men on ADT in my clinical experience are doing exceptionally well, likely because they are following my nutritional and exercise advice – at least, that’s what I’d like to think. Getting on ADT for the right patient and based on the scientific data supporting its use in improving survival is a good option.

Exercise Prescription for men on Hormone Deprivation Therapy or Androgen Deprivation Therapy (ADT) to treat Prostate Cancer

The goal for men on ADT and applying lifestyle and exercise program are:

  1. Minimize adverse and unwanted side effects from ADT treatment
  2. Create a hostile biological environment for cancer in the body to support medical treatment
  3. Optimize quality of life despite ADT.

Wow! That’s a lot. Can we accomplish all that?

Yes, it is. And yes you can.

The right lifestyle and exercise program like the CaPLESS method can minimize about 80% of those side effects. I am not kidding.

Low libido, impotence (or let’s call it sexual dysfunction. Impotence sounds a bit harsh) and hot flashes are non-life threatening and more difficult to overcome.

Most other life-threatening side effects  are greatly reduced.

Studies on Exercise while on Hormone Deprivation Therapy or ADT.

In one study of 2,700 male health care professionals (average age 70 years) with non-metastatic prostate cancer and found that those participating in vigorous physical activity for a duration ≥3 hours/week demonstrated a 49% lower risk of all-cause mortality and a 61% lower risk of death specifically from prostate cancer, compared with men who did 1 1 hour/week of vigorous activity. (Kenfield et al. 2011)

A systematic review of ten studies (five randomized and five uncontrolled clinical trials) examined the effects of exercise on patients receiving ADT. This paper demonstrated that physical performance was improved by exercise. Randomized controlled trials found exercise to be consistently beneficial for muscular performance: reported as increases in muscular strength and increases in upper and lower limb strength, compared with the control population. (Gardner et al. 2014)

Body composition (the amount of fat compared to muscle in the body) is a component of many studies investigating exercise effects on prostate cancer patients on ADT and resistance training has been shown to either increase lean body mass or not decline. Loss of muscle mass is a common scenario amongst ADT patients. (Galvão et al. 2010)

An observational study reported in 2006 looking at over 70,000 men observed 11% increase in myocardial infarction risk and a 16% increased risk of coronary heart disease and death from cardiac arrest in the study of prostate cancer patients receiving ADT, versus those not on hormone therapy. (Keating et al. 2006)

We would want to avoid those cardiovascular problems while on ADT, right?

Although there are no studies I can find specifically to evaluate the effect of exercise on ADT-induced cardiovascular events, there is a large body of evidence supporting the role of physical activity in the prevention and management of cardiovascular disease in the general population. (Thompson et. Al 2003)

Osteoporosis ( bone fragility), is a major side effect of ADT can lead to bone fractures, and bone fractures lead to 37% of deaths in older men. (Ebeling; 2008)

A study of 8,833 men aged 18–64.9 years used computed tomography to show an inverse relationship between adiposity (BMI and visceral and subcutaneous adiposity) and bone quality (Zhang et al. 2015)

Studies show that resistance training in older men and women, where only high-intensity, and not moderate-intensity, strength training resulted in increased bone mineral density. (Vincent et al. 2002)

METABOLIC SYNDROME WHILE ON ADT

Metabolic syndrome defined by weight gain, especially waist gain; fasting glucose 100 mg/dL or higher, peripheral insulin resistance; and increased diabetes risk increase the risk of heart disease and stroke, in addition to diabetes as is a common side effect when ADT.

Results from a randomized pilot study assessed the impact of over six months of combined metformin, a low-glycemic-index diet, and exercise in 20 prostate cancer patients at ADT initiation and compared this with 20 men who were on ADT alone. The metformin and exercise group had decreased abdominal girth, weight, BMI, and systolic blood pressure, compared with the group on ADT treatment alone, although insulin-resistant biochemical markers were not significantly different. In this small study, however, it was not possible to separate the metformin and dietary effects from the exercise components. (Nobles et al. 2012)

63 prostate cancer patients were randomized to receive either a 3-month aerobic and resistance exercise program or usual care, concomitant to initiation of ADT. Patients receiving the exercise-based intervention demonstrated significant reductions in ADT-associated metabolic effects, including decreased whole body fat mass, abdominal fat, and percentage fat, compared with the usual care control group. (Cormie et al. 2015)

C-reactive protein, an inflammation marker commonly elevated in metabolic syndrome, showed a clinically meaningful reduction in a randomized controlled trial of exercise in 57 men on ADT (Galvão et al. 2010)

Exercise Prescription while on ADT

Exercise four hours a week in moderate to high intensity. Anyone on ADT must include weight resistant exercise, two to three times a week, where you push and pull weight against gravity.

Types of exercises used in some studies include:

Leg presses 

Leg extensions

Leg curls 

Lat pull downs

Biceps curls (with dumbbell)

Triceps extension

These are the main strength training exercises performed on many of the studies listed above showing benefit.

Strength training movements I strongly recommend include:

Kettlebell training – Pavel on this video sounds like a military agent. He is the best at kettlebells and one of the most knowledgeable on physical strength. 

(Me and a friend after Kettlebell training)

Squats

Deadlifts

Benchpress

The Press

Pushups

Pull-ups

 

If the above movements and exercises sound foreign then consider hiring a physical trainer if able to. Not only can a trainer help you with the movements but also help prevent injuries.

If an injury occurs during any movements mentioned above, all bets are off, you will not or cannot get the benefit of the exercise.

Listen…

Fear should not stop you from trying and consistently training with the exercises mentioned.

Prostate cancer has to be fought with courage.

The most important point in doing any of the above exercises is to first master the technique of that movement. That is one of two ways you prevent injuries from doing those exercises. The other is avoiding doing too much weight too soon. Yes, you should challenge yourself and increase the weight you push or pull, but it must be done incrementally.

Again, hiring a personal trainer can be priceless if your pockets allow.

Last 3 Blog Posts:

Traditional Chinese Medicine treatment for Erectile Dysfunction

Why I’m Into Intermittent Fasting

Does Eating Chicken Cause Prostate Cancer

 

Resource:

Much of the research for this blog post is from Moyad et al; 2016

Nutrition while on ADT – Advanced ADT Support

 

References:

Kenfield SA, Stampfer MJ, Giovannucci E, Chan JM. Physical activity and survival after prostate cancer diagnosis in the health professionals follow-up study. J Clin Oncol. 2011;29(6):726–732.

Gardner JR, Livingston PM, Fraser SF. Effects of exercise on treatment-related adverse effects for patients with prostate cancer receiving androgen-deprivation therapy: a systematic review. J Clin Oncol. 2014;32(4):335–346

Thompson PD, Buchner D, Pina IL, et al. Exercise and physical activity in the prevention and treatment of atherosclerotic cardiovascular disease: a statement from the Council on Clinical Cardiology (Subcommittee on Exercise, Rehabilitation, and Prevention) and the Council on Nutrition, Physical Activity, and Metabolism (Subcommittee on Physical Activity) Circulation. 2003;107(24):3109–3116.

Keating NL, O’Malley AJ, Smith MR. Diabetes and cardiovascular disease during androgen deprivation therapy for prostate cancer. J Clin Oncol. 2006;24(27):4448–4456.

Ebeling PR. Clinical practice. Osteoporosis in men. N Engl J Med. 2008;358(14):1474–1482

Galvão DA, Taaffe DR, Spry N, Joseph D, Newton RU. Combined resistance and aerobic exercise program reverses muscle loss in men undergoing androgen suppression therapy for prostate cancer without bone metastases: a randomized controlled trial. J Clin Oncol. 2010;28(2):340–347.

Zhang P, Peterson M, Su GL, Wang SC. Visceral adiposity is negatively associated with bone density and muscle attenuation. Am J Clin Nutr. 2015;101(2):337–343.

Vincent KR, Braith RW. Resistance exercise and bone turnover in elderly men and women. Med Sci Sports Exerc. 2002;34(1):17–23.

Nobes JP, Langley SE, Klopper T, Russell-Jones D, Laing RW. A prospective, randomized pilot study evaluating the effects of metformin and lifestyle intervention on patients with prostate cancer receiving androgen deprivation therapy. BJU Int. 2012;109(10):1495–1502.

Cormie P, Galvao DA, Spry N, et al. Can supervise exercise prevent treatment toxicity in patients with prostate cancer initiating androgen-deprivation therapy: a randomized controlled trial. BJU Int. 2015;115(2):256–266

DA, Taaffe DR, Spry N, Joseph D, Newton RU. Combined resistance and aerobic exercise program reverses muscle loss in men undergoing androgen suppression therapy for prostate cancer without bone metastases: a randomized controlled trial. J Clin Oncol. 2010;28(2):340–347.

Why I’m into Intermittent fasting

The idea of therapeutic fasting is not new. Every religious text and many philosophers from ancient Greece fasted for certain periods of time.

” I fast for greater physical and mental efficiency” – Plato

In fact, I was introduced to the therapeutic benefits of fasting about twenty years ago when I read the books:

Rational Fasting by Arnold Ehret

and

The Miracle of Fasting by Paul Bragg

I then began practicing some level of fasting, either once a day, a full 24 hours,  every week or three days every three months or some variation.

Since then fasting has gained plenty of attention in the scientific community for improving everything from cancer to longevity.

Here’s what I know about Intermittent fasting and why I am suggesting it to patients.

What is it Intermittent Fasting?

Intermittent fasting (IF) includes everything from not eating any food for 2 to 7 days or more to skipping a meal or two on certain days of the week.

The most popular time periods of not eating during a fast include 12 to 16 hours a day – most of this time is during sleep. 

Is Intermittent Fasting different than calorie restriction?

IF is different than calorie restriction.

Calorie restriction involves eating very low calories, about 1500 or so a day without fasting.

IF involves no macronutrient consumption (protein, fat, sugar) within a period of time.

What are the benefits of Intermittent Fasting?

Studies have found that not eating for long periods of time is effective for improving weight loss, insulin sensitivity, and other health biomarkers.

Let’s talk a little about insulin sensitivity

Insulin does a lot of valuable things for us. It pulls glucose from the blood and delivers it away into our cells to be burned for energy (known as ATP in science) or stored as glycogen. It prevents toxicity from too much sugar in the blood (hyperglycemia) to nerve cell and other body tissues. It also improves muscle growth, especially following resistance training. So, we need insulin. A chronic disease where insulin is not made is type 1 diabetes; injections of synthetic insulin are required to assure healthy blood sugar levels.

Also, insulin stops your body’s ability to use fat for energy. Only after glucose is used (and stored in the form called glycogen) can fat be used for energy.

When this insulin/sugar metabolism work in concert, we are healthy or called in geeky terms, insulin sensitive, or we have insulin sensitivity.

The problem is that when we consume too much sugar, including simple carbohydrates your body produces much more insulin to metabolize sugar than it needs, sometimes two to three times the amount of sugar it needs. Too much insulin in the body causes insulin insensitivity or insulin resistance (both terms used equally depending on what you read) – a problem where insulin cannot properly drive sugar into the cell to make energy.

Insulin insensitivity leads to; obesity, type 2 diabetes, heart disease and cancer.

This is a long-winded explanation to help you understand one of the benefits of IF and why you should do it.

Why Practice Intermittent fasting?

The reason’s you may want to consider intermittent fasting is for; weight loss, longevity, cancer protection, more energy, clearer thinking, overcomes type 2 diabetes and metabolic syndrome.

What should you do?

My take on intermittent fasting at this point: eat sensibly most of the time, eat nothing for an extended period now and then, indulge only on occasion (perhaps once a week, say, on a designated “cheat day”).

A more specific suggestion is to restrict from food consumption for 12 – 16 hours – EVERY DAY. In other words, skip breakfast. I know, I know I too used to preach that breakfast is the most important meal of the day. I am not sure about that anymore, at least for middle-aged people looking to live longer and stronger. A good breakfast for younger people and athletes is still important. But for the rest of us, not so much.

I know, you looking at me like I have three heads. Many do when I suggest this. Believe me, this is difficult at first, but worth it later.

The only drinks allowed are plain tea, plain coffee or water – no sugar or milk.

You can start doing it 16 hours a day, mostly at night while sleeping. Or start at 12 hours then work your way up to 16 hours a day one week at a time. In other words, start at 12 hours for two weeks, then 13 hours for two to three weeks, then fourteen hours the next, etc.

The Science of Intermittent Fasting

Intermittent fasting:

Improves lipid metabolism

Potentially reduce the rate of cancer in the obese or overweight person.

Improve glucose metabolism in Type 2 Diabetes

Potential benefits for diseases associated with aging.

 

Does Eating Chicken Cause Prostate Cancer?

I love chicken, I admit. Furthermore, and a bit more embarrassing since I teach and preach health, I love fried chicken – fried drumsticks to be exact. Argh! (that was painful).

But I cant remember the last time I had any. Maybe it’s just selective memory.

The reason why I don’t have much of the fried hens is that it’s not good for my body, despite the fact I find it tasty. And it is more important to me to not die prematurely. So, I stay away from eating deep fried chicken, most of the times.

What if the chicken is not fried? Is it OK to eat? Does eating chicken contribute to prostate cancer?

Studies on Chicken and Prostate Cancer

First, I’ll say this;

While there is evidence for a dietary role in prostate cancer, the epidemiologic evidence is frustratingly inconsistent.

Thus, much of my conclusions are not based on the last study or the ones that attract more media headline. My recommendations are based on researching the best designed, prospective ( and less so retrospective research) and my clinical observations after seeing thousands of prostate cancer patients in my career so far.

OK, first, here is the current research os poultry and prostate cancer.

POULTRY AND PROSTATE CANCER

A study of 15 prospective cohort study involving close to 850,000 men from North America, Europe, Australia, and Asia, examined the association of incidence of prostate cancer and the intake of unprocessed and processed red meat, seafood, eggs, and poultry. Authors did not find a significative association among unprocessed red meat and processed red meat intake and prostate cancer risk

Also, poultry and seafood was not observed in association with prostate cancer risk

Other studies in humans have shown that consumption of skinless poultry, which is lower in cholesterol and saturated fat than many red types of meat, was not associated with the recurrence or progression of prostate cancer

However, consumption of baked poultry was inversely associated with advanced prostate cancer. Meaning, those who ate baked poultry had a lower incidence of aggressive, potentially metastatic disease.

When cooking practices were considered, intake of baked poultry showed a mild protective effect with advanced prostate cancer, but when poultry was pan-fried, there was an increased risk of prostate cancer. This inverse association may be explained by a form of vitamin K2, menaquinone, present in dark poultry meat (not white meat, which most think is healthy) that has been associated with reduced risk of advanced prostate cancer in this European cohort.

While the link between menaquinone (K2) and prostate cancer has not been duplicated, I take fish oils with K2 and often recommend them to patients.

Why does the method of cooking Poultry make a difference on Prostate Cancer?

Pan-frying has been consistently implicated in the formation of meat cancer-forming chemicals. Also, the oil used in pan-frying acts as an efficient heat transfer medium between the pan and the surface of the meat, and therefore high surface temperatures are reached. Pan-frying does not expose meats to open flames and fats from the meats do not have an opportunity to drip on the flames undergoing incomplete combustion. Thus, pan-frying is typically not associated with accumulation of Poly Aromatic Hydrocarbons (PAH).

To Eat or Not to Eat Chicken with Prostate Cancer?

Here are helpful tips if you or someone you love is trying to prevent, co-manage or prevent from dying from prostate cancer:

  • Cooking methods matters with all animal meats, including chicken. Fried and grilled poultry are not good. Yes, I know grilling in the backyard is a big deal in many households, but I would refrain from doing so.

 

  • Baking or slow cooking poultry like in a crockpot is best. In other words, slow, low-temperature cooking is better than fast, high-temperature cooking.

 

  • Free roaming, cage-free hens that eat their natural diet (which includes worms) are leaner and healthier in general, though not sure if the benefits are prostate cancer-specific.

In general, fish seems to be your best dietary animal source for prostate cancer protection. But the cooking methods in fish preparation; slow cooking, less charring explained earlier still apply. Also, give your body a break from all macronutrients (carbs, protein, and fats) and practice intermittent fasting.

UPCOMING PROSTATE CANCER EVENT

The CaPLESS Retreat – Lifestyle weekend intensive for prostate cancer men and their partner. Limited seats.

Last Three Blog Posts

Eggs, Choline & Prostate Cancer

Protection Against the Flu with Natural Medicine

What Dietary Supplements Can and Can’t-Do.

 

The Truth on Eggs, Choline & Prostate Cancer

Many studies, not all, have associated egg consumption to aggressive prostate cancer.

That’s a doozy since eggs are a staple diet for most and a preferred source of protein for many.

Let’s take a look at the scientific data regarding egg consumption and prostate cancer.

In The Health Professionals Follow-Up Study (HPFS), a study observing over fifty thousand male health professionals since 1986 noticed that men who consumed ≥2.5 eggs per week had a 1.8-fold increased risk of developing lethal prostate cancer compared with men who consumed <0.5 eggs per week. However, this study found no association between consumption of eggs and risk of deadly prostate cancer after diagnosis.

On the other hand, results from 15 prospective cohort study involving 842,149 men from North America, Europe, Australia, and Asia, examined the association of incidence of prostate cancer and the intake of unprocessed and processed red meat, seafood, eggs, and poultry. No association among unprocessed red meat, processed red meat poultry and seafood and prostate cancer was made.

However, a connection was detected between eggs intake and fatal prostate cancers risk.

The Cancer of the Prostate Strategic Urologic Research Endeavor (CaPSURE), another very large male study found an increased risk of recurrence for higher intakes of eggs (and poultry with skin) around the time of diagnosis.

Egg intake in CaPSURE was higher, with a mean of 7.9 servings per week compared to 3.2 servings per week in our population. Also, CaPSURE™, men who consumed the most eggs after prostate cancer diagnosis ( about 5.5 eggs per week) had a two-fold increased risk of prostate cancer recurrence compared with men who consumed the least eggs (<0.5 eggs per week)

A Swedish study also reported that men with the highest plasma levels of choline had a 46 % increased risk of prostate cancer compared with men with the lowest levels.

One study of studies (meta-analysis) suggested no association with risk of prostate cancer diagnosis or prostate cancer-specific mortality from consumption of eggs.

Breast cancer,  ovarian cancer and again prostate cancer were at higher rates amongst people who consumed eggs in this study.

Are Eggs from Hens raised in better conditions protective against cancer?

Almost all eggs in the United States are from hens living in a stressed environment under unsanitary cages surrounded by manure infested by flies, maggots, and rodents. Lastly, hens are often starved (a process called molting) to increase egg production.

Eggs raised in such unfavorable environments may play a role in the interaction of nutrient content in our bodies but I am not sure how protective or contributory they are in cancer formation.

Why are Eggs Connected to an Increase Risk of Prostate Cancer?

It seems like the connection between eggs, and prostate cancer is on an (important) nutrient called choline. The crux is that choline is essential for human life and mental performance and we would not do well without it.

And that’s what makes the association with nutrition and cancer confusing and frustrating.

Here’s another thing, choline is used as a tracer for a specific type of PET scan called Choline C-11 PET scan to find smaller prostate cancer cells in the body that can’t be found with other imaging technology.

What does this mean?

A tracer is a substance introduced into the body gobbled up by cancer cells so such cells can light up in images and location of cancer can be found.

Amongst integrative oncologists, it is often said that sugar is bad for cancer because glucose ( a simple sugar) is taken up by cancer cells in another type of PET scan called F-FDG PET.

If the argument with excess sugar consumption is true, then it must apply to choline as well. No?

What is Choline?

Choline is a nutrient in food with many important roles to support health including brain function similar to but not from the family of B-vitamins.

Choline and its metabolites are needed for three main physiological purposes:

  1. structural integrity and signaling roles for cell membranes,
  2. cholinergic neurotransmission (acetylcholine synthesis),
  3. a source for methyl groups via its metabolite, trimethylglycine (betaine), which participates in the S-adenosylmethionine (SAMe) synthesis pathways.

(Source)

If this is all sounds like gobbly gook to you, the bottom line is that choline does good things for your body. The recommended adequate intake (AI) of choline is 550 mg/day for men (425mg for women).

One study found that men with the highest choline intake (~500 mg/day) had a 70 % increased risk of incident lethal prostate cancer compared with men with the lowest intake (~300 mg/day)

The top 5 foods contributing to choline in the diets of the participants were whole eggs, beef, skim milk, reduced-fat milk, and poultry without skin.

What to Make out of the association with Eggs, choline and prostate cancer?

  • Don’t try to eliminate choline from your diet. You won’t be able to as this nutrient is found in a lot of foods and some of those foods are necessary for good health. Besides, many foods that are a five on the CaPLESS Food Rating System, like broccoli and cauliflower contain some choline.

 

  • The yolks in eggs carry the choline, not egg whites. One large egg has about 150mg of choline. Eat egg whites mostly, with maybe one egg yolk. I am not sure you have to give up eggs at all if you do not want to, just don’t eat them every day.

 

  • Eliminate or limit dairy consumption. Don’t do diets of exclusion, i.e., low-fat or 2% milk, for example. Fat is not your dietarily enemy. Plus taking out a macronutrient from food often mean adding other crap to it. In the case of choline, there seems to be more of it in low-fat and non-fat milk than whole milk.

 

  • Don’t take supplements that include phosphatidylcholine or stand-alone lecithin, often found in brain or memory boost supplements if you had prostate cancer or at high risk of it. Lecithin improves absorbability of fat-soluble nutrients like curcumin, and it is often blended for that purpose. The amounts of lecithin, when used for this purpose, is small.

 

 

And that’s the story between Eggs, choline and prostate cancer. Of course, I could have written a dissertation on this topic but wanted to provide you with brief, actionable information.

Thoughts?

 

Previous Three Blog posts:

Your Protection Against the Flu with Natural Medicine

What Dietary Supplements Can and Can’t-Do

Cauliflower Rice recipe – CaPLESS Eats