Another Year of VindicationDecember 2018
By William Faloon
In the May 2013 issue of this magazine, I reiterated Life Extension®’s long-standing position that PSA screening and a certain drug class reduces prostate cancer incidence and death.1
Up against me was the medical establishment that claimed the drug increased aggressive prostate cancer risk.2 They also claimed there was no value to screening for PSA (prostate specific antigen).3
A renowned expert (Patrick C. Walsh, MD) said drugs like finasteride (Proscar®) increased aggressive prostate cancer.2
Dr. Walsh is a pioneer in identifying genetic characteristics of prostate cancer and “nerve-sparing” surgery. So when someone of the caliber of Patrick Walsh writes me a letter, I pay attention. That’s why in 2013, I let readers know there are differing viewpoints.
The FDA went so far as to mandate a “black box warning” on finasteride and similar drugs, stating they may increase aggressive prostate cancer incidence.4
What you need to know
Leaders in the medical establishment have rejected claims that PSA (prostate specific antigen) testing and a drug that lowers dihydrotestosterone (DHT) effectively may prevent prostate cancer. This was due to a misrepresentation of data. Results from a recent trial vindicate Life Extension’s position on this drug. New evidence has also influenced others to change their position on PSA screening.
My Response to the Critics
rebuttal to FDA
and Patrick Walsh, M.D.
I responded to these allegations in the December 2013 edition of this magazine.5 In my rebuttal to Dr. Walsh and the FDA, I documented how drugs that lower PSA (like finasteride and dutasteride) not only help alleviate urinary symptoms related to benign prostate enlargement, but also reduce a man’s risk of developing prostate cancer. The evidence dating back to the 1994–2013 period was robust in my opinion.
In May 2018, at the annual meeting of the American Urological Association, the results of a long-term follow-up trial vindicated Life Extension’s position.6
Findings from the landmark Prostate Cancer Prevention Trial showed that finasteride slashed prostate cancer risk by around 25% with no increase in deaths from prostate cancer in men using this drug. 7 A follow-up study showed similar results8 and led the principal investigator to state:
“These results are transformational… We have found an inexpensive, effective drug [finasteride] that can prevent [prostate cancer]. ”6
While the news media treated this as a major advance, the reality is that over 100,000 American men may have needlessly died of prostate cancer because of the failure of the medical establishment and FDA to accurately interpret published scientific findings dating back to 2003 and earlier.7
This year, about 165,000 American men will be diagnosed with prostate cancer, and around 29,000 will die from this malignancy.9
The number of men diagnosed is artificially low because of an erroneous position taken in 2012 by the United States Preventive Services Task Force that argued against routine PSA screening.3,10
By recommending against low-cost PSA blood tests, hundreds of thousands of men will develop advanced prostate cancer that is difficult to cure.
In 2017–2018, the United States Preventive Services Task Force backtracked on its 2012 recommendation against PSA screening. Their new suggestion is that men aged 55–69 should make an individual decision about routine screening in consultation with their physician.11
While this represents a partial vindication of our position, we disagree that early diagnosis of prostate cancer should be limited to men aged 55–69 years.
Prostate cancer risk begins around age 40, and this is when men should have their first PSA blood test. 12
We don’t write off men over age 69, and we urge these men to have annual PSA blood tests to ascertain prostate cancer risk and take steps to reverse the course of early stage disease using nutritional and drug interventions.
Prostate Cancer Prevention Diet
As we have written for decades, the most effective way of reducing one’s risk of prostate cancer is by healthy diet. 13-16
Simply stated, avoid meat, dairy, refined sugar, eggs, most starches, and foods cooked at high temperatures. Following a Mediterranean-type diet may reduce prostate cancer risk up to 48%.17-19
Published scientific findings continue to validate our position on the striking role of diet and prostate cancer.20-27
The article on page 40 of this month’s issue provides an update to our 2013 report about foods that increase prostate cancer risks and those that reduce it.
Prostate Cancer Preventing Drugs
5-alpha reductase is the enzyme that causes testosterone to convert to dihydrotestosterone that stimulates both benign and malignant prostate cell proliferation.28-30
Generic drugs like finasteride or dutasteride inhibit 5-alpha reductase and thereby reduce dihydrotestosterone levels.7,30,31
A rapid effect of these drugs is the impact on the size (volume) of the prostate gland. Both medications are capable of shrinking an enlarged (benign) prostate gland by as much as 25%.32
In May 2018 the results from a large clinical trial were announced. The findings showed that finasteride markedly reduced prostate cancer risk.33
We urge all men to follow healthier dietary patterns and consider 5-alpha reductase inhibitors to further reduce their prostate cancer risk, as I’ve done for the past 18 years or so.
How PSA Fuels Prostate Cancer
PSA is more than a blood marker of prostate disease.
In prostate cancer, excessive levels of PSA (an enzyme) degrade structural barriers, allowing the expansion and escape of prostate cancer cells or colonies.52 Dihydrotestosterone stimulates prostate cell propagation.28
Drugs that lower dihydrotestosterone and PSA (like finasteride) thus reduce the odds that a man will contract prostate cancer by around 25%.8
Combining a healthy diet, certain supplements, and a 5-alpha reductase inhibitor is the most intelligent approach a man over age 40 can take to protect against the miseries of prostate cancer treatments and potential death from the disease.
The Latest Human Study
A study titled the Prostate Cancer Prevention Trial looked at 18,000 trial participants over a median follow-up of 16–18 years.
The findings revealed men taking finasteride had a 21% to 29% reduced rate of developing prostate cancer.8
Finasteride is a drug that blocks the 5-alpha reductase enzyme.53 Dutasteride blocks two different forms of 5-alpha reductase and is more potent (and more expensive). 54,55
Data for the follow-up analysis of the Prostate Cancer Prevention Trial took five years to gather. It corroborates previously published findings showing that finasteride reduces prostate cancer risk.6
During this time, we at Life Extension fought against mainstream medicine ignorance that claimed PSA screening to be useless and drugs like finasteride to be dangerous. The new (2018) publications show the opposite to be true.
The implications were not overlooked by experts at American Urological Association 2018 annual conference in San Francisco.56
According Joseph Smith, MD, editor of the Journal of Urology, this Prostate Cancer Prevention Trial is “one of the most powerful and important cancer prevention trials ever conducted…”6
The doctors who conducted this long-term trial lamented how the FDA’s misguided “black box warning” had the lethal impact of causing most men to fear using 5-alpha reductase inhibitors.33,57 This in turn caused many to needlessly develop prostate cancer.
According to Ian J. Thompson, MD, the principle investigator of this landmark Prostate Cancer Prevention Trial:
“This discovery could benefit tens of thousands of men each year in the United States by identifying a drug that can safely and effectively prevent prostate cancer.”33
It was back in 2003 that a study published in the New England Journal of Medicine showed a 25% reduction in prostate cancer incidence using the 5-alpha reductase inhibitor over a 7-year period.7 The new data from the Prostate Cancer Prevention Trial (2018) shows this risk reduction extends to at least 16 years!8
Evidence from this Prostate Cancer Prevention Trial found that men using the drug had improved detection of prostate cancer, improved detection of high-grade cancers, and no increased risk of high-grade prostate cancer death.6
This same information is what we published in the December 2013 issue of this magazine. By shrinking the size of the prostate gland, which occurs with 5-alpha reductase inhibitors, it is easier to detect high-grade prostate cancers at an earlier, curative stage.
Nutrients That Reduce 5-Alpha Reductase
While we advocate that men over age 40 consider drugs like finasteride, sexual side effects sometimes manifest. A side benefit to drugs that inhibit 5-alpha reductase is increased hair growth in those with male pattern baldness.
A number of our readers, however, don’t like taking prescription drugs despite favorable evidence spanning back to year 1993.
This prompted us to investigate plant-based nutrients that provide prostate benefits in a milder way than prescription drugs.
An article on page 40 of this issue describes nutrients that have demonstrated promising prostate cancer risk reductions in published scientific studies. Most readers of Life Extension Magazine® already take many of these nutrients.
Too Many Needless Cancers
Data published by the New England Journal of Medicine in 2003 confirmed the prostate cancer-risk reduction effects of 5-alpha reductase inhibiting compounds.
Mainstream medicine misinterpreted these findings showing reductions in prostate cancer occurrence in men taking finasteride.
The tragic result may be over 500,000 needless prostate cancer cases in American men that necessitate surgery, radiation, chemo, and androgen-deprivation therapies.
About 100,000 American men may have perished from prostate cancer because of the FDA’s erroneous black box warning that caused physicians and patients to fear drugs like finasteride and dutasteride.
Readers of Life Extension Magazine learned the scientific facts decades ago.
Hard data we provided enabled men to make informed choices as to whether to consider natural approaches and/or drugs that are now proven to reduce risk of prostate cancer.
Conventional medicine is waking up to the value of PSA blood testing to identify early changes that are often reversible with existing approaches that include diet, nutrients, and certain medications.
For longer life,
- Available at: https://www.lifeextension.com/Magazine/2013/5/Federal-Death-Panels/Page-01. Accessed September 19, 2018.
- Available at: http://urology.jhu.edu/newsletter/2012/prostate_cancer_2012_4.php. Accessed September 19, 2018.
- Moyer VA. Screening for prostate cancer: U.S. Preventive Services Task Force recommendation statement. Ann Intern Med. 2012Jul 17;157(2):120-34.
- Available at: https://www.fda.gov/Drugs/DrugSafety/ucm258314.htm. Accessed September 19, 2018.
- Available at: https://www.lifeextension.com/magazine/2013/12/Prostate-Cancer-Prevention-Controversy/Page-01. Accessed September 19, 2018.
- Available at: http://www.medscape.com/viewarticle/896942. Accessed September 19, 2018.
- Thompson IM, Goodman PJ, Tangen CM, et al. The influence of finasteride on the development of prostate cancer. N Engl J Med. 2003Jul 17;349(3):215-24.
- Unger JM, Hershman DL, Till C, et al. Using Medicare Claims to Examine Long-term Prostate Cancer Risk of Finasteride in the Prostate Cancer Prevention Trial. J Natl Cancer Inst. 2018Mar 9.
- Available at: https://seer.cancer.gov/statfacts/html/prost.html. Accessed September 19, 2018.
- Fleshner K, Carlsson SV, Roobol MJ. The effect of the USPSTF PSA screening recommendation on prostate cancer incidence patterns in the USA. Nat Rev Urol. 2017Jan;14(1):26-37.
- Available at: https://www.uspreventiveservicestaskforce.org/Page/Document/RecommendationStatementFinal/prostate-cancer-screening1. Accessed September 19, 2018.
- Sakr WA, Haas GP, Cassin BF, et al. The frequency of carcinoma and intraepithelial neoplasia of the prostate in young male patients. J Urol. 1993Aug;150(2 Pt 1):379-85.
- Available at: https://www.lifeextension.com/Magazine/2007/2/cover_prostate/Page-01. Accessed September 20, 2018.
- Available at: https://www.lifeextension.com/Magazine/2013/12/A-Natural-Arsenal-for-Prostate-Cancer-Prevention/Page-01. Accessed September 20, 2018.
- Available at: https://www.lifeextension.com/Magazine/2013/12/Impact-of-Diet-on-Prostate-Cancer-Risk-and-Mortality/Page-01. Accessed September 20, 2018.
- Available at: https://www.lifeextension.com/Magazine/2016/CE/How-to-Reverse-Markers-of-Prostate-Cancer/Page-01. Accessed September 20, 2018.
- Capurso C, Vendemiale G. The Mediterranean Diet Reduces the Risk and Mortality of the Prostate Cancer: A Narrative Review. Front Nutr. 2017;4:38.
- Kenfield SA, DuPre N, Richman EL, et al. Mediterranean diet and prostate cancer risk and mortality in the Health Professionals Follow-up Study. Eur Urol. 2014May;65(5):887-94.
- Chavarro JE, Stampfer MJ, Hall MN, et al. A 22-y prospective study of fish intake in relation to prostate cancer incidence and mortality. Am J Clin Nutr. 2008Nov;88(5):1297-303.
- Fabiani R, Minelli L, Bertarelli G, et al. A Western Dietary Pattern Increases Prostate Cancer Risk: A Systematic Review and Meta-Analysis. Nutrients. 2016Oct 12;8(10).
- Lin PH, Aronson W, Freedland SJ. Nutrition, dietary interventions and prostate cancer: the latest evidence. BMC Med. 2015Jan 8;13:3.
- Gathirua-Mwangi WG, Zhang J. Dietary factors and risk for advanced prostate cancer. Eur J Cancer Prev. 2014Mar;23(2):96-109.
- Nelson WG, Demarzo AM, Yegnasubramanian S. The diet as a cause of human prostate cancer. Cancer Treat Res. 2014;159:51-68.
- Hedelin M, Klint A, Chang ET, et al. Dietary phytoestrogen, serum enterolactone and risk of prostate cancer: the cancer prostate Sweden study (Sweden). Cancer Causes Control. 2006Mar;17(2):169-80.
- Sonoda T, Nagata Y, Mori M, et al. A case-control study of diet and prostate cancer in Japan: possible protective effect of traditional Japanese diet. Cancer Sci. 2004Mar;95(3):238-42.
- Pelser C, Mondul AM, Hollenbeck AR, et al. Dietary fat, fatty acids, and risk of prostate cancer in the NIH-AARP diet and health study. Cancer Epidemiol Biomarkers Prev. 2013Apr;22(4):697-707.
- Abdull Razis AF, Noor NM. Cruciferous vegetables: dietary phytochemicals for cancer prevention. Asian Pac J Cancer Prev. 2013;14(3):1565-70.
- Wen J, Zhao Y, Li J, et al. Suppression of DHT-induced paracrine stimulation of endothelial cell growth by estrogens via prostate cancer cells. Prostate. 2013Jul;73(10):1069-81.
- Lepor H. Pathophysiology, epidemiology, and natural history of benign prostatic hyperplasia. Rev Urol. 2004;6 Suppl 9:S3-s10.
- Available at: https://www.cancer.gov/types/prostate/research/prostate-cancer-prevention-trial-qa?redirect=true. Accessed September 20, 2018.
- Andriole GL, Bostwick DG, Brawley OW, et al. Effect of dutasteride on the risk of prostate cancer. N Engl J Med. 2010Apr 1;362(13):1192-202.
- Sarma AV, Wei JT. Clinical practice. Benign prostatic hyperplasia and lower urinary tract symptoms. N Engl J Med. 2012Jul 19;367(3):248-57.
- Available at: https://www.swog.org/news-events/news/2018/05/19/finasteride-safe-long-term-results-show. Accessed September 20, 2018.
- Singh RP, Agarwal R. A cancer chemopreventive agent silibinin, targets mitogenic and survival signaling in prostate cancer. Mutat Res. 2004Nov 2;555(1-2):21-32.
- Zi X, Agarwal R. Silibinin decreases prostate-specific antigen with cell growth inhibition via G1 arrest, leading to differentiation of prostate carcinoma cells: implications for prostate cancer intervention. Proc Natl Acad Sci U S A. 1999Jun 22;96(13):7490-5.
- Davis-Searles PR, Nakanishi Y, Kim NC, et al. Milk thistle and prostate cancer: differential effects of pure flavonolignans from Silybum marianum on antiproliferative end points in human prostate carcinoma cells. Cancer Res. 2005May 15;65(10):4448-57.
- Yang CS, Wang X. Green tea and cancer prevention. Nutr Cancer. 2010;62(7):931-7.
- Khan N, Mukhtar H. Multitargeted therapy of cancer by green tea polyphenols. Cancer Lett. 2008Oct 8;269(2):269-80.
- Reuter S, Eifes S, Dicato M, et al. Modulation of anti-apoptotic and survival pathways by curcumin as a strategy to induce apoptosis in cancer cells. Biochem Pharmacol. 2008Dec 1;76(11):1340-51.
- Agrawal DK, Mishra PK. Curcumin and its analogues: potential anticancer agents. Med Res Rev. 2010Sep;30(5):818-60.
- Vijayakumar S, Mehta RR, Boerner PS, et al. Clinical trials involving vitamin D analogs in prostate cancer. Cancer J. 2005Sep-Oct;11(5):362-73.
- Lou YR, Qiao S, Talonpoika R, et al. The role of Vitamin D3 metabolism in prostate cancer. J Steroid Biochem Mol Biol. 2004Nov;92(4):317-25.
- John EM, Schwartz GG, Koo J, et al. Sun exposure, vitamin D receptor gene polymorphisms, and risk of advanced prostate cancer. Cancer Res. 2005Jun 15;65(12):5470-9.
- Garikapaty VP, Ashok BT, Chen YG, et al. Anti-carcinogenic and anti-metastatic properties of indole-3-carbinol in prostate cancer. Oncol Rep. 2005Jan;13(1):89-93.
- Sarkar FH, Li Y. Indole-3-carbinol and prostate cancer. J Nutr. 2004Dec;134(12 Suppl):3493s-8s.
- Helzlsouer KJ, Huang HY, Alberg AJ, et al. Association between alpha-tocopherol, gamma-tocopherol, selenium, and subsequent prostate cancer. J Natl Cancer Inst. 2000Dec 20;92(24):2018-23.
- Spaccarotella KJ, Kris-Etherton PM, Stone WL, et al. The effect of walnut intake on factors related to prostate and vascular health in older men. Nutr J. 2008May 2;7:13.
- Guo Y, Wang S, Hoot DR, et al. Suppression of VEGF-mediated autocrine and paracrine interactions between prostate cancer cells and vascular endothelial cells by soy isoflavones. J Nutr Biochem. 2007Jun;18(6):408-17.
- Adjakly M, Ngollo M, Boiteux JP, et al. Genistein and daidzein: different molecular effects on prostate cancer. Anticancer Res. 2013Jan;33(1):39-44.
- Wright JL, Stanford JL. Metformin use and prostate cancer in Caucasian men: results from a population-based case-control study. Cancer Causes Control. 2009Nov;20(9):1617-22.
- Ben Sahra I, Laurent K, Giuliano S, et al. Targeting cancer cell metabolism: the combination of metformin and 2-deoxyglucose induces p53-dependent apoptosis in prostate cancer cells. Cancer Res. 2010Mar 15;70(6):2465-75.
- Mattsson JM, Ravela S, Hekim C, et al. Proteolytic activity of prostate-specific antigen (PSA) towards protein substrates and effect of peptides stimulating PSA activity. PLoS One. 2014;9(9):e107819.
- Finn DA, Beadles-Bohling AS, Beckley EH, et al. A new look at the 5alpha-reductase inhibitor finasteride. CNS Drug Rev. 2006Spring;12(1):53-76.
- Clark RV, Hermann DJ, Cunningham GR, et al. Marked suppression of dihydrotestosterone in men with benign prostatic hyperplasia by dutasteride, a dual 5alpha-reductase inhibitor. J Clin Endocrinol Metab. 2004May;89(5):2179-84.
- Andriole GL, Humphrey P, Ray P, et al. Effect of the dual 5alpha-reductase inhibitor dutasteride on markers of tumor regression in prostate cancer. J Urol. 2004Sep;172(3):915-9.
- Available at: www.aua2018.org/Documents/Publications/AUA2018-AUA-DailyNews-Saturday.pdf. Accessed September 20, 2018.
- Figg WD, Thompson IM. Effect of 5α-reductase inhibitor use on mortality from prostate cancer. JAMA Oncology. 2015;1(3):321-2.
- Available at: https://www.goodrx.com/. Accessed September 26, 2018.
- Matalka MS, Ravnan MC, Deedwania PC. Is alternate daily dose of atorvastatin effective in treating patients with hyperlipidemia? The Alternate Day Versus Daily Dosing of Atorvastatin Study (ADDAS). Am Heart J. 2002Oct;144(4):674-7.