Prostate Cancer Treatment
Dietary and Lifestyle Considerations
In addition to the information presented here, readers should also review the Prostate Cancer Prevention protocol, as it contains additional information about the potential role of diet and lifestyle factors in preventing prostate cancer.
Exercise and Body Weight
Regular exercise and maintaining a healthy body weight has been associated with better outcomes and quality of life for prostate cancer patients (Peisch 2017). A higher body mass index (BMI) has been associated with increased risk of aggressive prostate cancer (Xie, Zhang 2017). In one large observational trial, 5,158 men with prostate cancer were followed for several decades. In this study, long-term weight gain of more than 30 pounds was associated with a roughly 60% increased risk of prostate cancer-related death among non-smokers (Dickerman 2017; Perez-Cornago, Appleby 2017).
A meta-analysis of data on 1,199 participants from 32 clinical trials concluded that resistance exercise counters losses of muscle mass and strength associated with prostate cancer and its treatments (Keilani 2017). Another meta-analysis, which combined data from 1,574 participants in 16 randomized controlled trials, found exercise improved quality of life and reduced fatigue caused by prostate cancer (Bourke 2016). In one study with 25 patients, improved fitness was associated with slower rises in PSA levels (Hvid 2016). Additional studies are needed to address whether exercise programs can slow disease progression and improve survival (Hart 2017).
Exercise may be particularly helpful for patients on hormone therapy. Meta-analyses have shown that exercise improves some of the negative side effects attributed to hormone therapy, including muscle weakness, fatigue, weight gain, and sexual dysfunction (Yunfeng 2017; Baguley 2017). Results from one study suggest that, among patients on hormone therapy, those with the highest levels of fatigue may be the most likely to benefit from starting an exercise program (Taaffe 2017).
Emerging evidence suggests a diet emphasizing fruits, vegetables, and whole grains may contribute to reduced prostate cancer risk and improved prognosis and quality of life in prostate cancer patients (Carmody 2008; Nguyen 2006; Saxe 2001). In addition, preliminary evidence suggests specific foods, such as tomato sauce, cruciferous vegetables, olive oil, nuts, fish, and coffee, may be associated with lower risk of prostate cancer progression (Peisch 2017).
The Mediterranean diet is high in cancer-fighting phytonutrients, mainly from fruits, vegetables, whole grains, and olive oil, and has been associated with reduced risk of prostate cancer and prostate cancer-related death (Capurso 2017). In one study, men in the highest 25% of intake of cruciferous vegetables, such as broccoli, cabbage, and cauliflower, had about 60% reduced risk of prostate cancer progression compared with men whose intake was in the lowest 25% of the distribution (Richman 2012; Kirsh 2007). An association between higher fruit and vegetable consumption in general and increased prostate cancer survival has also been noted (Taborelli 2017).
Saturated fats, meat, and dairy may contribute to the development and progression of prostate cancer (Peisch 2017). One study noted that Swedish men with localized prostate cancer whose daily diet included at least three servings of high-fat milk were six times more likely to die of the disease; those reporting low-fat milk intake showed an associated borderline reduction in prostate cancer death (Downer 2017). Reducing saturated fat and increasing fruit and vegetable intake has been observed to prevent PSA level increases in men previously treated for prostate cancer (Hebert 2012).
Eating more fruits and vegetables and less red meat and saturated fat may also reduce prostate cancer risk and improve outcomes for some men with prostate cancer (Ballon-Landa 2018; Wilson 2016). Processed red meat and red meat cooked at high temperatures may be especially problematic and should be minimized (Wilson 2016).
A low ratio of omega-6 to omega-3 fatty acids in the diet may benefit prostate cancer patients (Apte 2013; Aronson 2011). In a group of 525 Swedish men with prostate cancer, the 25% of participants with the highest intake of the omega-3 fatty acid docosahexaenoic acid (DHA) and total marine fatty acids were 40% less likely to die of prostate cancer (Epstein 2012).
Carotenoids are plant pigments with documented health benefits, including some anti-cancer properties (Aghajanpour 2017). In one study, low circulating carotenoid levels were associated with more high-grade prostate cancers (Nordstrom 2016). In a study in men with recurrent prostate cancer participating in a 6-month program to improve diet and lifestyle, those with higher blood levels of carotenoids, including lycopene (a red pigment found in foods like tomatoes), had lower PSA levels at the end of the study (Antwi 2015). Cooked tomatoes are an especially rich source of lycopene (Story 2010). Higher consumption of lycopene has been correlated with a lower rate of prostate cancer diagnosis, especially lethal cancer (Chen 2013; Zu 2014).
Several population studies have shown that drinking coffee is associated with reduced risk of prostate cancer, especially lethal prostate cancer (Wang 2016; Pounis 2017; Wilson 2011; Peisch 2017). In a study of 630 men diagnosed with prostate cancer, those who drank an average of four cups of coffee per day or more had a 59% lower risk of cancer recurrence than those who drank one cup per day or less (Geybels 2013).
Smoking may be particularly harmful for men diagnosed with prostate cancer (Peisch 2017). Smokers are more likely to be diagnosed with aggressive disease and 61% more likely to die from the disease as compared to never smokers (Kenfield 2011). In a study of over 2,000 men, those who were smokers at the time of radiation therapy were more than twice as likely to die from their disease (Steinberger 2015). Other studies have found that smokers treated with radical prostatectomy were more likely to have rising PSA levels after treatment (Rieken 2015) and die earlier than non-smokers (Curtis 2017). Smokers have also been found to be more likely to experience treatment-related fatigue during chemotherapy with docetaxel (Bergin 2017) and complications after prostatectomy (Byun 2017).