Prevention

Prostate cancer screening and early detection

Other than skin cancer, prostate cancer is the most common type of cancer in U.S. men. Early detection and improvements in therapy have resulted in a dramatic decrease in prostate cancer deaths (by 40 to 50 percent) since the early 1990s.

Screenings to detect prostate cancer early

One of the best ways to detect prostate cancer early is through screening — testing to find the disease in men with no prostate cancer symptoms. 

Screening can help find some types of cancer at an early stage, when they may have a better prognosis. In fact, screening alone is credited for one-third of the recent decrease in prostate cancer deaths.

The two most common screening tests for prostate cancer are:

  • Digital rectal exam (DRE)
  • Prostate-specific antigen (PSA) test

Talk with your doctor about the benefits and risks of these screenings. Decisions should be based on:

  • Your individual prostate cancer risk 
  • Your overall health and life expectancy
  • Your desire for treatment if you are diagnosed with the disease
Antigen A foreign substance, such as bacteria, that causes the body’s immune system to respond by making antibodies. Antibodies defend the body against antigens. Digital rectal exam An examination in which a physician inserts a lubricated, gloved finger into the rectum to feel for abnormalities. Prognosis A statement about the likely outcome of a disease in a patient. Screening Checking for disease when there are no symptoms. Because screening may find diseases at an early stage, there may be a better chance of curing the disease Checking for disease when there are no symptoms. Because screening may find diseases at an early stage, there may be a better chance of curing the disease. Examples of cancer screening tests are the mammogram (for breast cancer), colonoscopy (for colon cancer) and Pap and HPV tests (for cervical cancer). Screening can also include a genetic test to check for a person’s risk of developing an inherited disease. Stage The extent of a cancer in the body. Staging is usually based on the size of the tumor, whether lymph nodes contain cancer and whether the cancer has spread from the original site to other parts of the body. Symptom A physical or mental problem that a person experiences that may indicate a disease or condition. Symptoms cannot be seen and do not show up on medical tests. A physical or mental problem that a person experiences that may indicate a disease or condition. Symptoms cannot be seen and do not show up on medical tests. Some examples of symptoms are headache, fatigue, nausea and pain.
Digital rectal exam

For a DRE, a doctor inserts a gloved, lubricated finger into your rectum to:

  • Feel your prostate gland.
  • Assess the texture of the back of the gland, where most prostate cancers begin.
  • Check for any bumps (nodules) or hard areas that might be cancer.

This exam usually isn’t painful and only takes a few seconds.

Since the PSA test was introduced in the late 1980s, doctors have commonly used it along with a DRE to screen for prostate cancer. Because the DRE can sometimes find cancers in men with normal PSA levels, Seattle Cancer Care Alliance (SCCA) recommends men 55 or older talk to their doctor about whether DRE is right for them. For some men, such as African-Americans or those with a family history of cancer, doctors may recommend screenings starting at an earlier age.

Digital rectal exam An examination in which a physician inserts a lubricated, gloved finger into the rectum to feel for abnormalities. Prostate-specific antigen test A laboratory test that measures the amount of prostate-specific antigen (PSA) found in the blood. Screening Checking for disease when there are no symptoms. Because screening may find diseases at an early stage, there may be a better chance of curing the disease Checking for disease when there are no symptoms. Because screening may find diseases at an early stage, there may be a better chance of curing the disease. Examples of cancer screening tests are the mammogram (for breast cancer), colonoscopy (for colon cancer) and Pap and HPV tests (for cervical cancer). Screening can also include a genetic test to check for a person’s risk of developing an inherited disease.
PSA test

The PSA test is a blood test that measures a protein released in the blood by prostate cells. The higher a man’s total PSA level, the more likely he is to have prostate cancer. A few things to keep in mind about this test:

  • Both normal and cancerous prostate cells secrete the protein.
  • Elevated PSA levels are usually caused by noncancerous conditions, such as benign prostatic hyperplasia or prostatitis.
  • Some men who have prostate cancer do not have elevated PSA.

While there is no perfect screening test for prostate cancer, a PSA test is the most common screening.

Most urologists consider these PSA levels to be normal:

  • Men younger than 60 — total PSA of 2.5 ng/mL or lower
  • Men 60 or older — total PSA of 4.0 ng/mL or lower 
Benign Not cancer. Benign tumors may grow larger but do not spread to other parts of the body. Prostate-specific antigen test A laboratory test that measures the amount of prostate-specific antigen (PSA) found in the blood. Prostatitis Inflammation of the prostate that can cause swelling and trouble with urinating. Screening Checking for disease when there are no symptoms. Because screening may find diseases at an early stage, there may be a better chance of curing the disease Checking for disease when there are no symptoms. Because screening may find diseases at an early stage, there may be a better chance of curing the disease. Examples of cancer screening tests are the mammogram (for breast cancer), colonoscopy (for colon cancer) and Pap and HPV tests (for cervical cancer). Screening can also include a genetic test to check for a person’s risk of developing an inherited disease.

PSA screening risks and benefits

In recent years, PSA screening has come under fire because of concerns that it has led to overdiagnosis and overtreatment. At SCCA, we believe there are several good reasons to continue PSA screening.

Screening Checking for disease when there are no symptoms. Because screening may find diseases at an early stage, there may be a better chance of curing the disease Checking for disease when there are no symptoms. Because screening may find diseases at an early stage, there may be a better chance of curing the disease. Examples of cancer screening tests are the mammogram (for breast cancer), colonoscopy (for colon cancer) and Pap and HPV tests (for cervical cancer). Screening can also include a genetic test to check for a person’s risk of developing an inherited disease.
Screening helps detect early-stage disease

PSA screening has yielded a dramatic transformation in how prostate cancer patients present — meaning, the status of their disease when they first get the diagnosis. More men begin care with early-stage and potentially curable disease.

Screening Checking for disease when there are no symptoms. Because screening may find diseases at an early stage, there may be a better chance of curing the disease Checking for disease when there are no symptoms. Because screening may find diseases at an early stage, there may be a better chance of curing the disease. Examples of cancer screening tests are the mammogram (for breast cancer), colonoscopy (for colon cancer) and Pap and HPV tests (for cervical cancer). Screening can also include a genetic test to check for a person’s risk of developing an inherited disease.
Screening and treatment can be done selectively, based on a man's individual situation

PSA screening has likely saved many lives, but it also uncovers many cases of prostate cancer that may not need to be treated. The main harm in screening is not the PSA test itself but the possibility that the results may lead to overtreatment of low-risk cancers in older men. 

Men who are younger and appear to be healthy are most likely to benefit from screening that leads to early detection and treatment. Some low-risk prostate cancers can be carefully followed with active surveillance rather than treated initially with the typical more aggressive measures.

Prostate-specific antigen test A laboratory test that measures the amount of prostate-specific antigen (PSA) found in the blood. Screening Checking for disease when there are no symptoms. Because screening may find diseases at an early stage, there may be a better chance of curing the disease Checking for disease when there are no symptoms. Because screening may find diseases at an early stage, there may be a better chance of curing the disease. Examples of cancer screening tests are the mammogram (for breast cancer), colonoscopy (for colon cancer) and Pap and HPV tests (for cervical cancer). Screening can also include a genetic test to check for a person’s risk of developing an inherited disease. Surveillance Closely watching a patient’s condition but not treating it unless there are changes in test results. Surveillance is also used to find early signs that a disease has come back. In medicine, surveillance means closely watching a patient’s condition but not treating it unless there are changes in test results. Surveillance is also used to find early signs that a disease has come back. It may also be used for a person who has an increased risk of a disease, such as cancer. During surveillance, certain exams and tests are done on a regular schedule. In public health, surveillance may also refer to the ongoing collection of information about a disease, such as cancer, in a certain group of people. The information collected may include where the disease occurs in a population and whether it affects people of a certain gender, age or ethnic group.
Screening studies in the medical literature have limitations

Published screening studies have had limited follow-up and a lower death rate than expected in the absence of screening. What does this mean? The studies almost certainly understated the lives saved over the long term and produced an overly negative view of the benefits of screening. Also, almost all men in these studies who were assigned to the “no screening” group actually did have screening either before or during the study. Several more recent studies reveal greater benefits for healthier, younger men.

Screening Checking for disease when there are no symptoms. Because screening may find diseases at an early stage, there may be a better chance of curing the disease Checking for disease when there are no symptoms. Because screening may find diseases at an early stage, there may be a better chance of curing the disease. Examples of cancer screening tests are the mammogram (for breast cancer), colonoscopy (for colon cancer) and Pap and HPV tests (for cervical cancer). Screening can also include a genetic test to check for a person’s risk of developing an inherited disease.
Screening works

Most importantly, there is no doubt that prostate cancer deaths have decreased by about 40 percent since the advent of PSA screening, as shown in a National Cancer Institute investigation.1

Screening Checking for disease when there are no symptoms. Because screening may find diseases at an early stage, there may be a better chance of curing the disease Checking for disease when there are no symptoms. Because screening may find diseases at an early stage, there may be a better chance of curing the disease. Examples of cancer screening tests are the mammogram (for breast cancer), colonoscopy (for colon cancer) and Pap and HPV tests (for cervical cancer). Screening can also include a genetic test to check for a person’s risk of developing an inherited disease.

DRE and PSA screening guidelines

SCCA’s prostate cancer specialists recommend the following:

  • Men under 40 — DRE and PSA screenings are not recommended for men at average risk.
  • Men 40 to 54 — DRE and PSA screenings are not recommended for men at average risk.
  • Men 55 to 69 — DRE, PSA or both screenings may be right for you. Talk with your doctor about the risks and benefits.
  • Men 70 or older — DRE and PSA screenings are generally not recommended, but older men who are in excellent health may benefit from screening.

Talk with your doctor about screenings if:

  • You have any questions about whether DRE or PSA is right for you.
  • You have risk factors, such as a family history of certain cancers or inherited genetic mutations that may increase risk.

SCCA prostate cancer doctors are well equipped to discuss the benefits and risks of screening and whether regular screenings are right for you.

Digital rectal exam An examination in which a physician inserts a lubricated, gloved finger into the rectum to feel for abnormalities. Mutation Any change in the DNA sequence of a cell. Mutations may be caused by mistakes during cell division, or they may be caused by exposure to DNA-damaging agents in the environment. Any change in the DNA sequence of a cell. Mutations may be caused by mistakes during cell division, or they may be caused by exposure to DNA-damaging agents in the environment. Mutations can be harmful, beneficial or have no effect. If they occur in cells that make eggs or sperm, they can be inherited; mutations that occur in other types of cells are not inherited. Certain mutations may lead to cancer or other diseases. A mutation is sometimes called a variant. Screening Checking for disease when there are no symptoms. Because screening may find diseases at an early stage, there may be a better chance of curing the disease Checking for disease when there are no symptoms. Because screening may find diseases at an early stage, there may be a better chance of curing the disease. Examples of cancer screening tests are the mammogram (for breast cancer), colonoscopy (for colon cancer) and Pap and HPV tests (for cervical cancer). Screening can also include a genetic test to check for a person’s risk of developing an inherited disease.

Other screening tests

If your total PSA test results are high or abnormal, your doctor may use other screening tests to help determine if you need a biopsy, which is the only way to definitively diagnose prostate cancer.

Biopsy The removal of a sample of tissue or fluid that is examined to see whether cancer is present. This may be done with a large needle or through surgical removal of tissue or fluids. Prostate-specific antigen test A laboratory test that measures the amount of prostate-specific antigen (PSA) found in the blood. Screening Checking for disease when there are no symptoms. Because screening may find diseases at an early stage, there may be a better chance of curing the disease Checking for disease when there are no symptoms. Because screening may find diseases at an early stage, there may be a better chance of curing the disease. Examples of cancer screening tests are the mammogram (for breast cancer), colonoscopy (for colon cancer) and Pap and HPV tests (for cervical cancer). Screening can also include a genetic test to check for a person’s risk of developing an inherited disease.
Free-PSA level

A free-PSA test checks for the amount of PSA in your blood that is not bound to other proteins. This is a subset of your total PSA. The test is usually ordered only if your total PSA is elevated. It can help your doctor determine whether you need further diagnostic tests. Your free-PSA level is divided by your total PSA to get the percentage of free PSA. A result of less than 10 percent means you have a higher risk for prostate cancer. The lower the percentage, the higher the risk.

Diagnostic test A type of test used to help diagnose a disease or condition. Mammograms (for breast cancer) and colonoscopies (for colon cancer) are examples of diagnostic tests.
Prostate health index (PHI)

A PHI is a blood test to detect and predict the probability of prostate cancer. It uses two of your PSA subset values to create a cancer risk ratio that may help your doctors determine whether they should perform a biopsy. Studies of the accuracy of this test are ongoing.

Biopsy The removal of a sample of tissue or fluid that is examined to see whether cancer is present. This may be done with a large needle or through surgical removal of tissue or fluids.
Urinary PCA3 test

This is a urine test for proteins that are specific to prostate cancer. Unlike PSA, PCA3 is produced only by prostate cancer cells, and the level is not affected by your prostate size. This test can be used with total and free PSA tests to help determine whether you need a biopsy. It is not used as a stand-alone test, and it is used more often in men who’ve had a negative biopsy (meaning cancer was not detected) to determine whether another biopsy may be warranted.

Biopsy The removal of a sample of tissue or fluid that is examined to see whether cancer is present. This may be done with a large needle or through surgical removal of tissue or fluids. Prostate-specific antigen test A laboratory test that measures the amount of prostate-specific antigen (PSA) found in the blood.
Multiparametric MRI

This is a specialized magnetic resonance imaging (MRI) scan of your prostate to identify potentially suspicious areas that doctors can target at the time of your biopsy (a method called MRI-fusion biopsy). This test is used most often in men whose biopsy did not show cancer but whose PSA level is rising or raises persistent concern. It’s possible to have a normal MRI but still have prostate cancer, so doctors often perform standard biopsies even when MRI results appear normal.

Biopsy The removal of a sample of tissue or fluid that is examined to see whether cancer is present. This may be done with a large needle or through surgical removal of tissue or fluids. Biopsy The removal of a sample of tissue or fluid that is examined to see whether cancer is present. This may be done with a large needle or through surgical removal of tissue or fluids. Imaging In medicine, a process that makes pictures of areas inside the body. Imaging uses methods such as X-rays (high-energy radiation), ultrasound (high-energy sound waves) and radio waves. Magnetic resonance imaging A procedure in which radio waves and a powerful magnet linked to a computer are used to create detailed pictures of areas inside the body. A procedure in which radio waves and a powerful magnet linked to a computer are used to create detailed pictures of areas inside the body. These pictures can show the difference between normal and diseased tissue. MRI makes better images of organs and soft tissue than other scanning techniques, such as computed tomography (CT) or X-ray. MRI is especially useful for imaging the brain, the spine, the soft tissue of joints and the inside of bones.

Preventing prostate cancer

Doctors don’t know the exact cause of prostate cancer, and many prostate cancer risk factors cannot be controlled, so it is not possible to prevent the disease. However, there are some things you can do, such as eat a healthy diet and exercise, that might help lower your risk (and might help you deal with the disease if you do develop it). The section on diet and exercise for men with prostate cancer may also help those who do not have the disease.

Hormone therapy

In 2003, a study called the Prostate Cancer Prevention Trial showed that hormone therapy with finasteride (Proscar) reduced the risk of developing prostate cancer by 25 percent. Finasteride is approved to treat benign prostatic hyperplasia (noncancerous enlargement of the prostate). This study was the first to show that a drug could be used to prevent prostate cancer.

In 2010, a similar drug, dutasteride (Avodart), was also found to reduce the risk of prostate cancer in men at higher-than-average risk for the disease.

However, there are potential side effects, and men who developed prostate cancer while on these medications were slightly more likely to have higher-grade cancer. As a result, finasteride and dutasteride have not been approved by the U.S. Food and Drug Administration for cancer prevention.

Benign Not cancer. Benign tumors may grow larger but do not spread to other parts of the body. Hormone therapy Hormones can cause some cancers to grow. To slow or stop growth, synthetic hormones or other drugs can be used to block the body’s natural hormones, or surgery is used to remove a hormone-producing gland. Treatment that adds, blocks or removes hormones. For certain conditions (such as diabetes or menopause), hormones are given to adjust low hormone levels. Hormones can also cause certain cancers (such as prostate and breast cancer) to grow. To slow or stop the growth of cancer, synthetic hormones or other drugs can be used to block the body’s natural hormones, or surgery is used to remove the gland that makes a certain hormone. Also called endocrine therapy, hormonal therapy and hormone treatment. Side effects A problem that occurs when treatment affects healthy tissues or organs. Some side effects of cancer treatment are nausea, vomiting, fatigue, pain, decreased blood cell counts, hair loss and mouth sores. Side effects A problem that occurs when treatment affects healthy tissues or organs. Some side effects of cancer treatment are nausea, vomiting, fatigue, pain, decreased blood cell counts, hair loss and mouth sores.
Diet and supplements

Eating well is important before, during, and after treatment for prostate cancer. It can help you feel better, have more energy, keep up your strength, and lower your risk of infection. It can also help you prepare for surgery and speed your recovery after cancer treatment, and it may help keep your cancer from coming back.

Seattle Cancer Care Alliance (SCCA) offers consultation with a nutritionist for all of our patients undergoing treatment. A nutritionist can recommend food choices to help with treatment side effects (like fatigue, nausea, and changes in sense of smell or taste); discuss diet variations (like plant-based diets, anti-inflammatory diets, and whole-food diets); and work with you on an individualized plan that optimizes your health and addresses specific goals (like bone health, blood-sugar control, and weight loss or gain).

While the exact role of diet in prostate cancer is not clear, researchers have studied several factors, and they continue to look for more specific associations between diet and prostate cancer. Many of the foods thought to lower the risk for and improve survival after prostate cancer are foods of plant origin. Men who eat a lot of red meat or high-fat dairy products and fewer fruits and vegetables appear to have a slightly higher risk of prostate cancer. Some studies have suggested that men who consume a lot of calcium (through food or supplements) may have a higher risk of developing prostate cancer; however, most studies have not found such a link with the levels of calcium found in the average diet, and it's important to note that calcium is known to have other important health benefits.

For optimal health, nutritionists at SCCA recommend eating a mostly plant-based diet and including moderate amounts of foods of animal origin. Some of the many foods and nutrients showing associations with prostate cancer risk and survival are listed below.

  • Protein
  • Dietary Fat
  • Fruits & Vegetables
  • Fiber
  • Soy
  • Calcium
  • Vitamin D
  • Vitamin E & Selenium
  • Green Tea, Coffee, & Red Wine
  • Supplements

Protein

Protein is important to help keep up your strength and rebuild tissues that may be harmed by cancer treatment. The best choices are beans (legumes), nuts, fish, eggs, and chicken without the skin.

Dietary fat

Everyone needs some fat as part of a healthy diet. Fat contains important nutrients, including vitamins A, D, E, and K, and is an important part of the cells in your body.

More research is needed to determine the effect fat has on prostate cancer. In any case, it is probably a good idea to choose healthy fats, limit your intake of saturated fats, and avoid trans fats. Healthy fats, such as monounsaturated and polyunsaturated fats, can lower LDL (“bad”) cholesterol and increase HDL (“good”) cholesterol, while saturated fats and trans fats can increase LDL cholesterol.

We recommend using olive and canola oils and eating avocado and a handful of nuts daily. Limit dairy to one to two servings daily. Limit your intake of red meats and chicken skin. It also is a good idea to eat foods containing omega-3 fatty acids, such as those found in fish, two to three times weekly. The omega-3 fatty acids in fish (EPA and DHA) appear to provide protection against prostate cancer and heart disease.

Increased consumption of omega-6 fatty acids, such as safflower, soybean, and corn oils, has been shown to double the risk of prostate cancer in men with a family history of the disease. In addition, regular consumption of deep-fried foods (once a week or more) is associated with increased risk for prostate cancer, and the effect appears to be slightly stronger for more aggressive forms of the disease.

Fruits and vegetables

Some research studies have found a significant association between eating vegetables—in particular, yellow or orange vegetables and cruciferous vegetables—and a lower risk of prostate cancer.

Fruits and vegetables provide the vitamins, minerals, and fiber that your body needs. Different colored fruits and vegetables contain unique varieties of disease-fighting phytochemicals. Only fruits and vegetables, not pills or supplements, provide all of these nutrients together.

Phytochemicals are natural antioxidants. Antioxidants are substances that may protect your cells against the effects of free radicals. Free radicals can damage cells and play a role in cancer and other diseases.

Try to eat a variety of colors of fruits and vegetables each day. Here are examples of colorful plant foods to work into your diet regularly, along with the phytochemicals they provide.

  • Red: tomato-based foods (tomato sauce, tomato juice, tomato paste, salsa, tomato soup), watermelon, pink grapefruit, papaya, and apricots, which provide lycopene
  • Red/purple: pomegranates, grapes, plums, cherries, and berries, which provide anthocyanins
  • Orange: carrots, sweet potatoes, mangoes, apricots, oranges, and cantaloupes, which provide carotenoids
  • Orange/yellow: oranges, peaches, papaya, and nectarines, which provide cryptoxanthin
  • Yellow/green: spinach, peas, corn, avocado, romaine lettuce, and honeydew melons, which provide lutein and zeaxanthin
  • Green/cruciferous: broccoli, cauliflower, radishes, cabbage, Brussels sprouts, kale, chard, collards, and mustard greens, which provide sulforaphane, isothiocyanates, and indoles
  • White/green: garlic, onions, asparagus, leeks, shallots, and chives, which provide allyl sulfides

In addition, some fruits and vegetables that don’t fit into the color system also have benefits. For example, celery contains salicylic acid, the active ingredient in aspirin, which has anti-inflammatory properties.

Lycopene

Lycopene, from red fruits and vegetables or from supplements, is a phytochemical of particular interest because it may affect antioxidant activity and lower the risk of prostate cancer. Laboratory and preclinical studies show less cancer cell growth in the presence of lycopene; however, clinical studies have had mixed results. Several issues—including prostate cancer stage, genetic risk factors, sources and types of lycopene, other dietary differences, and obesity—may impact whether lycopene helps prevent prostate cancer or is useful in treating prostate cancer.

Fiber

Fiber may bind to toxic compounds and carcinogens in the body; and a high-fiber diet may reduce levels of hormones that are involved in the progression of prostate cancer. Dietary fiber comes from the parts of plants your body can’t digest. There are two types, soluble fiber and insoluble fiber.

Soluble fiber

When eaten regularly as part of a low-fat, low-cholesterol diet, soluble fiber can help lower blood cholesterol. Oats have the highest proportion of soluble fiber of any grain. Foods high in soluble fiber include oat bran, oatmeal, beans (legumes), peas, rice bran, barley, citrus fruits, strawberries, and apples.

Insoluble fiber

Insoluble fiber doesn’t seem to help lower blood cholesterol. However, it’s an important aid in normal bowel function. Foods high in insoluble fiber include whole wheat breads, wheat cereals, wheat bran, rye, rice, barley, most other grains, cabbage, beets, carrots, Brussels sprouts, turnips, cauliflower, and apple peels.

Soy

There is some evidence that soy may help prevent prostate cancer (and more evidence that it can help reduce risk for heart disease). Soy contains phytochemicals called isoflavones, which have antioxidant, antimicrobial, and antifungal properties. Isoflavones are also antiangiogenic (they block formation of new blood vessels that nourish tumors) and may block growth of cancer cells.

Soynuts, edamame, tempeh, tofu, and soy milk are sources of soy. Soy may cause some gastrointestinal upset, such as gas, so if you do not eat soy foods regularly now, it may be better to introduce soy to your diet gradually over several weeks.

Calcium

The role of calcium in prostate cancer is unclear. Too much may increase the risk of prostate cancer (and lead to other harmful side effects), while too little may increase the risk of colon cancer. In a study reported in the Journal of Nutrition in 2007, increased dairy intake cut the risk of smokers developing prostate cancer by about 40 percent.

Since prostate cancer treatment may result in a loss of bone density, it is important to consume adequate calcium and vitamin D to help keep your bones strong. Exercise is also important in preventing bone loss. Your calcium requirements depend on whether or not you are receiving hormone therapy and whether or not you have osteoporosis.

  • If you have had a normal DEXA scan and you are not receiving androgen-deprivation therapy, you need between 1,000 and 1,200 mg of calcium a day.
  • If you have osteoporosis or osteopenia or are receiving androgen-deprivation therapy, you need 1,500 mg of calcium per day.

Calcium is found in many foods, including dark green vegetables, soy products, fish, nuts, and beans (legumes). While dairy products are a good source of calcium, research indicates dairy should be limited for prostate cancer survival and prevention. We recommend eating mostly plant-based sources of calcium and limiting intake of dairy to one to two servings daily.

If you do not consume enough calcium in food, you should take a supplement. Calcium carbonate supplements should be taken with meals for best absorption. Calcium citrate can be taken between or with meals. Avoid consuming more than 2,000 mg of calcium daily from food and supplements.

Vitamin D

Vitamin D helps the body utilize calcium and phosphorus to build bones and teeth. Since prostate cancer treatment may result in loss of bone density, it is important to get enough vitamin D to keep your bones strong. Research has found that men with high levels of vitamin D have a lower risk of developing the more lethal forms of prostate cancer.

With adequate sun exposure, your body can manufacture vitamin D. But as you grow older your ability to manufacture vitamin D declines. Risk factors for developing a vitamin D deficiency are living in a less sunny climate (such as the Pacific Northwest), being obese, being over 60, and not getting adequate dietary vitamin D.

It is best to get vitamin D from food, a multivitamin supplement, or a calcium supplement that includes vitamin D. Food sources of vitamin D are limited and generally include fortified sources, such as milk, soy milk, yogurt, orange juice, and cereal.

To determine how much vitamin D you need to get from your diet and possibly supplements, get a blood test to measure your current vitamin D level. Discuss checking your vitamin D level with your medical team.

Vitamin E and selenium

In a clinical study known as the SELECT trial, researchers studied whether selenium and vitamin E, taken together or alone, could help prevent prostate cancer.

As reported in the 2011 results, men who took vitamin E supplements alone had a 17 percent relative increase in prostate cancer. For this reason, we suggest you avoid taking vitamin E supplements and focus instead on consuming foods rich in vitamin E. These include nuts (such as almonds, hazelnuts, and peanuts), vegetable oils (such as olive and canola), seeds, wheat germ, whole grain products, and spinach and other dark, green leafy vegetables.

As reported in the study’s 2008 and 2011 results, there were more cases of diabetes in men taking only selenium, and men taking selenium alone or in combination with vitamin E were more likely to develop prostate cancer. The findings were not statistically significant and cannot be definitely linked to selenium. However, we recommend against taking selenium supplements. The best source of selenium is food. Foods rich in selenium include Brazil nuts, wheat germ, bran, brown rice, whole wheat bread, barley, onions, garlic, turnips, soybeans, mushrooms, fish, and eggs.

Green tea, coffee and red wine

The health benefits of green tea are thought to come from polyphenols, which include catechins—powerful antioxidants. Laboratory and preclinical studies have shown catechins slow the spread of prostate cancer by blocking the stimulating effect of androgen (male hormones, such as testosterone), and they may block a protein involved in the growth of prostate cancer. Catechins also make prostate cancer cells more susceptible to radiation and hormone therapy.

Coffee consumption has been associated with a lower risk of prostate cancer recurrence and progression. In a study reported by Fred Hutchinson Cancer Research Center in August 2013, men who drank four or more cups of coffee a day experienced a 59 percent reduced risk of prostate cancer recurrence and progression compared with men who drank only one or fewer cups of coffee per week. While more studies are needed to determine the mechanisms for this effect, researchers believe that the phytochemical compounds found in coffee have anti-inflammatory and antioxidant effects and modulate glucose metabolism.

Also, according to a study by researchers at the Hutch, men who drank four or more glasses of red wine per week reduced their risk of prostate cancer by half and had a 60 percent lower incidence of more aggressive types of the disease. This may be due to the anti-inflammatory and antioxidant properties of resveratrol, found in red grape skins, peanuts, and raspberries. Resveratrol is also available as a dietary supplement.

It is important to note that increased consumption of coffee may be harmful for some men, and heavy alcohol use has health risks that are well documented.

Supplements

Most research suggests that food is the best source of nutrients—a balanced diet, including fruits and vegetables, is of greater benefit than taking dietary supplements. Supplements can have both risks and benefits. Some studies indicate taking certain nutrient supplements in high doses may have negative health outcomes. In fact, as a result of a large clinical study known as SELECT, we recommend prostate cancer patients do not take vitamin E or selenium supplements. More information about vitamin E and selenium is included in the section on diet above.

Multivitamins and mineral supplements offer no known health benefits and are generally not needed if you eat a balanced diet. However, if you avoid specific groups of foods, such as meat, milk, cheese, eggs, or fruit, you may need to take a multivitamin or mineral supplement in order to get some of the nutrients these foods supply.

Before starting vitamins or other supplements, consult a nutritionist and your medical team.

Clinical trial A type of research study that tests how well new medical approaches work in people. These studies test new methods of screening, prevention, diagnosis or treatment of a disease. Clinical trial A type of research study that tests how well new medical approaches work in people. These studies test new methods of screening, prevention, diagnosis or treatment of a disease. Fluorescence in situ hybridization A laboratory method used to look at genes or chromosomes in cells and tissues with the help of fluorescent dye. It is used to help diagnose diseases such as cancer and to help plan treatment. A laboratory method used to look at genes or chromosomes in cells and tissues. Pieces of DNA that contain a fluorescent dye are made in the laboratory and added to a cell or tissue sample. When these pieces of DNA bind to certain genes or areas on chromosomes in the sample, they light up when viewed under a microscope with a special light. FISH can be used to identify where a specific gene is located on a chromosome, how many copies of the gene are present and any chromosomal abnormalities. It is used to help diagnose diseases such as cancer and to help plan treatment. Gastrointestinal Refers to the stomach and intestines. Also called GI. Hormone therapy Hormones can cause some cancers to grow. To slow or stop growth, synthetic hormones or other drugs can be used to block the body’s natural hormones, or surgery is used to remove a hormone-producing gland. Treatment that adds, blocks or removes hormones. For certain conditions (such as diabetes or menopause), hormones are given to adjust low hormone levels. Hormones can also cause certain cancers (such as prostate and breast cancer) to grow. To slow or stop the growth of cancer, synthetic hormones or other drugs can be used to block the body’s natural hormones, or surgery is used to remove the gland that makes a certain hormone. Also called endocrine therapy, hormonal therapy and hormone treatment. Physician assistant A health professional who is licensed to do certain medical procedures under the guidance of a physician. A health professional who is licensed to do certain medical procedures under the guidance of a physician. A physician assistant may take medical histories, do physical exams, take blood and urine samples, care for wounds and give injections and immunizations. Progression In medicine, the course of a disease, such as cancer, as it becomes worse or spreads in the body. Recurrence Cancer that has come back, usually after a period during which it could not be detected. It may come back to the same place as the original (primary) tumor or someplace else. Also called recurrent cancer. Side effects A problem that occurs when treatment affects healthy tissues or organs. Some side effects of cancer treatment are nausea, vomiting, fatigue, pain, decreased blood cell counts, hair loss and mouth sores. Side effects A problem that occurs when treatment affects healthy tissues or organs. Some side effects of cancer treatment are nausea, vomiting, fatigue, pain, decreased blood cell counts, hair loss and mouth sores. Stage The extent of a cancer in the body. Staging is usually based on the size of the tumor, whether lymph nodes contain cancer and whether the cancer has spread from the original site to other parts of the body.

1. Hans Lilja et al, “Prediction of Significant Prostate Cancer Diagnosed 20 to 30 Years Later with a Single Measure of Prostate-Specific Antigen at or Before Age 50,” Cancer 117 (2011): 1210-1219, doi: 10.1002/cncr.25568.

Antigen A foreign substance, such as bacteria, that causes the body’s immune system to respond by making antibodies. Antibodies defend the body against antigens.