The monthly lifestyle magazine for New England
by Rob Saint Laurent, MEd
While women have their share of reproductive maladies, men are not immune to the experience.
Disease surveillance data by the National Cancer Institute estimates 161,360 new cases of prostate
cancer in the US in 2017.1
Next to skin cancer, it’s the most prevalent cancer in men worldwide.
Alfred Diggs, a former pharmacist in California, became part of the ranks when he was diagnosed with prostate cancer in 2001 at the age of 55, and then again in 2011 despite having a prostatectomy the first time.2
He’s among good company, as more than three million US men were living with prostate cancer in 2014 according to the NCI. Though Diggs was able to pull through with elective radiation therapy, about 26,730 of his peers were not in 2017.
SMALL ORGAN, BIG THREAT
The prostate is an almond-shaped gland nestled beneath the urinary bladder in front of the rectum, with the urethra running through it. Prostates average about three centimeters in length and 20 grams in weight.
The gland nourishes and transports incoming sperm with a fluid matrix (i.e., seminal fluid).
While it’s normal for the prostate to enlarge with age in virtually all men, with many never experiencing complications, obstruction of bladder release into the urethra can occur, known as prostatism. The most common cause is benign prostatic hyperplasia (BPH), or an enlarged prostate from cell proliferation.
The origin of BPH isn’t conclusively known. But research suggests hormonal changes, since men who have had their testicles removed before puberty do not get BPH. One theory points to the imbalance of testosterone and estrogen as men age. Another involves the enzyme 5-alpha-reductase that converts testosterone into dihydrotestosterone (DHT).3
Prostatitis is yet a third potential condition, resulting from infection and usually treated with antibiotics.
Prostate cancer (PCa) differs from BPH in that the enlargement will feel smooth and firm. In BPH, digital palpation will feel hard and lumpy.4 Considered a malignant tumor; mutant prostate cells now can metastasize, or invade other areas of the body (typically the bones, lymph nodes, rectum, bladder, and urinary tract), threatening overall health.
According to the World Health Organization’s 2014 World Cancer Report, risk factors for prostate cancer include family history, being 50 or older, and being of African-American heritage (as is Diggs).
Dietary factors also play a role; high consumption of processed meat, red meat, milk products, along with—according to the European Prospective Investigation into Cancer and Nutrition (EPIC)—low fruit intake, especially citrus, appear to be contributing factors to the disease process.
BPH isn’t cancer, nor does it indicate the likelihood of it occurring, though the latter point is hotly contested among urologists who contend both conditions can be linked hormonally, genetically, and inflammation-wise—though they can’t yet be sure BPH causes PCa.5
WARNING SIGNS AND SCREENING
For the uninitiated, prostate-related symptoms are astutely visible.
They’re also generally non-specific, often making it difficult to differentiate between BPH and early cancer, underscoring the importance of proper diagnosis.
As described by the Centers for Disease Control, screening for prostate issues typically involves a thorough personal and family medical history, followed by a digital rectal exam whereby the physician feels the prostate to estimate the size and ascertain lumps and other abnormalities.
A PSA test then measures the level of prostate-specific antigen (a protein) in the blood, which can be elevated in men with cancer. The higher the level, the more likely there’s a problem.
However, the only way to diagnose PCa with confidence is via biopsy in which a small tissue sample is taken for lab analysis.
The array of options for treating prostate cancer can be confusing. As the Prostate Cancer Foundation states, “There is no ‘one size fits all’ prostate cancer treatment.”
A man’s Gleason score and grade group are significant decision-making factors.
The Gleason score indicates the level of cancer advancement on a scale of 1–5 (five being the highest or most abnormal-looking under a microscope). Since the degree of PCa usually varies in each case, a number is assigned to the two areas covering the most cancer in the gland, together yielding a score or sum of 6–10.
From there, a grade group is used to categorize the degree of PCa, ranging from one (Gleason 6 or less) to five (Gleason 9–10), representing the likelihood of PCa growing slowly to spreading quickly.
The American Cancer Society outlines possible treatment options based on disease stage.6–7
In stage one PCa, for example, which has the lowest Gleason score and PSA level, older more fragile men may benefit most from watchful waiting; in contrast, their younger counterparts may choose to wait, undergo radiation therapy, or, as Diggs had done, have a radical prostatectomy. Radiation can be by a traditional external beam or sealed radioactive material inserted directly into the prostate (brachytherapy).
But surgical removal isn’t always 100 percent curative. For Diggs, his cancer came back since it wasn’t initially confined to the prostate and had spread to the outer “bed” layers.
By stage four where cancer has metastasized, treatment focus is on reining in the disease and improving quality of life through a variety of options.
Other treatment examples are hormone therapy, chemotherapy, bone-directed treatment, radiofrequency ablation, cryo- (cold) ablation, proton beam radiation therapy, 5-alpha reductase inhibitors, clinical trial participation, pain therapy, and possible complementary and alternative methods.
The Prostate Cancer Foundation advises that a man’s decision-making involve his need for therapy, risk tolerance, risk-benefit ratio, personal circumstances, and intuition.
REDUCING BPH AND CANCER RISK
Preventive care is essential for staving off problems, particularly in the face of genetic predisposition.
The physician-reviewed resource prostate.net offers evidence-based lifestyle tips for reducing inflammation and estrogen that can contribute to BPH, which can be enacted alone or in conjunction with conventional options.
Healthy behaviors include eating whole versus processed foods, choosing plant-based proteins, and eating low-fat foods while selecting healthy fats such avocado, olive oil, and cold-water fish (salmon and sardines, for instance).
Also helpful is boosting fruit and vegetable intake; consuming lycopene—found in tomato-based products; drinking green tea for its potent antioxidant content that can target the prostate; and avoiding red and processed meats, excessive dairy, calcium, and sugary foods.
Of local interest, some experts have suggested supplementing a diet with vitamin D3, especially if living above 40 degrees latitude (i.e., New Englanders), and getting some exercise.
It’s also important not to delay urination which can aggravate BPH.
Interestingly, prostate cells are dependent on zinc for proper function; in prostate cancer, cells are virtually devoid of the mineral.8 However, supplementing with zinc beyond a quality multiple vitamin/mineral
formulation may be unnecessary and even counterproductive.9–10
The herbal DHT-inhibitors saw palmetto and pumpkin seed oil are also considerations.
An estimated 11.6 percent of US men will develop prostate cancer during their lifetime.1
According to statistics, the rate of prostate cancer incidence per 100,000 US men has been on the decline since 1992.1
In the face of increasing PCa prevalence, the reason for this lies in decreasing early detection. Most prostate cancers grow slowly and without health complications, leading to a false sense of security.
The good news is that death from PCa has also been declining, likely due to treatment advancements.
The Prostate Cancer Foundation recommends a yearly rectal examination and PSA test for those over age 50 (40 if African-American or with a family history of prostate disease).
If diagnosed, many PCa survivors recommend immediately finding a mentoring site such as You’re Not Alone Now at yana.org, or through PCF at pcf.org.
It’s critical, they advise, that newly diagnosed patients consult men who have been there and can relate practical information doctors can’t share.
3 National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health.
4 Mandal, A. Differentiating between prostate cancer and prostate enlargement.
5 Miah, S. & Catto, J. (2014, Apr–Jun). BPH and Prostate Cancer Risk. Indian Journal of Urology, 30(2), 214–18.
8 Christudoss, P. et al. (2011, Jan–Mar). Zinc status of patients with benign prostatic hyperplasia and prostate carcinoma. Indian Journal of Urology, 27(1), 14–18.
10 Song, Y. & Ho, E. (2009, Nov). Zinc and Prostate Cancer. Current Opinion in Clinical Nutrition and Metabolic Care, 12(6), 640–45.
Rob Saint Laurent, MEd is a health writer and editor.
Sign up for a free digital subscription to New England Monthly Magazine.