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Taking dead aim at early-stage prostate cancer: Why 'watchfully wait* when you can stop prostate cancer in its tracks? ELEVEN STRATEGIES BY ROBYN CHUTER Men who are diagnosed with early-stage prostate cancer are often given the option of 'watchful waiting'. This means that the man's prostate specific antigen [PSA) level will be checked regularly, and If it rises, or if complications from the prostate cancer develop, then surgical and/or medical treatment of the cancer will commence. This approach is generally favoured for men over the age of 75 and/or those with other health problems. What follows are 11 top prostate cancer containment and reversal strategies. [Note that nothing here is to do with treating or curing cancer; these points are all about making the body as healthy as possible so as to strengthen its self-healing powers and contain the cancer and prevent it becoming life-threatening.] 1„ Ent a diet based on unrefined plain foods. Dr Dean Ornish has demonstrated the dramatic benefits for men, diagnosed with early-stage prostate cancer, of switching to a vegan diet, pee box. The Prostate Cancer Lifestyle Trial', p.5O0 A healthy vegan diet - that is. one based on vegetables, fruits, legumes, nuts, seeds and whole grains, not vegan marshmallows and soy hot dogs - is rich in dietary factors like antioxidant vitamins, carotenoids, other phytochemicals and fibre that help prevent many chronic diseases including cancer, and may assist in overcoming them. In addition, this dietary pattern is low in factors that promote chronic disease, such as saturated fat and cholesterol'^' [see the more detailed discussion of cholesterol below). ow-grade prostate cancer has a slow growth rate, so if you are elderly or already ¡II with another disease. you are likely to die from these conditions long before your prostate cancer kills you. Younger healthy men may also choose watchful waiting because they dread the side-effects of prostate cancer treatment: impotence; urinary incontinence: bowel problems: and in the case of hormonal treatments, depression, cognitive decline, loss of libido and increased risk of high blood pressure, diabetes and heart attack. L Poultry and eggs are just as risky as red meat A recent study of 1300 men who had been diagnosed with prostate cancer, found that those who ate the most eggs and poultry with skin, were twice as likely to have their cancer recur after treatment, or progress to a more serious form, as men with the lowest intake. ^•' Animal protein is a key factor in raising levels of a hormone called IGF-l Gnsulin-like growth factor 0. which is a known risk factor for prostate cancer, (On the other hand, plant proteins including soya beans, raise levels of IGF-1 binding proteins, which protect against prostate cancer,)'"' While the watchful waiting approach saves many men from treatment that would not actually benefit them - in fact, Dr Otis Brawiey of the American Cancer Society states that "More than 90% of men getting [treatment for prostate cancer] do not need it"''' - it represents a gigantic wasted opportunity Firstly slow-growing prostate cancers can suddenly become aggressive and life-threatening, and at the moment there is no way of predicting which cancers will change in this way. Secondly, the dietary and lifestyle risk factors for prostate cancer are the same as the risk factors for heart disease, type2 diabetes and several other types of cancer, including colorectal. Being diagnosed with cancer tends to grab one's attention, and many men are more open to change at this point than at any other time of their lives. If you make changes to get your prostate cancer under control, you'll also be reducing your risk of the other major causes of death for Australian men. That's why. rather than leaving men with eariy-stage prostate cancer in the limbo of watchful waiting. I favour aggressive nutritional and lifestyle intervention. Why sit there on the tracks, waiting for the train to run you over, when you can get yourself out of its way? And dairy products have no place in the diet of a man who wants to avoid dying of prostate cancer. Milk, yoghurt, cheese and other dairy products contain high levels of IGF-1 and also stimulate the body to make more of it. In addition, the steroid hormone 5alpha-pregnanedione [5alpha-P). present in milk, is converted to dihydrotesterone CDHT), a hormone which drives the growth of prostate cells, and hence is involved in the development of both benign prostatic hypertrophy and prostate cancer.'-^' This potent double-whammy is probably responsible for the association found in epidemiological (population) studies, between dairy product intake and prostate cancer 48 Natural Health and Vegetarian Life C678.,û) 2. Exercise regularly. As well as reducing the risk of developing prostate cancer in the first place,'"^ regular exercise is beneficial for men already diagnosed with prostate cancer but it appears that the exercise must be fairly vigorous to show benefit. Researchers from the Harvard School of Public Health found that men with prostate cancer who engaged in five or more hours of vigorous physical activity a week, decreased their risk of dying from prostate cancer. In the same study, jogging, cycling, swimming or playing tennis for about half an hour per week reduced all-cause mortality (death from any cause) in these men by 35%, Men who walked for 90-plus minutes at a normal to brisk pace each week had a STHi lower all-cause mortality rate than men yi/ho walked less than 90 minutes at an easy walking ''^' Winter 2010 3. Get your cliolesterot level downl! Cholesterol increases prostate cancer cell division, and therefore tumour growth. It upregulates Gncreases the activity oO a prostate cancer-promoting gene, called PCGEMl, in both androgensensitive and androgen-insensitive prostate cancer cell lines."^^ To lower cholesterol, you must stop eating animal protein, and .,, i*. Consume plant sterols. Plant sterols, or phytosterols. are found in abundance in nuts, seeds and grains. They have been found to suppress prostate cancer cell grovirth and induce cell 'suicide' in prostate cancer cells Ccell 'suicide' is known as programmed cell death, or apoptosis; doctors use radiotherapy and chemotherapy to try to induce apoptosis]. Significantly, plant sterols reverse the cancer-promoting effects of cholesterol mentioned above.'"" 5. Consume foods rich in phytochemicats, especially lycopene. The red pigment lycopene. a member of the carotenoid family, lends tomatoes, watermelon, pink grapefruits, papaya, apricots and pink guavas their vibrant hue. Epidemiological studies have found that men with a high intake of lycopene (usually from cooked tomato products) have a lower risk of prostate cancer."^' Men with prostate cancer who consumed more dietary lycopene had lower PSAs, slower progression of their cancers, and less cancer-related pain and urinary tract symptoms.'"^^ Lycopene has been found to inhibit the growth of prostate cancer cells and induce apoptosis. Lycopene is a potent antioxidant, able to prevent cancercausing oxidative damage to DNA, It also has specific activity against many of the mechanisms used by prostate cancer cells to grow and multiply: it reduces inflammatory signals, blocks the growthpromoting activity of IGF-1 and androgens Cmale' hormones), and makes cancer cells 'listen' to signals sent by neighbouring healthy cells (normally, cancer cells tune out these messages, which help to control their qrovrth rate)."" 6. Eat cruciferous vegetables. The cruciferous, or brassica, vegetables include broccoli, cauliflower, Brussels sprouts, cabbage, bok choy, tatsoi, rocket, horseradish, watercress, kale, collard greens, kohlrabi, mizuna, turnip, rutabaga, radish and wasabi. While all vegetables are beneficial for people with cancer, men who ate three or more servings of cruciferous vegetables per week were found to have a Al per cent lower risk of developing prostate cancer than did men who ate less than one serving a week.''^' Sulphoraphane, an Winter 2010 isothiocyanate compound found in cruciferous vegetables, particularly broccoli sprouts, increases cells' defences against cancerous change, and slows down the rate of prostate cell On the other hand, some epidemiological studies have found that men with the highest intake of alpha-linolenic acid CALA - of which flaxseed oil is the richest commonly-consumed source) have an increased risk of developing prostate cancer compared to men with 7. Consume pomegranate. The fruit the lowest intake/^^' ' Until more and juice of the pomegranate are extraordinarily rich in poiyphenols, a type definitive studies are done, it is prudent to avoid concentrated sources of ALA. of phytochemical with strong antioxidant While whole or ground linseed does activity. Pomegranate contains a unique group of poiyphenols called punicalagins. contain ALA, the anti-cancer lignans it contains appear to offset any cancerPunicalagins down-regulate the growth promoting effect that this type of fatty factors that cancer cells use to acid may have. propagate themselves, thus inducing apoptosis in these ceils.'^''^^' 9. Avoid folie acid supplements. Men who took a daily 1 mg folie acid Researchers at the University of supplement for up to 10 years were California, Los Angeles, studied the found to more than double their risk of effects of pomegranate juice on 50 men developing prostate cancer compared to with prostate cancer in whom medical men taking a placebo. Interestingly, men therapy had failed. Their PSA levels had who did not take folie acid supplements, doubted, on average, only 15 months but had high blood levels of folate from after they had had surgery and/or dietary sources, showed a trend toward radiation, indicating that their prostate reduced risk of prostate cancer.''^'^' cancer cells were rapidly propagating. The men were given 225 ml of 10. Ensure your vitamin D level is pomegranate juice daily. The average optimal. The 'sunshine vitamin' is the PSA doubling time increased to 54 current megastar of the nutrition world. months, and 80% of the men who There has been an explosion in vitamin received the juice reduced the velocity of D research in the last couple of years, their PSA increase. Blood samples were and it seems that there aren't many taken from the men before and after the diseases that vitamin D doesn't prevent pomegranate juice treatment, and the or aid in treating! Prostate cancer is scientists grew prostate cancer cells in definitely on the lisL Vitamin D inhibits the sampled blood. The posthuman prostate cancer cells from pomegranate blood samples decreased proliferating, invading surrounding prostate cancer cell proliferation by 12%, healthy tissue, and metastasising and increased apoptosis by 17%, Cspreading through the body); and it compared to the pre-pomegranate blood promotes differentiation of these cells (thus reversing the process by which healthy cells turn into cancer eel Is).'^^^ 8. Eat ground linseed/flaxseed - but not flaxseed oil. Flaxseed Cor linseed) A study of men who had been treated contains high amounts of lignans. These for prostate cancer, but still had rising compounds are converted in the body PSA levels (indicating that their prostate into enterolactone. which has been cancer was relapsing), found that found to inhibit prostate cancer growth vitamin D supplementation decreased and develop ment ^^''^ PSA levels, or kept them steady, for nearly 2 years of follow-up. This means Researchers took 161 men with prostate that the vitamin D was slowing down or cancer, who were scheduled for surgical preventing the recurrence of prostate removal of the prostate gland, and cancer'^''^ randomised them into A groups. The first group received a diet supplemented with 11. Manage stress, and seek 30 grams flaxseed per day; the second, a emotional support. The Prostate low-fat diet: the third, a low-fat diet Cancer Lifestyle Trial conducted by Dr supplemented with flaxseed; and the Dean Ornish included multiple avenues fourth ate their usual diet. All the men for building connections between the followed their allocated diet for an men who were facing cancer. Ornish average of thirty days, until their surgery. himself considers this to have been a The prostate tumours were then examined very significant aspect of the program. for proliferation Ccancer cell growth) and Most of the men who participated apoptosis Ccancer cell 'suicide'). The two reported that their participation in the groups that received flaxseed were found program contributed to feelings of hope, to have less than half the rate of tumour optimism and fighting spirit, and many cell proliferation compared to men who felt they were much more comfortable consumed their usual diets, while no with emotional expression as a direct significant effect on proliferation was result of this peer group involvement.'^^^ observed among those vyho received a low-fat diet without flax.^^^' Natural Health and Vegetarian Life 49 THE PROSTATE CANCER LIFESTYLE TRIAL IN CONCLUSION The pioneering medical doctor, Dean Ornish, has shown that a low-fat vegan diet including soya foods, along with participation in stress management psychosocial group support and exercise programs, can prevent or delay the need for medical treatment in men with early-stage (Gleason score of 7 or less) prostate cancer. Being told that you have cancer is one of the scariest experiences you can possibly have. But for men who are diagnosed with early-stage prostate cancer, there is a silver lining to this dark cloud: the diagnosis can spur them on to make diet and lifestyle changes that will substantially reduce the chances of their prostate cancer becoming aggressive and claiming their lives. As an added bonus, these same changes will also substantially improve their quality of life, and protect them against other deadly conditions such as heart disease, type-2 diabetes and bowel cancer, which share many risk factors with prostate cancer. Ornish took 93 men who had elected watchful waiting to manage their early stage prostate cancer, and put half of them into the diet and lifestyle intervention group. The intervention group experienced significant improvements in weight, abdominal obesity, blood pressure and lipid profile (blood cholesterol and triglycerides)/^^^ and their PSA level went down by an average of 4% after one year on the program, while the control group suffered an average PSA increase of After 2 years. 27% of the control patients had had to undertake conventional prostate cancer treatment (radical prostatectomy, radiotherapy or androgen deprivation] compared to only 5% of the patients who had participated in the lifestyle experiment. Three of the controi patients had a PSA level of 10 ng/mL or higher, while none of the experimental group did.'^^^ The researchers also took serum (blood minus the red blood cells] from the men after they had made the diet and lifestyle changes, and cultured prostate cancer cells in it. TTiey found that this serum inhibited the growth of prostate cancer cells 8 times more effectively than serum from men in the control group, who had made no changes.'^^^ Diseases such as cancer are often blamed on 'bad genes', with the assumption that a man inherits genes that predispose him to cancer, and there's nothing he can do about it. However. Ornish and his co-researchers found proof that diet and lifestyle changes can change the expression of genes - in other words, you can turn 'cancer genes' on or off depending on how you live. They studied the gene expression of men before and after the diet and lifestyle intervention, and found that over 500 genes were affected by the changes the men made. Many of these genes play crucial roles in generating cancerous tumours.'^'^ CASE HISTORY David was diagnosed with early-stage prostate cancer (Gleason score 6] in November 2009. He had been having symptoms of benign prostatic hypertrophy (non-cancerous enlargement of the prostate] for some time. His PSA. which should be no more than 3.5 ng/ml in men in his age group early 50s - was 78 ng/ml. David's urologist urged him to have a prostatectomy, but he resisted, and began looking for a more wholistic way to manage his condition. Prior to coming to see me. he began exercising regularly, cut refined carbohydrates and meat out of his diet and increased his consumption of vegetables, salads and tofu. When he had his PSA tested again 4 months later, it had dropped to 5.6. We are now working on getting his PSA even lower. We are doing this by optimising his vitamin D level, by including pomegranate, flaxseed and more brassica vegetables in his diet, and by using carefully targeted nutritional supplements to decrease inflammation in his prostate, and so inhibit the growth of the prostate cancer cells. David has also realised that he needs to make big changes in his life to allow himself to be truly happy, rather than just 'staying on the treadmill'. David is a joy to work with, because he has really grasped the opportunity that his diagnosis has presented him with: the opportunity to make changes in his way of eating and living that decrease his risk of dying from prostate cancer, enhance his feeling of overall wellbeing. and put him back in the driver's seat when it comes to his health and happiness. 50 Natural Health and Vegetarian Life So don't sit around 'watching' your PSA levels rise, and 'waiting' until the urologist says it's time to cut your prostate gland out. Follow the example of Dr Dean Ornish's patients and start making life-saving changes in your diet and lifestyle today. THE AUTHOR Robyn Chuter, BHSc, ND, GradDipCouns. is a naturopath, EFT therapist and counsellor practising in Jannali and Caringbah in southern Sydney. She offers in-person, telephone and Skype consultations. Visit Robyn's website at www.empowertotalhealth.com.au and sign up for her free monthly e-newsletter, or contact her on 02 9528 8927 or [email protected]. • REFERENCES l.http://jncr.oxfordjournats.org/cgi/c ontent/full/101/19/1295 2J Am Diet Assoc 2QQ8 Feb;108[2):347-56. 3 httpy/vi/ww.ajcn.org/cgi/content/ abstract/ajcn.2009.28474v1 4 Nutr Cancer 2007:58(1 ];35-42. 5 http://www.cancer.gov/cancertopics/ factsheet/prevention/pcpt 6 Dermatoendocrino 2009 Jan:Ul):12-6. 7 Cancer Epidemiol Biomarkers Prev 2007 Dec;16(12):2623-30. 8 Cancer Epidemiol Biomarkers Prev 2008 Apr;17[4]:930-7 9 Cancer Causes Control 200^ Aug:12C6]:557-67 }0 BrJ Cancer 2008;9a[9];1574-81. 11 7t/ro/2009Nov;182t5]:2226-31. 12 http://www.lef.org/news/LefDailyNe ws.htm?NewslD=9107&Section=Dis ease&source=DHB_091212&ke>^B ody+ContinueReading 13 httpy/www.ncbi.ntm.nih.gov/pubmed /19186008?itool=EntrezSystem2.PEn trez.Pubmed.Pubmed_ResultsPanel.P ubmed_RVDocSum&ordinalpos=2 14 http://www.ncbi.nlm.nih.gov/pubme/ 19186008?itool=EntrezSystem2.PEnt rez.Pubmed.Pubmed_ResultsPanel.P ubmed_RVDocSum&ordinalpos=2 15 Nutr Cancer 2009;61 [6}:775-83. 16 Prostate Cancer Prostatic Dis 2009:12(4]:325-32. 17 Nutr Cancer 2009;61 (6]:775-83. 18 J Nati Cancer Inst 2000 Jan 5;92(l]:61-8. 19 Cancer Epidemiol Biomarkers /Vei'2001;10(9]:919-54. 20 Prostate 2009:69(2]:181-90. 21 J Nutr Biochem 2005 Jun:16(6):360-7 22 J Agrie Food Cfiem 2006 Feb 8;54(3]:980-5. 23 Clin Cancer Res 2006 Jul l:1203):4018-26. 24jA/ütr2009:l39(4):653-9. 25 Cancer Epidemiol Biomarkers P/ei/2008:170 2]:3577-87 26 Cancer Epidemiol Biomarkers Prei/2000:9C3):335-8. 27 Cancer Epidemiol Biomarkers Prev2007 Jul;16(71:1364-70. 28 JNCI Journal of tiie National Cancer Institute 2009:101 (6]:432435.29 29 J Steroid Biochem Mol Biot 2004:92(4]:317-25. 30 Cance-^fles 2005:65(12]:5470-9. 31 Nutr Cancer 2Q05;5:Oy.32-G. 32 Canee/-A/ur.5 2005;28(2]:99-107 33 Proc Nati Acad Sei USA 2008 Jun 17:105(24):8369-74. 3A J Uroi2005 Sep;174(3):10S5-9. 35 Urology 2008 Dec:72(6]:1319-23. 36 J Uro/2005 Sep:174C3):1065-9. 37 Proc Nati Acad Sei USA 2008 Jun 17;105(24]:8369-74. 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