Recently for the Prostate Cancer Foundation (PCF), I interviewed two scientists who study lifestyle factors and their effect on prostate cancer: Epidemiologist June Chan, Sc.D., of UCSF, and epidemiologist Lorelei Mucci, M.P.H., Sc.D., of Harvard. In the last post, we talked about diet. Now let’s look at exercise, and we’ll wrap up with some quick takes on various foods.
Here’s some good news: By launching your proactive strike against prostate cancer, you’re not just helping your prostate (or helping to keep cancer from coming back, if your prostate is long gone): You’re helping your heart, and you’re also helping to lower the risk of diabetes and insulin resistance. Go, you!
A sedentary life is not good for the heart. Diet is important, but it’s not the whole story here. The research team of June Chan at UCSF has shown in multiple studies that exercise can help delay or prevent prostate cancer progression. “Aerobic exercise after prostate cancer diagnosis may reduce the risk of prostate cancer recurrence or death by 60 percent.” Chan’s earlier studies in this field, funded by PCF nearly a decade ago, showed a benefit to an hour of jogging six days a week – the level of exercise most of us can’t or don’t want to sustain. But don’t get discouraged! In more recent studies, she and colleagues have been looking at more doable levels of exercise – walking 30 minutes a day, or three or more hours a week, at a brisk pace (3 mph or faster). The brisk pace is important: One study found that men who walked three or more hours a week after diagnosis had a 57-percent lower risk of having prostate cancer recur than men who walked at a slower pace, for less than three hours a week.
“Just walking, not running! Walking is so common. During these Covid times, when we’re confined to small spaces, people might find it difficult to walk the way they would prefer,” says Chan. “But I would say, just use it as a break to get fresh air – even if you’re just going up and down the same block. Any little bit of walking, as opposed to sitting. Movement is good for your overall bone health. Don’t push yourself to injury; just get in a good habit. It’s something you can do when you’re doing something else;” for example, “when I’m walking, often I’ll grab my phone, and use it as a chance to catch up with somebody.” Don’t focus on the number of steps, or the time. “If you’re always looking at your watch, you’re not enjoying the walk as much.” And don’t overdo it: “If you get injured, you might lose all interest in continuing.”
Note: the key here is giving the cardiovascular system a good workout, not necessarily the act of walking itself. So, apply this to your own needs: if walking that much is not a good option for you, swimming and riding an exercise bike – whatever you are able to do – are good, too. Studies by Chan and others have provided so much proof of the benefit of aerobic activity, in fact, that “we’re actually at the stage now that the updated Physical Activity Guidelines put out by the American College of Sports Medicine specifically note that exercise is recommended for men with prostate cancer to avoid the risk of dying from prostate cancer. We’re really excited that we got to contribute to that work.”
What is it about exercise? Chan and colleagues are still tapping the surface of all the ways exercise is good for the body. “It improves energy metabolism, lowers inflammation and oxidative stress, helps boost immunity, and is beneficial for androgen signaling pathways.” It is good for the heart and lungs, improves muscle strength and muscle mass, burns fat, lowers fatigue, anxiety, stress, and depression. “It just improves your overall quality of life,” says Chan. Bonus: exercise also may help slow down prostate cancer’s growth.
Chan is investigating the underlying biological mechanisms for “why exercise has these benefits for prostate cancer and overall health. Is it a systemic effect, or an anti-androgenic effect? Is it acting on oxidative stress pathways?” Her group is looking for insight from blood and tissue samples taken from men with prostate cancer before and after exercise interventions. In another large, phase 3 clinical trial funded by Movember, Chan and epidemiologists Stacey Kenfield and Lorelei Mucci, with principal investigators Rob Newton and Fred Saad, are studying high-intensity exercise in men with metastatic prostate cancer, at more than a dozen sites worldwide. “It’s a two-year, tailored intervention, with both strength and aerobic components,” to see if exercise can help men with metastatic prostate cancer live longer and better. What else lowers stress? Meditation. Stress may play a role in the growth of prostate cancer, so lowering stress is a strategy worth pursuing.
Speaking of strength training: We all lose muscle mass as we get older. Strength training (lifting weights or using resistance bands, and doing muscle-building exercises) fights this loss. Strength training can be especially helpful in men on androgen deprivation therapy (ADT) for advanced prostate cancer, who are at higher risk of loss of muscle mass, osteoporosis, and also of weight gain, metabolic syndrome, and diabetes. Note: If you have advanced prostate cancer, check with your doctor to make sure strength training is safe, and also for some guidance about the weights you should be lifting.
Final note on exercise: Start out slow. “If you have not exercised regularly for a long time, consult with a physician or personal trainer, to get a program tailored to fit you,” says Chan. “Start small, and go up by five- or ten-minute increments. Then see if you can pick up the intensity. Just make little changes.”
Look to the long haul: “Thank goodness I ate that broccoli on Thursday. Now I won’t get prostate cancer,” said no one ever. It’s not just one good food choice, but many years of erring on the side of healthy. The other side of that, however, is reassuring: It’s not just one bad food choice, or being a couch potato last weekend, but many years of not eating things that can help your body fight prostate cancer, many years of not exercising. “Diet is something you have to do every day,” says Chan. So is exercise. That said, “we’re all balancing so many things with food. Food is part of our culture, taste, our family habits, celebrations. I feel like the recommendations should just be like filters.” In other words: many good decisions, over time, will help fight prostate cancer more than the occasional lapse will help promote it.
Thumbs Up, Thumbs Down: Quick Takes on Food
I asked Lorelei Mucci for her expert opinion on some foods you may be wondering about for their cancer-fighting powers. Here’s the rundown, in no particular order:
Extra virgin olive oil (EVOO): Yes! More than 2 tablespoons a day. Among other things, EVOO contains hydroxytyrosol, which scientists now recognize as a natural means of cancer chemoprevention. It is a powerful antioxidant, and it has been shown to protect against cancer by slowing proliferation of tumor cells and increasing apoptosis – “suicide” – of cancer cells.
Tomatoes: Yes! Especially when cooked in, or drizzled with, olive oil, which helps you absorb a key component of tomatoes, lycopene. “The prostate accumulates a lot of things,” including cholesterol. “It accumulates lycopene. When a man eats a diet high in lycopene, for some reason, lycopene levels in the prostate go up. Lycopene makes sense biologically, because it does accumulate in the prostate. It is an antioxidant. This is one of the individual dietary components that seems pretty promising.”
Don’t like tomatoes? Good news: Lycopene is in watermelon and grapefruit, too!
Coffee: “Coffee is looking more and more promising . There are now a number of studies that suggest drinking coffee regularly, one to two cups a day, can help prevent aggressive forms of prostate cancer. Some studies say three to four cups offer even more of a benefit, but there’s an initial benefit with one to two cups. Coffee may also lower the risk of diabetes, liver cancer, and Parkinson’s disease.”
Tea: Sure, what the heck. There are far fewer studies on tea than on coffee, but tea has antioxidants. People in Asia, which has less prostate cancer than the U.S., drink a lot of green tea. “Tea lowers inflammation, but has not been shown to have an effect on insulin levels.” However, and this is important: it doesn’t seem to raise your risk of getting prostate cancer.
Note: If you go to a fancy coffee shop and get a 1,500-calorie coffee with not only cream but whipped cream, and loads of sugar, or if you drink a super-sweet tea loaded with sugar or high fructose corn syrup, the effects on insulin resistance and risk of weight gain will probably cancel out the antioxidants.
Fish: Yes. “We published a meta-analysis of epidemiologic studies that looked at fish and prostate cancer death, and there was a pretty good benefit with regular consumption of fish.” Particularly “dark-meat” fish rich in omega-3 fatty acids, like salmon and red snapper.
Devil’s advocate: Are men healthier because they eat fish, or because if they choose fish, they’re not eating a big old ribeye steak cooked in butter? Talk amongst yourselves, but fish is not nearly as pro-inflammatory as red meat.
Nuts: Sure. “There’s not much evidence one way or another with prostate cancer death, but they really seem to lower the risk of cardiovascular disease and overall mortality.” Also, if you’re eating a handful of nuts as a snack, maybe you won’t be eating a bag of chips. “In one of our studies,” says June Chan, “we observed that substituting 10 percent of calories from carbohydrates for calories from healthy, plant-based fat (nuts) was associated with a 29-percent lower risk of prostate cancer death, and a 26-percent lower risk of all-cause death.”
Pasta: In moderation. However, non-traditional pastas, made from cauliflower or chick peas, are another way to sneak in vegetables. They may also help you manage your weight. “Excess body weight, particularly the visceral fat around the abdomen, is associated with worse outcomes from prostate cancer. Anything men can do to help reduce their weight – limiting bread and pasta, and increasing things like cauliflower pasta and vegetable intake – is beneficial.”
Charred meat: Try to limit it. When food is charred, it makes a chemical compound called PhIP, that is a known carcinogen. Even worse: those beautiful (charred) grill marks combined with a pro-inflammatory food, like red or processed meat.
Soy: sure. “Consumption of soy is much higher in Asia, where the incidence of prostate cancer death is lower. Soy is probably part of a strategy for maintaining healthy weight, and it’s a way of replacing red meat. Does it lower prostate cancer death? I don’t know that we have that evidence.” Another complicating factor: “Men who eat more healthy diets tend to get screened for prostate cancer. If you get regular PSA testing, you’re five times more likely to get diagnosed with prostate cancer.” And, if you get diagnosed early, you are more likely to get early treatment while the disease is confined to the prostate. It’s like the children’s book, If You Give a Mouse a Cookie, a domino effect.
Vitamin D: Yes. “There’s really promising data on vitamin D and prostate cancer mortality.” One randomized trial, the VITAL study, showed “specifically in black men who have low levels of vitamin D, there’s a reduction in prostate cancer mortality. Evidence from many studies suggests that this makes sense; there’s a lot of genetic data on inherited vitamin D pathways; this pathway seems to be very important for prostate cancer.” Vitamin D is found in some foods, such as fatty fish and egg yolks, and your body makes vitamin D when you get out in the sunlight. However, most people don’t have sufficient levels of vitamin D. Thus, your best strategy is to take a vitamin D3 supplement: 2,000 IU daily. It’s not a case of “more is better.” 2,000 IU is what you need.
Final thought on food: In the words of the title song on Al Jarreau’s 1977 breakthrough album: Look to the Rainbow. Build your diet around an array of colorful, plant-based fruits and vegetables: green, red, yellow, orange and purple. Those colors reflect the good nutrients in them. Eat less red meat, and have restraint with sugar and carbs, and go for EVOO instead of butter.
In addition to the book, I have written much more about prostate cancer on the Prostate Cancer Foundation’s website, pcf.org. The stories I’ve written are under the categories, “Understanding Prostate Cancer,” and “For Patients.” As Patrick Walsh and I have said for years in our books, Knowledge is power: Saving your life may start with you going to the doctor, and knowing the right questions to ask. I hope all men will put prostate cancer on their radar. Get a baseline PSA blood test in your early 40s, and if you are of African descent, or if cancer and/or prostate cancer runs in your family, you need to be screened regularly for the disease. Many doctors don’t do this, so it’s up to you to ask for it.
©Janet Farrar Worthington