Be proactive during active surveillance for prostate cancer

Men diagnosed with prostate cancer have numerous treatment options available, one of which is active surveillance.  Active surveillance a viable method of monitoring prostate cancer that falls into the category of being low-grade or is considered to be very slow growing and not likely to spread.  The concept of active surveillance has increasingly emerged as a viable option for men who decide not to undergo immediate treatment (surgery or radiation therapy) for prostate cancer.

Active surveillance will be considered by a physician to use to monitor a man’s prostate cancer if:

·      The tumor is small and limited to the prostate

·      The tumor is considered to be slow-growing and unlikely to spread (metastasize) or that the man’s chances of dying from the cancer is unlikely.

·      A man is elderly and is more likely to die from another cause

·      A man has other serious health problems

 During active surveillance a man usually will see his doctor about every 6 months, which most often includes a prostate specific antigen (PSA) blood test and digital rectal exam. A repeat biopsy is usually done within the first year and may be repeated periodically in the future. If a man’s test results change, then his doctor would talk with him about other treatment options.

Be proactive during active surveillance

Many men may find it hard to take a passive wait-and-see approach when faced with news of a cancer diagnosis. But that doesn’t mean men can’t be proactive. When men embrace the attitude that a diagnosis like this can be a wake-up call to change their lifestyle, improve their health and possibly keep their cancer from becoming more aggressive, all the better.

What steps can men take to be proactive during active surveillance?  First, any man who smokes needs to quit smoking.  After that it comes down to two areas to improve – diet and exercise.

·      Diet change – Go Mediterranean

At this time, there is no specific diet for prostate cancer.  But several studies have shown that men who adopt certain dietary habits, can influence their prostate cancer growth.

One dietary improvement is to start following a diet based on the Mediterranean way of eating. The Mediterranean diet follows an approach that looks at diet as a whole - it encourages low intakes of red meat, processed meats (sausage, bacon, bologna, etc.) and sugar, both of which can cause inflammation, and instead recommends eating more whole fruits and vegetables, legumes, fatty fish, and grains.

Mainly known for promoting heart health, a 2018 observational study in The Journal of Urology suggested that it also may be helpful for men with prostate cancer. The researchers compared three types of eating patterns – Wester, prudent, and Mediterranean on almost 2,000 men, average age of 66 and who either had prostate cancer or were healthy.

The Western diet included large amounts of fatty dairy products, refined grains, processed meat, caloric beverages, sweets, fast food, and sauces. The Prudent diet had low-fat dairy products, whole grains, fruits, vegetables, and juices. The Mediterranean diet consisted of fatty fish (high in healthy omega-3 fatty acids), fruits, vegetables, legumes, olive oil, and low consumption of juices.

After five years, the researchers found that men who strictly followed a Mediterranean diet had a much lower risk of aggressive prostate cancer, while men who ate the other two diets did not see the same benefits.

It is speculated that the reason why the Mediterranean diet was best for beating back prostate cancer is that its core foods, like fruits and olive oil, can help lower inflammation, which may reduce the chances that cancer will grow or spread.

·      Exercise change – Increase intensity

Exercise is a great way to influence a wide range of biological processes, including anti-inflammatory and insulin pathways that may be linked to a lower risk of prostate cancer.  This has been further strengthened thanks to a 2018 study found in European Urology that found that vigorous activity may offer the greatest benefit.

More than 49,000 medical records were analyzed of men ages 40 to 75 years old that were followed for 26 years. The men answered questions biennially that included questions about their diet, health, and physical activity. Among the participants, more than 6400 developed prostate cancer and 888 had aggressive prostate cancer – cancer that spread or caused death during the study period.

The results showed that men who engaged more frequently in vigorous activity had a 25% lower risk of developing aggressive prostate cancer compared with men who exercised the least. On average, men in the highest category of vigorous activity did about 25 minutes of running per day.  Other activities comparable to this, depending on duration and intensity, include cyclin, swimming, heavy outdoor work, and playing sports like tennis or racquetball.

The reason why increased intensity of physical activity appears to lower prostate cancer risk is that besides helping with weight management, it might affect prostate cancer on a cellular level. The study also looked at the impact exercise had on a common molecular alteration in prostate tumors called TMPRSS2:ERG, a gene fusion that occurs in the tumors of about half of prostate cancer patients. The results showed that long-term vigorous physical activity was specifically associated with a lower risk of developing TMPRSS2:ERG.