How you can prevent, detect and treat prostate cancer.
It’s one of those weird anatomical-arboreal coincidences: The human prostate is about the size and shape of a walnut. But what if it really were a walnut?
For one thing, you’d never get prostate cancer. Which sounds great, until you realise that you could get “walnut curculio” or “walnut-husk maggot” instead. Better to deal with the devil you know.
Putting the science below into action (read: more sex, more wine) won’t confer absolute immunity, but it will make your prostate one tough nut to crack.
1. Love thyself
As if masturbation didn’t already provide enough of a payoff, an Australian study found that DIY sex may also help prevent prostate cancer. The study of 2 338 men showed that the guys who masturbated five or more times a week were 34% less likely to develop prostate cancer by age 70 than those who handled matters less often.
“Seminal fluid contains substances that are carcinogenic,” says Graham Giles, PhD, the lead study author. “Regular ejaculation may help flush them out.”
And in case you’re wondering, no, masturbating more than once a day won’t offer more protection, and yes, straight-up sex works, too. But before you have unprotected nookie with your partner, be sure she’s been tested for cytomegalo-virus, a type of herpes found in cancerous prostate tissue.
2. Be happy you’re going bald
Turns out the hair-loss drug Propecia has one impressive side effect. In a National Cancer Institute (NCI) study of 18 882 men, researchers found that the men who took 5mg of Propecia, a.k.a. finasteride, daily for seven years had a 25% lower risk of prostate cancer than those taking a placebo.
Finasteride blocks production of dihydrotestosterone, a hormone that triggers hair loss and prostate growth. “It’s the first study to prove that prostate cancer is preventable,” says Peter Greenwald, MD, the NCI’s director of cancer prevention – and one of those 18 882 men. “My prostate’s normal,” he adds.
One caution: Men on finasteride had a slightly greater chance of being diagnosed with a more aggressive form of the disease than the placebo takers did. More research on the drug is needed, but if you’re concerned about prostate cancer, discuss these findings with your doctor.
3. Wine and dine
There’s a good reason Western European men have lower prostate-cancer rates than we do. And it has nothing to do with Speedo thongs. New research suggests that certain staples of the Mediterranean diet have prostate-cancer-fighting properties.
For starters, a study published in the Journal of the National Cancer Institute shows that men who eat more than 10g of garlic or scallions (about three cloves of garlic or two tablespoons of scallions) daily have a 50% lower risk of prostate cancer than those who eat less than 2g. (Give credit to organosulfur compounds, which are common to both vegetables.)
Then there’s red wine; red grapes are flush with resveratrol, an antioxidant found in some plants that may help inhibit the growth of prostate cancer, according to a report from the MD Anderson Cancer Center at the University of Texas. A glass or two of red wine daily should suffice. “If you drink too much,” says Catherine O’Brian, Ph., the lead study author, “you can neutralise the beneficial effects.”
4. Lower the bar
Here’s a PSA (public-service announcement) regarding your PSA (prostate-specific antigen): Using a score of 4.1 or greater as the alarm for prostate cancer could prove fatal.
A recent study of 6 691 men, published in the New England Journal of Medicine (NEJM), showed that this traditional threshold for ordering a follow-up biopsy may be missing 82% of prostate-cancer diagnoses in men under 60. “The threshold of 4.1 that’s being used has never been rigorously studied,” says Karen M Kuntz, ScD, one of the study’s authors.
And while critics say a lower threshold will lead to unnecessary biopsies, Rinaa Punglia, MD, another of the study authors, believes that the broader standard could be worth it. “It’s a trade-off,” she admits. “But it could save lives.”
So how low should you go? Dr Punglia recommends that when you have your PSA level checked (annually beginning at age 50 – or 45 if you have a family history or are African-American), you observe a threshold of 2.6, especially if you’re under age 60; according to the NEJM study, following this guideline doubled the cancer-detection rate, from 18 to 36%
5. Calculate your risk
Let’s say your PSA is 2.6. You still may not need a biopsy. Instead, ask your doctor to use a nomogram. This needle-free analysis turns a patient’s age, PSA density (PSA divided by the volume of the prostate), digital-rectal-exam result and transrectal-ultrasound result into a score that helps determine whether a biopsy is really warranted.
“We can say whether or not, for your prostate, that’s a high PSA,” says Mark Garzotto, MD and director of urologic oncology at the Portland VA Medical Center.
In a study of 1 200 men, Dr Garzotto found that if a nomogram had been used in every case, it would have spared 24% of the men from unnecessary biopsies.
If your doctor can’t crunch the numbers, ask for copies of your test results; you can find and print out the same nomogram here, and do the math yourself.
6. Hit the spice rack
Researchers at the Center for Holistic Urology at Columbia-Presbyterian Medical Center in New York City recently found that a blend of herbs including ginger, oregano, rosemary and green tea reduced prostate-cancer cell growth by 78% in the lab.
Sold as Zyflamend, it’s thought to inhibit the activity of COX-2, a protein linked to the progression of the disease. “We’re using it with promising results in some of our patients,” says Dr Aaron Katz, the centre director.
Another herbal option is FBL 101. When researchers at the National Cancer Institute gave FBL 101 to mice with prostate cancer, they found that it decreased a tumour blood-vessel growth factor called VEGF to undetectable levels. Crimp the blood supply and cancer can’t survive, says William Figg, PharmD, the principal investigator.
“Men who want to delay the time before they begin traditional treatment should check this out,” he says.
Get your doctor’s okay before starting on either treatment.
7. Use a computer-assisted doctor
The radical prostatectomy recently became a lot less radical, thanks to a new robotic version of the procedure. With the da Vinci system, doctors use three-dimensional imaging to direct two nimble robotic hands through a few small slits in the patient’s abdomen to remove the cancerous prostate.
According to data from the Vattikuti Urology Institute at the Henry Ford Health System in Detroit, 90% fewer men became incontinent and 50% fewer became impotent with the da Vinci system than with manual gland removal. “It’s like playing golf with a titanium driver versus a wooden driver,” says chief of urology Mani Menon, MD.
Another plus: Patients spent an average of 1.5 days in the hospital, compared with 2.3 days for open surgery.
8. Rehab your erections
Unless you’re David Beckham, this one’s a no-brainer: Take a nerve graft from your ankle and save your sex life.
The cavernous nerves, a.k.a. the boner bugle corps, are often a casualty of prostate removal if cancer has (or might) spread outside the gland. But by replacing the cavernous nerves with the sural nerve that runs along the ankle, as many as 9 000 men a year could recover erectile function, says Peter Scardino, MD, one of the developers of the procedure and chairman of urology at Memorial Sloan-Kettering Cancer Center in New York City.
“If you’ve got only one (cavernous) nerve left, you’re firing on four cylinders, but if I do a graft, it’s like you’re firing on seven out of eight.”
And don’t worry; a slight numbness in your foot is the only side effect. Talk to your urologist about where to find a surgeon experienced in sural-nerve grafting.