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PROSTATE CANCER

RISK FACTORS AND PREVENTION TIPS FOR BLACK MEN

Part 58 Part Health Series

A Special Supplement ofThe Philadelphia Tribune

September 1, 2019

Page 2 • Sunday, September 1, 2019

Wire Report

Each year, more than 164,000 American men are diagnosed with prostate cancer. No one knows if or when the disease will develop, but understanding the risk factors for prostate cancer may help you take pre-ventive measures to reduce the likelihood of getting the disease. Screenings may help detect prostate cancer early, before symp-toms occur.

What causes prostate cancer?Prostate cancer forms when the DNA

in cells in the prostate develop mutations that may disable their ability to control cell growth and division. In many cases, these mutated cells die or are attacked by the immune system. But some mutated cells may escape the immune system and grow out of control, forming a prostate tumor.

While the exact cause of prostate cancer may not be known, the risk of developing the disease increases with age. Also, men with a family history of prostate cancer

have an increased risk of developing the disease.

Some common risk factors for prostate cancer include:

GeneralRace: Studies show that African Ameri-

can men are approximately 70 percent more likely to develop prostate cancer in their lifetime than Caucasian or Hispanic men.

Age: The risk of developing prostate cancer increases with age. While only one in 10,000 men under age 40 will be diag-nosed with prostate cancer, one in 15 men in their 60s will be diagnosed with the dis-ease.

GeneticsFamily history: Men with an immediate

blood relative, such as a father or brother, who has or had prostate cancer, are twice as likely to develop the disease. For men who have another family member diagnosed with the disease, the chances of developing prostate cancer increase.

LifestyleDiet: A diet high in saturated fat, as well

as obesity, increases the risk of prostate cancer.

High testosterone levels: Men who use testosterone therapy are more likely to develop prostate cancer, as an increase in testosterone stimulates the growth of the prostate gland.

Other conditionsProstat ic i nt raepit hel ia l neoplasia

(PIN): This condition may be associated with increased risk of prostate cancer. PIN is a condition in which prostate gland cells look abnormal when examined with a microscope. It is not necessarily linked with any symptoms. Nearly one half of men will be diagnosed with PIN before age 50.

Genome changes: Certain genes have been known to elevate prostate cancer risks, such as BRCA1 and BRCA2 genes.

Source: Cancer Treatment Centers of America

Risk factors for prostate cancer

Sunday, September 1, 2019 • Page 3

Dr. Tracy DownsUniversity of Wisconsin Hos-pitals and Clinics Authority

A recent repor t f rom t he U W Ca ncer Hea lt h Dispa r-it ies I n it iat ive (CH DI) had the shocking news that Afri-ca n-A mer ica n men i n W is-consin are 71 percent more l ikely to be diag nosed w it h prostate cancer and die of it more often than white men.

D r . T r a c y D o w n s , U W Hea lt h cancer surgeon and c u r r e n t p r e s i d e n t o f t h e national association of black urologists, the R. Frank Jones Urological Society, offers his perspect ive on t hese nu m-bers. Downs is faculty direc-tor of CHDI, which has com-mu n it y pa r t nersh ips a nd a re s e a rc h pr oje c t a i me d at improving the health of black men in Wisconsin.

What do you think is behind these numbers?

I’ve been here in Wisconsin eight years, and as an outsid-er coming in, you hear great t hings about Da ne Count y: well-educated people and a high percentage of them with good i n su r a nc e. But t hen, t he “Race to Equit y ” repor t looked under the proverbial rock a nd sa id, “Maybe t hat narrative is not the same for ever yone i n Da ne Cou nt y.” CHDI’s recent report says the cancer narrative is also dif-ferent for African Americans in Dane County and Wiscon-sin.

We know that social deter-minants of hea lt h — where you live, your education level, y o u r u n e m p l o y m e n t r a t e — al l t hose “bad actors” on public health were lopsided against the health of African A mer ica ns. So, i f you have t he head l i ne: St ate c a ncer

rates getting better, you have to add the subhead, But not as quickly for African-American men.

Is there a reason the prostate cancer rates are especially bad?

Lung cancer rates are also worse, but prostate uniquely jumps off the page. In gener-al, prostate cancer news (on whether PSA tests are a good idea) has people con f used. A b o u t f i v e y e a r s a g o , t h e U.S. Prevent ive Task Force me s s a ge s a y i n g not to ge t screened got broadcast to all groups. Unfortunately, Afri-can-American men, the group most at r isk , a re a lso most l ikely not to get screened at all, to be diagnosed at a later stage, and to die.

T he y shou ld have hea rd a d i f f e r e n t m e s s a g e t h a t wasn’t communicated. When t he USPT recom mendat ion ca me out, over-d iag nosi ng and over-treatment were the buzzwords. What happened is we saw a decrease in screen-ing, and also a drop-in diag-nosis while the mortality rate was increasing.

But t his is a group t hat is not doi ng a s wel l a s ot her Americans to begin w ith on prostate cancer, so let’s follow

through w ith screening. We can f igure out later whether it’s a cancer that needs treat-i n g . I t ’s t he o v e r-t r e a t i n g t hat is t he problem, not t he over detect ion. We’re smart enough now to k now which group needs treatment.

Why is this such a tragedy for the community?

Here is a communit y that loses young men to criminal-ization and prison, and then on the other side of the lifes-pan, we’re losing more wise, e x p er ienc e d e lder s of ou r com mu n it y to c a ncer. T he role of the African-American male in his own communit y is get t i ng sma l ler i n ma ny w a y s . To o m a n y y o u n g e r men are not out in t he gen-eral population, and then the older men who have survived a l l t h e h o o p s a r e d y i n g a decade younger due to many causes — cancer, heart dis-ease, diabetes.

Can community members make a difference?

W hen I f i rst star ted (as a physician) in the 1990s, men were very fearful of the rectal exam, and reasons why t he ex a m was i mpor t a nt, were communicated by a healt h-care provider. If the message would have come from some-one they trust, someone who l i v e s i n t he i r c om mu n it y, giving advice on the benefits of the exam, they would have more likely heard it and acted on it.

Tr y ing to help men advo-c ate for t hem s el ve s i n t he doctor’s off ice is part of our i n i t i a t i v e w i t h 10 0 B l a c k Men of M ad i s on . T he w a y you change that equation is maybe not the way I’ve been

Prostate Cancer: What African-American

Men Need to Know

Dr. Tracy Downs

INFO » 8


National Cancer Institute

For African American men, the risk of dying from low-grade pros-tate cancer is double that of men of other races, a new study has found. But, despite the difference, the risk is still small.

W hen a man is diagnosed w it h prostate cancer, the disease is given a g rade, or score, ba sed on how abnormal (or aggressive) the cancer cells look under a microscope. This system for assessing the aggressive-ness of a prostate tumor is called the Gleason score.

Prostate cancer w it h a Gleason score of 6 is considered low grade, meaning it is less likely to grow and spread t han cancer w it h a higher score (7 to 10). The vast major it y

of men diagnosed w it h localized, low-grade prostate cancer will die of somet hing ot her t han prostate cancer.

But, according to the new f ind-ings, doctors may be “underestimat-ing the risk” of death from low-grade prostate cancer in African American men, said lead investigator Franklin Huang, M.D., Ph.D., of the University of California, San Francisco.

T he st udy f i nd i ngs, publ ished December 18 in JAMA, are consistent with other reports that have identi-fied racial differences in the biology and presentation of low-grade pros-tate cancer, said Howard Parnes, M.D., chief of the Prostate and Uro-log ic Ca ncer Resea rch Group i n NCI’s Division of Cancer Prevention, who was not involved in the study.

This body of evidence, Dr. Huang added, supports the idea that certain biolog ical factors may make low-grade prostate cancer more likely to grow and spread in African Ameri-can men than in men of other races.

Do Prostate Cancer Disparities Differ by Grade?

Compared with white men, Afri-can American men are more likely to develop prostate cancer and are twice as likely to die from the dis-ease.

But, before Dr. Huang’s study, it wasn’t clear if the disparity in pros-tate cancer death occurred equal-ly across all disease grades or if it occurred mainly in one grade, he said.

“It was a quest ion that we were

s u r p r i s e d h a d n ’ t r e a l l y b e e n addressed,” he added.

So, the researchers analyzed data from NCI’s Surveillance, Epidemi-ology, and End Results (SEER) pro-gram. First, they used a specialized SEER database conta i n i ng i n for-mation on more than 190,000 men w it h prostate ca ncer who u nder-went active surveillance, or watch-ful waiting, between 2010 and 2015. Patients were followed for a median of 3 years.

Active surveillance is one of sev-eral options for the management of localized low-grade prostate cancer, as is immediate treatment with sur-ger y or radiation. Each individual patient and his doctor should make that decision together, Dr. Huang explained.

The specialized SEER database also includes information on socio-economic status—a measurement of a person’s income, education, and occupation. Socioeconomic differ-ences can lead to health disparities such as access to treatment.

These data allowed the research-ers to partially control for socioeco-nomic differences so that they could better observe possible associations between death rate and race/ethnic-ity. Their analysis doesn’t rule socio-economic differences out entirely as an explanation for prostate cancer disparit ies, but it does do a better job than was previously possible, Dr. Huang said.

African-American Men More Likely to Die from Low-Grade Prostate Cancer

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Jim Stallard

Cancer does not discrimi-nate, except when it does. Pros-tate cancer takes a harsher toll on African American men than other American men, including other men of color. What is the cause of this discrepancy, and what can be done about it?

Ph i l ip K a ntof f , C h a i r of Memorial Sloan Kettering’s Department of Medicine, talks about the reasons for this dis-parity. He offers insights into whether African American men — and their doctors — should change the way they approach prostate cancer screening and treatment. These are four main points to consider:

1. African American men both get and die from pros-tate cancer at a higher rate. The reasons are complex and unclear.

“African American men are 50% more l ikely to develop prostate cancer in their lifetime and twice as likely to die from the disease,” Dr. Kantoff says.

It is difficult to untangle the various factors that might affect the risk and outcome of prostate cancer, Dr. Kantoff explains. “Prostate cancer in A frican Americans tends to have biolog-ical characteristics associated with more aggressive disease,” he says. “There is evidence sug-gesting that this is partly related to inherited genetic factors.”

He points out that in addition to differences in tumor biology, the higher risk may be tied to disparities in environment and behavior. This could include social stress or more exposure to cancer-causing pollutants. Smoking, poor diet, and lack of exercise, which can cause obesity, may also have effects. Disparities in outcome could be affected by differences in when the cancer is diagnosed and how the men are treated after diagnosis.

2. African American men should be screened for pros-tate cancer more proactively.

Given t he h ig her r i sk of developing and dy ing f rom prostate cancer, African Amer-ican men are more likely to be saved by screening, Dr. Kantoff says. The main prostate cancer screening tests are a digital rectal exam, in which a doctor checks for swelling and inflam-mation, and a PSA test, which measures the level of prostate specific antigen (PSA) in the blood.

Dr. Kantoff explains that a calculation commonly used in the context of screening is: How ma ny men need to be screened in order to save one life? “Theoretically,” he says, “among African American men, that number should be lower.” Screening guidelines have been based on studies that included very few African Americans, so they may underestimate the screening benefit for this group. Overall, African Americans may need earlier and more fre-quent screening than the gen-eral guidelines would suggest.

3. African-American men and their doctors should be more cautious about active surveillance.

Act ive sur vei l lance is an approach in which low-risk prostate cancer is not treated with surgery or radiation ther-apy. Instead, it is monitored ver y closely for any signs of change over months or years. Active surveillance is increas-ingly the treatment option of choice for low-risk prostate cancer. Many men embrace this approach because the side effects of treatment, usually surgery or radiation therapy, can be significant.

A f r ic a n A me r ic a n men , however, are more l ikely to develop more-aggressive pros-tate cancer. Because of that, Dr. Kantoff maintains that active

surveillance may be less appro-priate for many African Amer-ican men. As with screening guidelines, there is little evi-dence to provide guidance one way or the other. African Amer-icans have been underrepre-sented in active surveillance studies as well.

“Having said that, I think some African American men could benefit from active sur-veillance,” Dr. Kantoff says. “This question needs to be stud-ied more before we can come to firm recommendations.”

4. Large research studies are seeking participants to help u ndersta nd prostate cancer in African Americans.

In 2018, the National Cancer Institute and Prostate Cancer Foundation launched a large-scale research effort to study underlying factors that put Afri-can American men at a higher risk for the disease. The five-year study is called RESPOND (Research on Prostate Cancer in Men of African Ancestr y: Defining the Roles of Genet-ics, Tumor Markers, and Social Stress). The study will enroll 10,000 African Americans with prostate cancer. Those interest-ed in participating can contact t he study’s leaders to learn more.

A not her st udy led by Dr. Kantoff and colleagues is called IRONMAN (International Reg-istry to Improve Outcomes in Men With Advanced Prostate Cancer). It is enrolling 5,000 men with advanced prostate ca ncer f rom d iverse popu-lations to look at genetic dif-ferences as well as different treatment patterns across the groups.

“A lot of researchers have been studying this topic, but we don’t have solid answers yet, so large studies should be very valuable,” Dr. Kantoff says.

Source: Memorial Sloan Kettering Cancer Center

4 Things African American Men Should Know about

Prostate Cancer

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Charlie Schmidt

Racial differences have long been evident in prostate cancer statistics. In particular, African American men are diagnosed with prostate cancer more often than white men, and they’re also nearly twice as likely to die of the disease.

But new research also shows that African American men who receive the most advanced treat-ment s for late-stage prostate cancer can live at least as long — or even longer — than their Cau-casian counterparts.

Why is this the case? Scientists are searching for an explanation. “The fact that African American men have better sur v ival is of huge research interest,” said Dr. Stephen Freedland, a urologist at Cedars-Sinai Medical Center in Los Angeles. “If we can figure this out, we’ll obtain key insights into the factors driving survival in late-stage prostate cancer. And that in turn will help spur better treatments for all men — regard-less of race.”

Each year, about 160 per 100,000 African American men receive a prostate cancer diagnosis. That’s three times higher than the com-parable figure for white American men, and it’s also higher than the number of Black men diagnosed annually with prostate cancer in Africa.

It’s possible that dietary or envi-ronmental factors — perhaps in combination with genetic suscep-tibilities — put African American men at greater risk in the United States. But African American men also tend to have less access to health care than white Americans, and many of them are diagnosed after their tumors have already begun to metastasize, or spread.

A surprising survival advantageWhat the new research shows,

however, is that survival advan-tages can favor African Ameri-cans who undergo treatment for advanced prostate cancer in clin-ical trials. One study pooled data from nine clinical trials, enroll-

ing a combined 88,200 men with metastatic prostate cancer who were treated with a chemotherapy drug called docetaxel. The Afri-can American and white men had similar survival rates — 21 months and 21.2 months respectively. But after adjusting for factors such as age and prostate-specif ic anti-gen levels, the researchers found that African Americans were 20% less likely to have died during the course of those trials than their white counterparts.

Freedland co-authored anoth-er recent study showing that Afri-can Americans respond better to newer drugs that target testos-terone, which is a hormone that drives prostate cancer to grow faster. Using data gathered by the Veterans Health Administra-tion between 2013 and 2018, the researchers looked at how long African American and white men with metastatic prostate cancer lived after treatment with one of two drugs: abiraterone acetate or enzalutamide. They had access to records from nearly 3,000 men. The unpublished results, presented at a medical conference in Febru-ary, showed that median surviv-al among the African Americans lasted 30 months, compared to 26 months among their white coun-terparts. “So, the key takeaway is t hat i f t hey get to advanced prostate cancer, and are treated equally in an equal access med-ical center, black men can have similar or even better outcomes,” Freedland said.

The data still need to be con-f irmed in additional research, Freedland emphasized. But in the meantime, the studies add to a growing body of evidence that’s cha ng i ng how scient ists look at racial differences in prostate cancer. Ideally, the research will reveal new biological insights into prostate cancer, and allow doctors to tailor treatments more effective-ly.

Charlie Schmidt is editor, Harvard Medical School Annual Report on Prostate Diseases

African American men respond better to treatments for advanced prostate cancer in clinical trials

Mayo Clinic

If you’re concerned about your risk of prostate cancer, you may be inter-ested in prostate cancer prevention.

There’s no sure way to prevent prostate cancer. Study results often conf lict with each other, and most studies aren’t designed to definitive-ly prove whether something prevents prostate cancer. As a result, no clear ways to prevent prostate cancer have emerged.

In general, doctors recommend that men with an average risk of pros-tate cancer make choices that benefit their overall health if they’re interest-ed in prostate cancer prevention.

Choose a healthy dietThere is some evidence that choos-

ing a healthy diet that’s low in fat and full of fruits and vegetables may contribute to a lower risk of prostate cancer, though research results have been mi xed and t his hasn’t been proved concretely.

If you want to reduce your risk of prostate cancer, consider trying to:

Choose a low-fat diet.Foods that contain fats include

meats, nuts, oils and dairy products, such as milk and cheese.

In some studies, men who ate the highest amount of fat each day had an increased risk of prostate cancer. This doesn’t prove that excess fat causes prostate cancer. Other studies haven’t found this association. But reducing the amount of fat you eat each day has other proven benefits, such as helping you control your weight and helping your heart.

To reduce the amount of fat you eat each day, limit fatty foods or choose

Prostate cancer prevention: Ways to reduce your risk

There’s no proven prostate cancer prevention strategy. But you may reduce your risk of prostate cancer by making healthy choices, such as exercising and eating a healthy diet

PREVENTION » 10A


taught as a physician, but to maybe level the f ield on the patient side.

I t ’s h a r d t o t h i n k o f a c o m m u n i t y g r o u p b e i n g e v e r y t h i n g t o e v e r y o n e . With prostate cancer, we’re a l w a y s l i m i t e d b y i n s u r-ance. What about things like ads, incentives, what about he a lt h i n s u r a nc e c omp a-n ies i ncent iv i z i ng hea lt hy b e h a v i o r s u c h a s g e t t i n g your screening? We also need health navigators for men to help guide them through the system.

How could the health care system be improved?

I n ea rl y loc a l i z ed pros-tate cancer, t he treatments offered to African-American men are less likely to be cura-tive treatments. They tend to be of fered hormone-lower-ing dr ugs more t han white men, and t hey a lso tend to be offered radiation therapy rat her t ha n su rger y. W hen

t he y shou ld have a l y mph node dissection, they’re less likely to be offered that. So, t here could be some biases there.

It could also be a question of w her e t he y a r e ge t t i n g t heir care. A re t hey in aca-dem ic med ica l centers, or i n places where t he tea ms are less experienced in those treatments?

You a lso ask, is it a “one and done” consultat ion, or building a relationship with the patient? W ho would say yes to some of these options t he f i r s t t i m e t he y he a r d about them? Maybe the phy-sic ia n s hou ld s ay, “I f u l l y u n d e r s t a nd w he r e y ou’r e com i ng f rom, but let ’s see you back in a few weeks and talk some more.” Then offer some v ideos or readings so they can build their k nowl-edge in the meantime.

W i t h a d v a nc e d c a nc e r, where it is no longer respond-ing to hormonal treatment, or has advanced to the bones, we have made great progress

with new drugs that improve survival. Unfortunately, the percentage of African Amer-ica n men i n t hose t r ia ls is sma l l and t heir chances of getting the drugs rather than placebo in the trials are also small. One of the new drugs, an immunotherapy vaccine, has shown promise of actu-a l l y b e i n g mor e e f f e c t i v e i n A f r ica n-A mer ica n men. Some of t he leaders i n ou r A f r ica n-A mer ica n Urolog y associat ion a re work ing to get the drug to more men.

So, i s t here a biolog ic a l d i f ference? We don’t k now t hat. But we do k now t here a r e d i f f e r e n c e s i n l o w e r s c r e en i n g le v e l s ; i n t her-apeut ic opt ions of fered at t reat ment; i n t he levels of t reatment prov ided; and in more advanced cancer, there are very few African-Ameri-can men in the novel clinical t r ia l s t hat have been wel l done. S o, we h ave lot s we ca n work on to reduce t he prostate cancer burden for African American men.

INFO « 3A


A Surprising Finding about Low-Grade Disease

O v e r a l l , f e w m e n i n t h e s p e -cialized SEER database died from prostate ca ncer, t hey fou nd. But t here were d i f ferenc es b y g r ade and race.

In particular, African Americans were more likely to have died from low-grade prostate cancer than men of other races (0.40% versus 0.22%). By contrast, the rates of death from h ig h-g rade d isease were si m i la r among A fr ican A mericans and of men of ot her races (1.44% versus 1.35%).

The investigators found similar resu lts when t hey a na ly zed data from the main SEER database, which includes information on more than 400,000 men w ith prostate cancer who were followed for a median of more than 5 years.

In that analysis, a greater propor-tion of African American men than men of ot her races had died from low-grade prostate cancer 12 years after diagnosis (2.2% versus 1.4%). By comparison, the 12-year death rate

from higher-grade prostate cancer was similar among African Amer-ican men and men of ot her races (5.5% versus 5.3%).

“We were surprised to f ind that d ispa r it ies were g reatest i n low-g rade disease,” Dr. Huang noted, because they had expected it to be similar across all grades.

Exploring Differences in Tumor Genomics

There may be variables that make low-g r ade prost ate c a nc er g row and spread more quickly in African American men than in men of other races, but those features have yet to be defined and understood, Dr. Huang said.

One possible variable is biological dif ferences, such as genomic fea-tures of prostate tumors. In a sepa-rate study, Dr. Huang, along w it h Brandon Mahal, M.D., of Dana-Far-ber Cancer Institute, and their col-leag ues, explored t his possibi l it y using a test that estimates the risk of metastasis based on specific genom-ic characteristics of prostate tumors.

In that study, more African Amer-ican men w ith low-grade prostate

cancer had tumor genomic charac-teristics linked to metastasis than white men. However, the research-ers found that estimates of metas-tasis risk were similar among men with high-grade disease, regardless of race.

These findings suggest that differ-ences in tumor genomics may make low-g rade prost ate c a ncer more aggressive in African American men, Dr. Huang explained.

Differences in Tumor LocationAnother possibility is that tradi-

tional biopsies may be more likely to miss areas of high-grade prostate ca ncer in A f r ica n A mer ica n men than in men of other racial/ethnic groups, leading to a higher l ikeli-hood of misdiagnosis of low-grade disease.

A 2014 study found that African American men are more likely than white men to have t u mors in t he anterior region of the prostate, which is harder to reach with a tradition-a l t ra nsrecta l biops y, Dr. Pa r nes explained.

And at a follow-up biopsy or sur-ger y, more African American men

than men of other races are given a higher Gleason score than they were i n it ia l ly d iag nosed w it h—what’s called upgrading.

But advances in MRI technology have enhanced the ability to biopsy suspicious areas in the anterior pros-tate, reducing the chances that high-grade tumors in this part of the gland are missed.

“Image-guided biopsy, as well as another approach called transper-ineal biopsy, can pick up anterior lesions much bet ter t ha n a sta n-d a rd biops y,” D r. Pa r nes note d . African American men should ask their doctor about these methods for improving detection of anterior lesions, he added.

However, image-guided biopsies a re not t he sta nda rd of ca re a nd access may be limited.

The Bottom Line for African American Men

B e c a u s e l o w - g r a d e p r o s t a t e cancer has more aggressive features in A frican A mericans, many phy-sicia ns have quest ioned whet her active surveillance is still an appro-priate option for them.

The f indings f rom Dr. Huang’s s t ud y “don’t me a n t h at A f r ic a n A mer ic a n s s hou ld n’t be of fered ac t ive su r vei l la nce,” Dr. Pa r nes stressed. After up to 18 years of fol-low-up, the largest prospective study of active surveillance for men with low-risk prostate cancer reported only two deaths from prostate cancer among the 1,298 participants, 96 of whom were African American, he noted.

These findings should be part of the conversation between patients and their doctors, Dr. Parnes said.

As should the risks of treatment, he added. “I think overtreatment—actively treating people who may not benefit—is still the bigger problem,” he said.

“T he benef its of t reat ment a re relat ively sma ll in men w it h low-risk prostate cancer and, therefore, we shou ld t a ke i nto accou nt t he potent ia l ha r ms of i nter vent ion, such as erect i le dysf u nct ion a nd bladder and bowel complications, b e f o r e r e c o m m e n d i n g s u r g e r y or radiat ion t herapy to men w it h low-risk prostate cancer,” said Dr. Parnes.

MEN « 4A


low-fat varieties. For instance, reduce the amount of fat you add to foods when cooking, select leaner cuts of meat, and choose low-fat or reduced-fat dairy products.

Increase the amount of fruits and vegetables you eat each day

Fr u it s a nd veget ables a re f u l l of v itamins and nutrients that are thought to reduce the risk of pros-tate cancer, though research hasn’t proved that any particular nutrient is guaranteed to reduce your risk.

Eating more fruits and vegetables also tends to make you have less room for other foods, such as high-fat foods.

You might consider increasing the amount of fruits and vegetables you eat each day by adding an additional serving of a fruit or vegetable to each meal. Consider eating fruits and veg-etables for snacks.

Reduce the amount of dairy products you eat each day.

In studies, men who ate the most d a i r y produc t s — suc h a s m i l k , cheese and yogurt — each day had the highest risk of prostate cancer.

But study results have been mixed, and the risk associated with dair y products is thought to be small.

Maintain a healthy weightMen w ho a re obese — a bod y

mass index (BMI) of 30 or higher — may have an increased risk of pros-tate cancer. If you are overweight or obese, work on losing weight. You can do this by reducing the number of cal-ories you eat each day and increasing the amount of exercise you do.

If you are at a healthy weight, work to maintain it by exercising most days of the week and choosing a healthy

diet that’s rich in fruits, vegetables and whole grains.

Exercise most days of the weekSt ud ie s of e x erc i s e a nd pros-

tate cancer risk have mostly shown that men who exercise may have a reduced risk of prostate cancer.

Exercise has many other health benefits and may reduce your risk of heart disease and other cancers. Exercise can help you maintain your weight, or it can help you lose weight.

If you don’t already exercise, make an appointment with your doctor to make sure it’s OK for you to get started.

When you begin exercising, go slowly. Add physical activity to your day by parking your car farther away from where you’re going, and try taking the stairs instead of the elevator.

Aim for 30 minutes of exercise most days of the week.

Talk to your doctor about your riskSome men have an increased risk

of prostate cancer. For those w ith a very high risk of prostate cancer, there may be other options for risk reduction, such as medications. If you think you have a high risk of prostate cancer, discuss it with your doctor.

PREVENTION « 7A



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