47th Annual Scientific AssemblyIslamic Medical Association of North

AmericaArusha, Tanazania

August 9th & 10th, 2014PROSTATE CANCER: Its Prevention and

the Role of Nutrition

Mahmood Abdul Hai, M.D., F.I.C.S.President & Executive Director,

The Surgical Institute of MichiganWestland, Michigan, USA.

Disclosure“IMANA is committed to providing CME

activities that are fair, balanced and free of bias.

Full and specific disclosure information is provided in your handouts.”

I have no relevant financial relationship with any of the commercial interests.

Cancer Statistic: 2013 Cancer New Cases

Cancer Statistics: 2013 Cancer Deaths

Worldwide Incidence of Prostate Cancer

Risk Factors in Prostate Cancer1. Age 2. Family History & Genetic factors3. Race4. Diet5. Life style & Overweight6. Hormonal Status7. Enviornment & Sun exposure8. Alcohol & Smoking

Relation of Age to Prostate Cancer

Race and Prostate Cancer

Role of Diet in Prostate Cancer Diet is clearly implicated in the origin of many

cancers Higher incidence with:1. Increase consumption of red meat and animal fat2. Reduced consumption of vegetables, fiber and

starch

Mechanism of diet effectLow fat diet reduces Prostate cancer risk by

reducing androgen levelsIngestion of simple glycemic carbohydrates

stimulates high level of insulin production promoting increased risk of prostate cancer

Prostate tumors grow faster in animals fed a high fat diet

Effect of Diet in Prostate CancerFoci of Prostate cancer exist in 30% men >50 & 75%>80These are consistent worldwide Most of these foci remain latent and do not grow or

spreadDiet may be a crucial factor in the transformation into a

more aggressive formThese facts are confirmed by epidemiological,

laboratory, intervention and migration studies.These factors make prostate cancer an ideal target for

preventionIt can help proactively to prevent and also slow or

reverse the progression of premalignant lesions

Diet and Prostate Cancer Risk

Current Theories about Prevention1. Blocking the effects of hormones Drugs: Finasteride,Dutasteride2. Eating a healthful diet Limiting red meat and dairy products Including Antioxidants in moderation Soy products3. Exercise and Life style changes

ASC Report on Cancer Survivors: 2014

Current # of cancer survivors in US:14.5mEstimated survivor growth by 2024: 19 mAmong males living with cancer:Prostate43%64% of these were diagnosed in 5yrs or more62% of PCa survivors are 70 or olderFactors responsible for better survival: 1.Awareness & early detection 2.More effective treatment 3.Cancer rate decreasing in the last 10 years

Role of Nutrition in PCaRole of nutrition in PCa is very complexNutrients modify genetic susceptibilityStrongest dietary factor is obesityRandomoized and carefully controlled studies are requiredAwareness of patients, physicians and dietetians is needed

Principal message from nutritional studies

Benefits of diet consisting mainly of vegetables, fruits, grains and fish combined with restricted caloric intake and regular exercise.

Adopt diet when youngNutrients contained in food is better

and more easily absorbed than synthetically produced supplements.

American Institute of Cancer Research1/3rd of PCa can be prevented by

avoidance of tobacco and alcohol1/3rd of PCa deaths can be prevented by

dietary changes, adequate physical activity and control of body weight

High intake of red meat makes a person three times more susceptible to PCa

High fat diet stimulated cancer growth in animals

High intake of saturated fats caused higher incidence, more aggressive form and more deaths from PCa.

CarotenoidsRisk of PCa reduced in men using caotenoidsLycopene is considered most efficientCommon sources of Lycopene: Tomato (more in cooked form), pink

grapefruit, watermelon, apricot, guava, papaya

A high intake of tomato products was associated with 35% decrease risk of PCa.

Cruciferous vegetablesBroccli, cauliflower, cabbage, Brussel sprout, bok choy

and kale prevent PcaThey contain high levels of anticarcinogenic

phytochemicals which produce antioxidant enzymes which in turn protect cell damage

Selenium

It is an essential non-metallic trace metalFound in Brazil nuts, walnuts, fish, shell fish,

beef, turkey, eggs, whole grains, garlic, onions, broccoli, cabbage mushroom

Nutrition Prevention of PCa Trial: High selinium levels confer a 50% reduction

in the risk of PCa

Vitamin E

Lipid-soluble antioxidant found in veg. oils,nut oils, hazel nut, whole grain and leafy vegetables.

Benefits only in smokersCleveland Clinic found a significant increase in the

risk of PCa among healthy men who took a dietary supplement of Vitamin E (Klein)

Vitamin DMost important source is sunlight but also

contained in dairy products, eggs, fatty fish like salmon & Tuna

Many men are Vitamin D deficientAdequate levels of Vit D significantly reduce

the incidence and mortality of PCaStrengthens the immune system in generalSpecially important in pts. on Androgen

Deprivation Therapy(ADT) to treat PCa

Calcium and ZincHigher consumption of whole milk has been

consistently shown to be associated with an increased risk of developing advanced PCa. This is due to the high fat content

Calcium is good in moderation specially from natural sources

Excessive use of calcium supplements to prevent/treat osteoporosis has lead to marked increase in urinary stone disease.

High doses of Zinc have been shown to promote PCa

Testosterone Therapy in 2014American Society of Clinical Oncology Long term testosterone supplement in

hypogonadal men does not increase the risk for Pca

Most researches have shown that testosterone replacement therapy(TRT) is not harmful in PCa pts.

Pt. with metabolic syndrome have 54% greater risk of developing Pca

Stress and lack of family support is associated with higher PCa mortality.

Dietary advice to pts. Diagnosed with PCaVegan diet supplemented with antioxidants,

aerobic exercises and stress management can lower PSA levels

Dietary modifications coupled with exercise and life style changes may decrease PCa growth rate

Should be used in concert with accepted therapyRelying on diet and supplements alone to cure

PCa is unrealistic and often fatal

Specific Foods and HerbsPomegranateLycopenesSoyGreen teaGinsengHoly BasilTumericGinger

Saw palmettoFlaxseedMedicinal mushroomsBaikal scullcapHu zhangPao pereiraRauwolfia vomitoriaLignans

Soy(Isoflavones) and Green Tea(Polyphenols)Soy has been shown to have a beneficial

effect in the prevention and reduction in growth rate of PCa

Effects the production and metabolism of androgens and estrogens in the body

Polyphenols are present in green tea, red wine, grape juice, fruits and vegetables.

Inhibits cancer cell growth which has been proven in several human PCa sudies.

Superfoods in Chemoprevention of Prostate Cancer

Spinach, Broccoli, Brussels sprout, cauliflower and cabbage

Wild caught salmon, Fish oilsPomegranate and BlueberriesSoy foodsOats and oat productsGreen tea

BREAKING NEWS FROM AUAStudy suggests adding Broccoli to weekly diet

may change gene activity linked with Prostate Cancer

First study in which gene expression in a target tissue has been studied after a dietary intervention

Men with low-risk Prostate Cancer showed profound changes microscopically

Life style Changes to prevent PCa

Heart healthy is prostate healthyMonitor Cholesterol and Blood pressureMaintain a healthy weight:

Body Mass Index (BMI)Waist-to-hip ratio (WHR)

Exercise and move moreDecrease Total calories not just fat contentAbove all : LIVE IN MODERATION

Ideal Prevention for Prostate Cancer

CASTRATION AT BIRTH

OUCH !!!!

AUA Guidelines for PCa screening Begin PSA screening for Prostate Cancer

at age 40Consideration should be given to overall

health, family history, age, race and riskScreening should include DREIncreases in PSA velocity of greater than

0.4 ng/ml/yrare associated with 50% higher likelihood of significant disease

Screening Tools for Prostate Cancer

Digital Rectal Examination (DRE)Yearly total PSA: If high it may be

repeatedor a Free PSA done

Transrectal Ultrasound (TRUS) If any abnormal areas seen, Transrectal

ultrasound guided needle biopsiesSaturation biopsies if indicatedMRI/Ultrasound Fusion image guided Bx

Recent Advances in Detection and Staging of PCaNew Diagnostic Blood Tests:1. Onko cell MDX2.OPKO 4K scoreSpecial Tissue Diagnostic test to assess the

aggressive nature of the cancer:1.Polaris2. Oncococyte gene testing

Joint Guidline (AUA,ASCO) recommends 5-alpha reductase inhibitors for

preventing Ca P – 25% better than placeboIt recommends benefits in asymptomatic

younger men with PSA of 3ng/ml or higherIt may be considered in patients with higher

risk factors like family history, raceIncrease in erectile dysfunction, decrease in

libido and ejaculate volume and gynecomastia are known side effects

CONCLUSIONSProstate Cancer has a very high prevalance in

men in the USThe risk factors have been well studiedDiet and Lifestyle have a definite impactProstate cancer can be successfully

prevented by changing lifestyle, diet and chemoprevention.

General AdviceReduce intake of white bread,meats and

saturated fat.Increase fruits,vegetables,fiber & Fish oilEliminate smoking and excess alcoholReduce stress,sleep well,regular exerciseIncrease soy,Vitamin D & Green teaAvoid unnecessary hormones especially

Androgens

Suggested Reading

PROMOTING WELLNESSGuide for Cancer Patients

Mark Moyad, M.D.,M.P.H.Director of Preventive & Alternative Medicine

University of Michigan Medical Center

Disclosure“IMANA is committed to providing CME

activities that are fair, balanced and free of bias.

Full and specific disclosure information is provided in your handouts.”

I have no relevant financial relationship with any of the commercial interests.