THE UROLOGY GROUP. DIET & PROSTATE CANCER From 100 Questions & Answers About Prostate Cancer

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1 THE UROLOGY GROUP Walter M. O'Brien, M.D., Kevin P. O'Connor, M.D., Nicholas G. Lailas, M.D. Gregory Schenk, M.D., Darlene Gaynor, D.O., Jennifer Young, M.D. Julie Spencer, C.U.N.P., Kristin Tamburro, C.F.N.P., Kathleen Cage, C.F.N.P. DIET & PROSTATE CANCER From 100 Questions & Answers About Prostate Cancer A variety of dietary risk factors exist for Several studies suggest that a high-fat diet stimulates prostate cancer to grow; in particular, beef and high-fat dairy products appear to be stimulators of Conversely, a low-fat diet rich in fruits and vegetables may help decrease the risk of prostate cancer. Such healthy foods include soy (tofu and soy milk), tomatoes, green tea, red grapes, strawberries, raspberries, blueberries, peas, watermelon, rosemary, garlic, and citrus. Soy contains substances called phytoestrogens, which resemble the female sex hormone estrogen. In dietary doses-that is, amounts normally found in foods, not the amounts of supplements--phytoestrogens can decrease the risk of Green tea contains antioxidants, which are chemicals that help prevent changes in cells and reduce damage that can cause the cell to become cancerous. Vitamin E is a free-radical scavenger and is also associated with a decreased risk of prostate cancer, but men with a history of bleeding problems or who take blood thinners should discuss the use of Vitamin E with their doctor before taking it. A high intake of dairy products has also been associated with an increased risk of High levels of fructose, a form of sugar, have been associated with a lower risk of Selenium has been associated with a decreased risk of Lycopene, a carotenoid (chemicals that give orange, red, or yellow coloring to plants), is associated with a decreased risk of Lycopene is found in high levels in tomatoes and is beneficial only if one eats cooked tomatoes, such as tomato sauce, not tomato juice. Many studies are in the process of looking at the effects of such dietary risks. Dietary factors that may affect prostate cancer risk Selenium (trace mineral) Antioxidant works closely with 200 µg selenomethioxine once a day. Take upset, increased flat- linked to low selenium intake GI (gastrointestinal) Higher risk of cancer has been Vitamin E to prevent damage to the body. May also work with a meal. Seleniumrich foods: wheat germ, hair, tooth, and nail associated with decrease in ulence, and possibly Dose of 200 µg once a day is like aspirin by decreasing levels of prostaglandins. May bran, wheat, brown rice, problems. localized and advanced prostate repair damaged cells or cause garlic, soy- beans. cancers. abnormal cells to die. Dietary intake of seleniumrich foods linked to a 50-75% decrease in advanced prostate cancers.

2 Catechins (flavanols) Greens teas: 30-40% catechins Black tea: 5-100% catechins Green tea polyphenols may offer protection from cancer by potentially blocking the formation of cancer-causing compounds such as nitrosamines. Epigallocatechin-3 gallate (EGCG) is the most important polyphenol component in tea in terms of cancer prevention. EGCG is a strong inhibitor of enzyme, 5α-reductase, which converts testosterone to DHT. 1 cup green tea daily May behave as a diuretic. Green tea contains a large amount of Vitamin K, which helps blood clot. May interfere with effects of the anticoagulant with Warfarin (Coumadin). EGCG has been shown in labs to kill cancer cells. No strong clinical data to support use of green tea after a prostate cancer diagnosis.

3 Easy bleeding. ASA (aspirin) Blocks prostaglandin synthesis. Dose as small as 30 mg is effective. Betacarotine (carrots) Lycopene (tomatoes) Fiber Phytoestrogens Soy Isoflavonoids Flaxseed Lignans PC-SPES PC = prostate cancer; SPES = Latin for hope Composed of 8 herbs Antioxidant Can be converted by body into Vitamin A. Antioxidant one of the strongest in nature In animals, it has been shown to prevent tumors from attaching to various components of the blood and spreading throughout the body. Natural source of estrogen Appears to have strong estrogenic activity. PC-SPES decreases serum testosterone and PSA levels, almost equal to levels seen with LHRH treatment and estrogen treatment. Best to obtain from dietary sources of fruits and vegetables. Heat releases lycopene: cooked tomatoes are best. Eat tomatoes or tomato products several times per week (>10 servings a week associated with 35% decrease in prostate cancer risk.) If too much is eaten, a temporary skin discoloration called carotenemia results. Need further studies to assess affect on ASA on incidence of prostate cancer and growth of May have beneficial cardiovascular effects. Betacarotine supplements haven t been shown to decrease Prostate cancer risk may be decreased if one eats a diet low in fat and high in vitamin-rich fruits and vegetables. s no benefit may possibly increase risk in smokers and drinkers. Increased risk of prostate cancer with high fat intake. Fat may also affect the progression of behavior of the Clear link between fat and cardiovascular disease. More is better Laxative effect Lab animal and several human studies have shown that dietary fiber can decrease risks of prostate cancer and/or prostate cancer progression. Soy Asians consume mg of isoflavonoids a day Flaxseed 1 to 2 tsp or tbsp a day Lignans also found in lentils and garlic Soy may be useful in treatment of hot flashes in men with prostate cancer on hormonal treatment (1 serving soy along with 800 IU Vitamin e) Best sources of soy are: soybeans, miso, Tofu, soy protein powder, tempeh and soy milk. 320 mg capsule Dose of 3-6 capsules per day is preferred dose. Need to take on an empty stomach at least 2 hours before or after meal because of decreased effectiveness when combined with food. Flaxseed: GI discomfort May affect absorption of prescription meds if taken at same time. Soy: GI upset Iron overload in high doses Breast tenderness, loss of libido, swelling or clotting in the legs, loss of body hair, change in cholesterol, diarrhea. Patients taking PC- SPES need to be on anticoagulants (blood thinners) with higher doses. Countries that consume large amounts of phytoestrogens typically have low rates of cancer. Study demonstrated an association between increased consumption of natural garlic and garlic supplements and decreased risk of prostate cancer a greater reduction occurred with natural garlic. May reduce cholesterol levels. Concerns over quality of product can be an issue

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5 Vitamin D Vitamin E IP-6 phytate Anticancer effects inhibit human prostate cancer in lab animals. Both natural and synthetic Vitamin E inhibit prostate cancer cells. However, naturally occurring Vitamin E demonstrated a greater ability to inhibit growth of prostate cancer and at a lower concentration than synthetic antioxidant. IP-6 as a supplement has been shown to inhibit numerous cancer cell lines, including prostate IU supplemental Vitamin D daily in fall/winter IU in spring/ summer IU (International units) of synthetic or natural Vitamin E. In high doses, it may act as a pro-oxidant. Dietary sources probably provide enough IP-6 to derive any health benefits Increased risk of prostate cancer with greater consumption of milk and milk products may be due to high levels of fat in these products. Too much Vitamin D may cause hypercalcemia, and increased amounts of calcium are associated with higher risk of May thin blood, temporarily increase blood pressure, disturb the effects of prescribed anticoagulant (blood thinner) or aspirin, and can increase risk of a hemorrhagic stroke. IP-5 is an inhibitor of iron and zinc absorption. Limited exposure to sunshine on skin stimulates production of Vitamin D. Melanin blocks body s ability to create Vitamin D; African Americans have a greater risk of May aid in prevention of osteoporosis by promoting calcium absorption. Appears to be most effect for current or recent smokers. Found in a variety of healthy foods, including beans, corn, and wheat. Dietary consumption linked with a lower risk of calcium stores and to lower cardiovascular and cancer rates in several epidemiological studies Deerfield Avenue, Suite 112, Lansdowne, VA Town Center Drive, Suite 150, Reston, VA D Cornwall Street, N.W., Suite 400, Leesburg, VA