Prostate Cancer Archive

Q. In the May 2014 issue, you reported on findings from the Selenium and Vitamin E Cancer Prevention Trial (SELECT), which said that taking vitamin E and selenium raises the risk of prostate cancer. My multivitamin contains both of these nutrients. Should I worry?

A. Based on what we know right now, there is no reason to think that a multivitamin would raise your risk of prostate cancer. Standard multivitamins contain less vitamin E and selenium than men took in SELECT. Also, multivitamins have not been linked to an increased risk of prostate cancer. For example, in a study of over 14,000 male physicians, taking a multivitamin (compared to placebo) did not affect the risk of individual cancers, although it reported a very modest reduction in total combined cancers over 11 years. This effect has not been reproduced in other studies.

Taking daily doses of the erectile dysfunction drug tadalafil (Cialis) does not reduce erectile problems in men undergoing radiation therapy for prostate cancer, according to a clinical trial in the Journal of the American Medical Association.

Some men who have radiation treatment for prostate tumors later have trouble getting or maintaining erections. Researchers have explored using ED drugs early in hopes of preventing ED after radiation or surgery for prostate cancer.

The prostate is can be a troublesome little gland. It is prone to painful infections and inflammation (prostatitis), enlargement that interferes with urination (benign prostatic hyperplasia, or BPH), and cancer. Prevention is the best medicine, something exercise can help with. Exercise has also been shown to help treat various prostate-related conditions.

Although relatively few studies have looked at the impact of exercise specifically on prostate health, the ones that have suggest that regular physical activity can be good for this walnut-sized gland.

Q. I know a bad diet can increase prostate cancer risk, but what about testicular cancer?

A. Diet does appear to have an important influence on a man's risk of prostate cancer, but it's not as simple as good vs. bad. Saturated fats, particularly those from red meat and whole dairy products, are linked to an increased risk, and they are bad news for general health as well. But a few items typically considered healthful have been associated with an elevated risk of prostate cancer; they include a very high consumption of both calcium (which may lower osteoporosis risk) and alpha-linolenic acid (ALA), the omega-3 fatty acid in flaxseed and canola oil (which may reduce heart disease risk). It's wise for men to keep their saturated fat consumption down to less than 10% of their total calories, to limit calcium to less than 1,500 mg a day, and to count on fish or fish oil rather than ALA for heart-healthy omega-3s. And men should get lots of whole grains, tomatoes (especially cooked tomatoes) and other fruits and vegetables, fish, and soy products, all of which have been associated with a reduced risk of prostate cancer and many other woes.

Prostate cancer is about 25 times more common than testicular cancer, and we know much more about its risk factors. But testicular cancer is on the rise, and scientists are starting to ask if diet may have a role in the disease, which tends to strike white males between the ages of 20 and 35. One study evaluated the impact of diet on testicular cancer. Only dairy products were linked to an increased risk; cheese was a particular culprit.

When you've already had a biopsy and your PSA remains high, the PCA3 urine test can help you and your doctor to decide if another biopsy is really needed.

Prostate biopsy is not an experience you want to go through without a good reason. Although some men weather it with only moderate pain and discomfort, other men would prefer the first biopsy to be their last. Now, a urine test called PCA3 can help reduce unnecessary biopsies.

For some men, the smartest move after diagnosis may be to delay treatment and carefully watch the progression of the cancer.

After a prostate biopsy confirms cancer, the next step might seem obvious: get treatment as soon as possible, either by removing the prostate gland entirely (radical prostatectomy) or zapping it with radiation. But immediate treatment is not the only option or necessarily the best one. Treatment itself can cause more harm in the long run than the cancer. Some men with early low-risk prostate cancers can choose to hold off on the decision to treat until the disease presents a greater threat. Then the cancer can still be treated effectively. The approach is called active surveillance with delayed intention to treat.

The latest thinking on this controversial screening.

If you're wondering whether to have your PSA tested, you're not alone. Some experts think you should have the test, but others disagree. In May 2012, the United States Preventive Services Task Force (USPSTF) issued its final report concerning screening for prostate cancer using the prostate-specific antigen (PSA) test. After weighing the best evidence, the expert panel concluded that PSA screening for prostate cancer should not be offered routinely to all men.

When used as a screening tool, the PSA test aims to check seemingly healthy men for hidden cancer at an early stage, when (hypothetically) it may be more curable. To date, the most positive research findings have shown that screening with PSA, at best, prevents about one death from cancer for every 1,000 men who have the test. This means many men are diagnosed and treated for cancers that would not have made them sick or shortened their lives. For such men, the treatment—which can produce side effects—is worse than the disease.

The FDA has approved a new kind of PSA test for determining prostate cancer risk. The company that developed the test, Beckman Coulter, Inc., claims that it can help physicians to tell the difference between prostate cancer and benign prostate conditions.

The Prostate Health Index (PHI) test is approved for use in men 50 years and older with a total PSA between 4.0 and 10 nanograms per milliliter (ng/ml) and whose physical exam does not find signs of cancer. Making a diagnosis in this PSA range requires a biopsy, but it would find cancer only 25% of the time. The PHI test is intended to help doctors determine which men with a PSA between 4.0 and 10 are most likely to have prostate cancer, potentially reducing unnecessary biopsies.

Q. I take Avodart for my enlarged prostate. But I heard that Avodart increases prostate cancer risk. Is that true? Should I quit taking Avodart?

A. You are on the right track about the cancer risk, but it's complicated.