Prostate Cancer Archive

Q. I was very interested in your article on aspirin and cancer. You commented that aspirin may help prevent cancer, but I can't take aspirin, even in low doses. I use Tylenol for pain and fever — can it also help against cancer?

A. The aspirin story is encouraging, but it's a work in progress. Current evidence suggests that daily low-dose aspirin, such as 81 milligrams, may help reduce the risk of certain malignancies. The evidence is best for gastrointestinal cancers, including colon cancer, but research also offers hope that aspirin may help protect against other tumors, including prostate cancer. However, aspirin can produce gastrointestinal bleeding and other side effects, even in low doses. All in all, most experts think it's too early to recommend aspirin specifically for cancer prevention, except, perhaps, for some people who are at high risk for colon cancer and low risk of peptic ulcers and bleeding.

Q. I am trying to decide between a radical prostatectomy and radioactive seed therapy for my newly diagnosed prostate cancer. All the doctors I've consulted say I have very early disease (PSA 4.9, Gleason score 6) and that I should be cured either way. I'm basing my decision on side effects, but I need more information on one thing I learned about on the Internet, penile shortening.

A. I won't try to advise you about your choice of treatment, since there is no clear answer as to which is best. In addition to the options you're considering, many men would also consider external beam radiation therapy, and older men might consider deferred treatment or active surveillance.

"What can I eat to reduce my risk of developing prostate cancer?" This is one of the most common questions physicians hear from men concerned about prostate health. Undoubtedly, many hope that their doctor will rattle off a list of foods guaranteed to shield them from disease. Although some foods have been linked with reduced risk of prostate cancer, proof that they really work is lacking, at least for now.

Aim for a healthy eating pattern

Instead of focusing on specific foods, dietitians, physicians, and researchers tout an overall pattern of healthy eating — and healthy eating is easier than you might think. In a nutshell, here's what experts recommend:

Prostate cancer is an important disease; in fact, it's the most common internal malignancy in American men. Prostate cancer is a variable disease; many cases are slow growing, even harmless, but some cases are aggressive and even lethal. And it's a puzzling disease; some cases are passed down from father to son, but most occur without apparent rhyme or reason.

Important, variable, and puzzling — it is no wonder that men pay attention when research reports that common dietary elements appear to reduce risk. Two studies have attracted a lot of press; both contain surprising information, but to understand what they mean for you, you'll have to dig behind the headlines and sound bites.

Most medications have potentially harmful side effects, such as stomach upset with aspirin. A team from Johns Hopkins and Harvard universities found what looks to be a beneficial side effect for digoxin — lowered risk of prostate cancer. Digoxin, which was originally extracted from the foxglove plant, has been used for decades to treat heart failure and some heart rhythm problems.

Using an automated system, the researchers tested the ability of nearly 3,200 compounds to halt the growth of prostate cancer cells. Digoxin was one of the top five. As a real-world check, the researchers looked at nearly 48,000 men in the ongoing Health Professionals Follow-up Study. Those who had routinely taken digoxin were 24% less likely to have developed prostate cancer over the 20-year period of the study (Cancer Discovery, published online April 3, 2011).

Genitourinary malignancies are a worry for men. In adolescents and young adults, testicular cancer is the main concern. One of the unappreciated benefits of growing older is that cancer of the testicles becomes rare — but as men outgrow that risk, they face the problem of prostate cancer. With these well-publicized diseases to head their worry list, it's easy for men to overlook bladder cancer — but that would be a mistake. In fact, about 53,000 American men will be diagnosed with the disease this year alone, and over 10,000 will die from it.

Bladder cancer is the fourth most common internal malignancy in American men; it is also one of the 10 deadliest cancers, and it saps our strapped economy of almost $3 billion a year. But there's good news, too. Early diagnosis can nip the disease in the bud, and new treatments are improving the outlook for patients with advanced disease. And when it comes to good news, you'll also be glad to know that you can take simple steps to reduce your risk of getting bladder cancer.

Every man desires to live long," wrote Jonathan Swift, "but no man would be old." Much has changed over the centuries, but the desire to retain youthful vigor during the golden years has endured. Fortunately, modern medicine has developed a plan for successful aging. It includes getting regular physical activity and mental stimulation; eating right; controlling blood pressure, cholesterol, and blood sugar levels; staying lean; building strong interpersonal relationships; and avoiding tobacco and other risky exposures and activities.

A wise lifestyle can help extend life and slow the aging process — but it takes effort and discipline, especially for gents who have started down the wrong path. So it's no surprise that men continue to look for a medicinal shortcut. One of the most tempting is testosterone.

Think rehab, and you may conjure up the image of an athlete working his way back from a torn ligament or an older guy getting back on his feet after a total hip replacement. Penile rehabilitation is harder to picture. Indeed, it may sound more like a creative pick-up line than serious therapy, but it's a real, if unproven, program advanced by many urologists.

The problem

Before you decide that penile rehabilitation sounds like fun, remember that it's triggered by a diagnosis of prostate cancer. About 218,000 American men will receive that diagnosis this year, and all will face the difficult decision of what to do next. Some men will choose to defer treatment ("watchful waiting" and active surveillance programs). Others will decide to have radiation therapy (external beam radiation or brachytherapy with implanted seeds). And many men will opt to "get it all out" by undergoing the radical prostatectomy operation; it's a particularly good choice for younger men with life expectancies of over 10 years and aggressive-looking cancers still confined to the prostate itself.

At your annual check-up, your doctor discusses the pros and cons of a PSA test. You decide to go ahead, and a week later you get a call with the unwelcome news that the result is high. The next step is a repeat test, with another week of waiting. High again, so you're referred to a urologist. It takes three weeks to get the appointment, another week to get your ultrasound-guided prostate biopsy, then a really long week of waiting. Now the verdict: You have prostate cancer. Fortunately, though, it looks like early disease that's very likely curable.

By now, nearly two months have elapsed since your first PSA test. Since your PSA was just 6 nanograms per milliliter, your risk of widespread disease is extremely low, and so you don't need to spend time lining up scans and waiting for more results. You're eager to get on with treatment, but your primary care doctor tells you it's not so simple. You have a choice of treatment, since surgery, radiation, and even deferred therapy ("active surveillance") are all reasonable. Your doctor sets up appointments with the urologist, a radiation oncologist, and a medical oncologist so you can get a full range of opinions. It takes another month to make the rounds, and then you spend a long weekend at a country inn to think things over with your wife.

Prostate cancer is the most common internal malignancy in American men; it's second only to lung cancer among the leading causes of male cancer deaths. That makes it an urgent problem, and it is finally getting the scientific respect it deserves. Still, despite thorough investigations that have yielded major advances, many aspects of the disease remain unknown.

One area of uncertainty is the cause of prostate cancer. Genetics certainly play an important role, but heredity cannot explain most cases. Lifestyle factors have also been implicated; the leading candidate is diet. A high consumption of saturated fat from animal sources is linked to an increased risk of prostate cancer, while whole grains, tomatoes, some vegetables, fish, and soy appear protective. Although the data are less complete, red wine may be protective, while a very high consumption of calcium may be harmful. Some studies also implicate alpha-linolenic acid, the omega-3 fat in flaxseeds and canola oil, as a risk factor. Other lifestyle elements that have been linked to the disease include obesity, lack of exercise, and heavy smoking and drinking.