Medically reviewed in February 2022
Updated on February 10, 2022
After skin cancer, prostate cancer is the most common cancer type and the number two cause of cancer death among men in the United States. Because of its prevalence, scientists have been working hard in recent years to improve screening methods, treatments, and outcomes for patients.
“Prostate cancer research is an exciting field because we’re seeing so many advancements,” says Shaw Zhou, MD, a urologist at Northside Hospital in St. Petersburg, Florida. More targeted therapies, for example, along with newer forms of hormone therapy, are making treatment more advanced.
But with the stream of breakthroughs and headlines touting the latest developments, it can be difficult to know which treatments may actually benefit you or someone you know with a prostate cancer diagnosis. Here’s how to make sense of the key issues.
Be wary of supplements for prostate cancer prevention
There’s no known way to prevent prostate cancer, but you may have read about foods or supplements that can help lower your risk.
“You see prostate supplements and fad diets in the media all the time,” says Dr. Zhou. “Be sure to discuss these with your healthcare provider (HCP) before trying them.”
As with any remedies that seem too good to be true, a dose of skepticism is warranted. There’s not always enough evidence to determine whether a supplement touted to help with prostate health is safe and effective. Even if something seemed to work in a study, it may not be a good fit for you.
Be especially wary of men’s multivitamins that claim to have cancer-fighting abilities.
In one study involving nearly 300,000 men published in 2007 in the Journal of the National Cancer Institute, those who took multivitamins seven or more times a week actually had higher rates of advanced-stage prostate cancer. There was no association seen between the use of multivitamins and the risk of localized prostate cancer.
People who took lower doses of multivitamins, meanwhile, did not have an increase in prostate cancer diagnoses overall. It’s worth noting that the links between heavy multivitamin use and prostate cancer were strongest in men who had a family history of prostate cancer or who took individual supplements, including selenium, beta-carotene, or zinc. More research is needed to learn what multivitamin doses, if any, may start to increase prostate cancer risk.
Fish oil capsules and vitamin E, which are often advertised as men’s health supplements, may also increase the chances of a diagnosis, according to studies published in 2013 in the Journal of the National Cancer Institute and in 2011 in JAMA, respectively. Researchers aren’t sure of the reasons behind the apparent increases.
Depending on your health needs, the benefits of these pills may still outweigh the risks (for example, if you have a vitamin E deficiency). Check with your HCP before adding them to your daily regimen.
What may help reduce prostate cancer risk?
There are some evidence-based recommendations for reducing prostate cancer risk that you can apply to your daily routine. These include:
- Enjoy a daily cup of coffee. Men who drank more coffee were less likely to develop advanced prostate cancer in one 20-year study published in 2011 in the Journal of the National Cancer Institute. The authors noted that the association seemed to be related to components of coffee other than caffeine.
- Cook with tomatoes. Tomatoes contain lycopene, an antioxidant plant compound, which prevents cell damage from toxins called free radicals. Men with diets rich in lycopene had lower rates of prostate cancer and fewer instances of late-stage prostate cancer, according to a 2020 study published in Biomedicine & Pharmacotherapy.
- Include soy foods in your diet. Research published in 2018 in the journal Nutrients suggests that the phytoestrogens, or estrogen-like plant compounds found in soy, block the male hormones that contribute to prostate cancer.
A mounting body of evidence also suggests that reducing your intake of meat can help lower your risk of prostate cancer.
What you should know about the PSA test
The prostate specific antigen (PSA) blood test is used, along with the digital rectal exam (DRE), for prostate cancer screening. If your PSA level is higher than normal, your HCP may recommend additional testing to check for prostate cancer.
The decision to have the PSA test should be made after discussing the pros and cons with your HCP. Keep in mind that the PSA isn’t always reliable. Your level could go up if you have an enlarged prostate or an infection. Another factor to consider: The PSA doesn’t always go up when someone actually has cancer.
The United States Preventive Services Task Force (USPSTF) recommends that men between the ages of 55 and 69 should make an informed, personal decision with their HCP about whether to get the PSA test. The USPSTF advises against screening for prostate cancer if you’re over 70, and gives no recommendation for men under 55.
Screening tools are evolving
A PSA test alone is not entirely reliable for diagnosing prostate cancer.
“With the PSA, it’s not like a pregnancy test where you get a positive or a negative result, and then you have an answer,” says Zhou. “Instead, you have to consider a whole spectrum of risk factors to decide whether you’ll do more testing.” These factors include age, race, weight, and medical history.
That’s why many HCPs are now putting together a more complete picture using precision medicine, rather than looking at the PSA alone, Zhou explains. Precision medicine takes into account a person’s genes, their lifestyle, and their medical history to better tailor treatment decisions to them. Precision medicine tests include:
- 4Kscore: This test system measures four proteins in a patient’s blood to evaluate their likelihood of aggressive prostate cancer. It also takes into consideration factors like age, medical history, and the results of a DRE.
- Prostate Health Index (phi): This is a combination of three blood tests that provides information on the probability of finding cancer that would require treatment.
- Gene testing: A type of gene mutation is sometimes found in the urine of men with prostate cancer collected after undergoing a DRE.
- ExoDx Prostate IntelliScore (EPI): This is a test that looks at levels of three biomarkers in urine to determine your risk for aggressive prostate cancer.
Your HCP may recommend you get these tests if your PSA level is borderline or you’re trying to decide whether or not to undergo cancer treatment.
The latest in prostate cancer treatment
To confirm that you have cancer and determine how advanced it is, you’ll likely need a biopsy. A biopsy involves using a needle to remove a sample of prostate tissue, which is then sent to a lab for testing under a microscope.
If your biopsy reveals that you have cancer, you may opt for surgery to remove your prostate. “Currently, many prostate removals are done with minimally invasive robotic surgery,” says Zhou. “The newest generation of robots has improved tremendously. They’re easier to move and operate on the very small level that surgeons need to work.”
Most men have a number of treatment options available in addition to surgery. “Again, precision medicine is making treatment very specific to the individual,” says Zhou. “For example, immunotherapy involves using your own immune system—your own white blood cells—to treat the cancer.” Other treatment approaches include:
- Active surveillance: Prostate cancer is often slow-growing and many men live with it for years or decades without needing treatment. Active surveillance involves making routine visits to your HCP for blood tests and, possibly, for additional biopsies to make sure the cancer hasn’t spread.
- Radiation therapy: High-energy beams are directed at your prostate or radioactive pellets are placed inside of your prostate to kill cancer cells.
- Cryotherapy: This procedure uses very cold temperatures to freeze and kill prostate cancer cells. It's sometimes used if prostate cancer comes back after radiation.
- Hormone therapy: For most prostate cancer cells to grow, male sex hormones called androgens need to attach to a protein in the prostate cancer cell called an androgen receptor. Anti-androgen drugs connect to these receptors, preventing the androgens from causing tumors to grow. Androgen deprivation therapy works by using surgery or medicine to reduce androgen levels in the body.
- Chemotherapy: Chemo uses drugs that attack cancer throughout the body. It's sometimes used if cancer has spread beyond the prostate gland and hormone therapy isn't enough to contain it.
- Targeted therapy: Unlike chemo, which affects the whole body, newer forms of treatment like PARP inhibitors aim to pinpoint cancer cells while leaving healthy cells alone.
- Adjuvant therapy: For men with high-risk prostate cancer, adjuvant therapy can help decrease mortality. Adjuvant therapy involves getting a specific chemo drug after radiation and hormone therapy.
Your HCP can discuss all your options, weighing the risks and benefits, to help develop a treatment plan that makes the most sense for you.
