Medically reviewed in December 2018
After skin cancer, prostate cancer is the most common cancer type and the number two cause of cancer death among US men. Because of that, scientists are putting in overtime to improve screening methods, treatments and outcomes.
“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. “I can’t predict where it will go—not even in four or five years—because it’s constantly evolving.”
With the never ending stream of breakthroughs and the enthusiastic headlines that follow, it can be difficult to know which stories are based on scientific evidence.
Can you prevent prostate cancer?
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. Discuss these with your healthcare provider (HCP) before trying them,” says Dr. Zhou. There’s not always enough evidence to determine whether a supplement is safe and effective. Even if something worked in studies, it may not be a good fit for you.
Be especially wary of men’s multivitamins that claim to have cancer-fighting abilities. Men who took multivitamins seven or more times a week actually had higher rates of advanced stage prostate cancer in a study involving over 200,000 men. However, individuals who took lower doses of multivitamins didn’t have an increase in prostate cancer diagnoses overall—more research is needed to learn which multivitamin dose may start to increase prostate cancer risk.
Fish oil capsules and vitamin E, which are often advertised as men’s health supplements, may increase your chances of an aggressive diagnosis as well, according to preliminary studies. Researchers aren’t yet sure what the reason is behind that increase. Depending on your health needs, the benefits of these pills may outweigh the risks (for example, if you have a vitamin E deficiency). But check with your HCP before adding them to your med list.
Here are some science-backed recommendations that may reduce your risk of prostate cancer:
- Enjoy a daily cup of coffee: Men who drank more coffee were less likely to develop advanced prostate cancer in one 20-year study.
- Cook with tomatoes: Tomatoes contain lycopene, a 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 in a number of large studies.
- Snack on soybeans: Some researchers believe that the phytoestrogens, or estrogen-like plant compounds found in soy block the male hormones that contribute to prostate cancer.
Also, a mounting body of evidence suggests that avoiding red meat reduces your risk of prostate cancer, along with a host of other chronic illnesses.
The latest on the PSA test
Currently, the prostate specific antigen (PSA) blood test is used, along with a digital rectal exam, for prostate cancer screenings. 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 of screening with your HCP. Keep in mind that the PSA isn’t always reliable. It could also go up if you have an enlarged prostate or an infection. Another factor to consider: The PSA doesn’t always go up when a man actually has cancer.
The United States Preventive Services Task Force (USPSTF) had previously recommended against the test for all age groups because a positive result could potentially do more harm than good by leading to unnecessary cancer treatments—and most prostate cancers are slow growing and non-fatal.
But in May 2018, the USPSTF formally revised their stance, saying instead that men between the ages of 55 and 69 should make an informed, personal decision about the PSA with their doctor. The USPSTF still advises against screening if you’re over 70 and gives no recommendation for men under 55.
Screening tools are evolving
“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. Instead, you have to consider a whole spectrum of risk factors to decide whether you’ll do more testing, including age, race, medical history and weight,” says Zhou.
That’s why many healthcare providers are now putting together a whole picture with precision medicine, rather than looking at the PSA alone, he explains. Precision medicine takes into account a person’s genetics, their lifestyle and their medical history so treatment decisions can be tailored to them. Precision medicine tests include:
- The 4Kscore: This blood draw includes a number of tests, including the PSA score. It also takes into consideration factors like your age and medical history. It can help HCPs confirm your diagnosis, determine how aggressively to treat prostate cancer and avoid unnecessary biopsies.
- Genetic testing: A type of gene mutation is sometimes found in the urine of men with prostate cancer after undergoing a digital rectal exam.
These tests aren’t used on a routine basis yet, but they can be helpful 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, 95 percent of 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 treatments include:
- Radiation therapy: High-energy beams are directed at your prostate or radioactive pellets are placed inside of your prostate to kill cancer cells.
- Hormone therapy: Medication or surgery is used to reduce levels of hormones like testosterone, which contribute to prostate cancer.
- Active surveillance: Prostate cancer is often slow growing and many men live with it for years or decades without needing treatment. Active surveillance involves routine visits to your HCP for blood tests and, possibly, for additional biopsies to make sure the cancer hasn’t spread.
Before pursuing any treatment, consider all of your options and ask about the risks and benefits of each choice.
