Click here to read Part I of "Why Men Should Consider an Integrative Approach to Prostate Cancer."
3. How strong is the link with diet/lifestyle and prostate cancer, and can changes in diet/lifestyle slow tumor growth or eradicate an early-stage cancer (prostate cancer)?
Dr. Cohen: It is now becoming much clearer that obesity is a risk factor not only for cardiovascular disease but many cancers. Although the research to date is not definitive, it is thought that lifestyle factors can influence disease outcomes of men with prostate cancer at each stage of the cancer continuum -- early stage treatable disease, treatment response for patients with more advanced disease, and people with late stage disease. Most of the research to date is epidemiological in nature, meaning examining lifestyle factors in large groups of men with prostate cancer and seeing which factors are associated with worse and better outcomes. There have been only a few randomized trials examining comprehensive lifestyle change in men with prostate cancer, and the findings are supportive. Research by Dean Ornish, M.D. and colleagues for men with early stage disease undergoing active surveillance and research by Gordon Saxe, M.D. and colleagues for men with a biological recurrence of prostate cancer suggest that comprehensive lifestyle change can influence PSA levels, PSA doubling time, gene expression, and other cancer-related pathways. Certainly more research is needed, but it is unlikely that getting overweight men to lose weight, and getting ALL men to eat well, exercise regularly, and manage stress will result in any harm. If history shows that these factors have no association with cancer, which is highly unlikely, then at least the men will be more protected from a cardiovascular event, for which the research is not disputed.
For men who make the decision to undergo active surveillance instead of surgery, radiotherapy, or hormone therapy (with the input and support of their physician) it does not mean doing nothing and waiting for the cancer to grow. It is a time when they should engage in comprehensive lifestyle change to alter the terrain of their body to control further cancer growth. This is taking an active role in your health and using healthy foods, exercise, stress management, and social engagement as "treatments" that we know have bioactive effects on the body.
4. Would you advocate a plant-based diet with no dairy, no meat for all men being treated for prostate cancer? What about alcohol consumption?
Dr. Cohen: What exactly to recommend men with prostate cancer eat is a challenge due to a lack of definitive evidence. However, the recommendation from the American Cancer Society (ACS) and the American Institute for Cancer Research is an emphasis on a plant-based diet and reduce processed meat and red meat for cancer prevention and the same recommendations for cancer survivors. The new guidelines from the USDA also recommend a reduction in protein from animal sources, sugar, and salt, and an increase in vegetables, whole grains, and fruits as well as trying to increase protein intake from plant sources (beans, nuts, certain grains, etc.). The best recommendation is to have as much variety of "colors" on your plate as possible and all the cancer-fighting phytochemicals in fruits like tomato, pomegranate, etc., and vegetables like broccoli, Brussels sprouts, cabbage, garlic, onions, soy beans, mushrooms and more all will work to keep you healthy.
Some epidemiological research has linked dairy consumption with risk of prostate cancer. Although this does not indicate a direct causal link between dairy and prostate cancer, there are many substitutes to dairy available.
I am not aware of data directly linking alcohol consumption to risk of prostate cancer or related to worse outcomes for those with prostate cancer. However, alcohol exposes people to a tremendous amount of sugar calories with no nutrient value, and, if consumed without food, dramatically increases insulin levels. If consumed at all, the ACS recommends that alcohol be limited to no more than two drinks a day.
5. What is research telling us about men battling prostate cancer who participate in programs like yoga or tai chi while going through treatment (radiation, chemo, prostatectomy)?
Dr. Cohen: We are in the processes of completing a trial of Tai chi/Qigong for men with prostate cancer undergoing radiotherapy. We do not have the outcomes yet, but the men indicate they enjoyed participating in the program during treatment. We do know that women with breast cancer who participate in yoga during radiotherapy report better quality of life and there is no reason to believe the outcomes would be different for men. My laboratory also published research showing that men who participated in stress management before surgery had lower distress before surgery, better immune function 48 hours after surgery, and better quality of life 12 months after surgery than men who did not participate in the stress management. We also know that exercise is very important. A recent study by Stacey Kenfield, ScD examined survival after diagnoses of prostate cancer and found that men who were more active lived longer overall and had less probability of dying of prostate cancer. Although a more formal randomized trial needs to confirm these findings, we know that moderate to vigorous exercise 5-6 days a week is important to improve quality of life and overall health and is the recommendation by the ACS.
Dr. Lorenzo Cohen is Professor and Director of the Integrative Medicine Program at The University of Texas MD Anderson Cancer Center and Distinguished Clinical Professor, Fudan University Cancer Hospital, Shanghai, China. Dr. Cohen is a founding member and past president of the international Society for Integrative Oncology. Dr. Cohen is currently conducting a number of NIH-funded randomized controlled clinical trials examining the biobehavioral effects of contemplative mind-body practices aimed at reducing the negative aspects of cancer treatment and improving quality of life including studies of meditation, Tibetan yoga, Patanjali-based yoga, Tai chi/Qigong, and other behavioral strategies such as stress management, emotional writing, and neurofeedback. He is interested in examining different types of complementary programs that can be easily incorporated into conventional treatment to decrease the psychophysiological consequences associated with treatment and improve outcomes. He is principal investigator of a newly funded phase III clinical trial of yoga for women with breast cancer with colleagues from Bangalore, India and a phase III clinical trial of acupuncture to prevent radiation-induced xerostomia with colleagues from Shanghai, China. Dr. Cohen is also conducting research to demonstrate that lifestyle changes can influence cancer outcomes. Ongoing studies are examining lifestyle changes in the areas of diet/nutrition, physical activity, and stress management/social network to change the risk of developing cancer and influencing outcomes in those with cancer.
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