Are you a male over 50? Has your GP advised you to have a PSA (prostate specific antigen) test, “Just as a routine check”? Ready for a shock? There are very good reasons NOT to!
The Prostate Cancer Foundation of Australia (PCFA) recommends annual screening, through PSA testing and digital rectal examination (DRE) to all men over 50 – whether or not they have any symptoms that might indicate that they have prostate cancer.
The Urological Society of Australia and New Zealand (USANZ – the organisation for prostate surgeons, who make a living out of operating on men with prostate cancer and other prostate conditions) recently released a report recommending PSA testing and DRE from the age of 40.
On the other hand, the Cancer Council of Australia does not recommend annual screening. Here is an excerpt from their position statement:
“The benefits of population screening for prostate cancer are, at this time, unproven. The central concern is that many prostate cancers will not progress sufficiently to cause harm in the man’s lifetime, while others will progress and be lethal. No current test (including the PSA test) adequately differentiates between these types of cancer.
The Cancer Council Australia does not support population-based screening of asymptomatic men for prostate cancer, because as yet there is no direct evidence showing a net benefit of screening in terms of reduction in mortality [death] rates.”
What is PSA anyway?
Prostate specific antigen (PSA) is a protein produced by the cells of the prostate gland. Levels tend to rise when the prostate gland enlarges. The majority of men with an elevated PSA test do not have cancer; instead, they have benign prostatic enlargement, urinary tract infections, prostatitis or other non-cancerous conditions. Recently, US researchers discovered that elevated levels of parathyroid hormone (which are found in 10% of white men), can elevate PSA levels in men who do not have prostate cancer (1).
The PSA blood test does not differentiate between benign prostate conditions and cancer; or between slow-growing cancers which would never cause harm, and aggressive, potentially lethal cancers.
Some men who do have prostate cancer have a low PSA level; this is called a ‘false negative’.
On the other hand, a ‘false positive’ (a test result that falsely indicates the presence of prostate cancer) will usually result in biopsy of the prostate, a procedure that carries significant risks (including rectal bleeding, blood in the semen, difficulty with passing urine, fever, infection (potentially severe), sexual impairment and decreased libido) (2), and incurs financial cost and anxiety for the man involved, and his family.
The standard treatments for prostate cancer are surgery, chemotherapy and radiotherapy. All have the potential to cause side-effects that significantly diminish quality of life. For example, up to 70% of men treated for prostate cancer suffer erectile dysfunction; up to 50% of men develop urinary incontinence and up to 25% develop bowel problems.
This is particularly worrying when, as Dr Otis Brawley of the American Cancer Society puts it, “more than 90% of men getting [treatment for prostate cancer] do not need it.” (3)
Even USANZ acknowledges that, in the main study which they claim supports their pro-PSA testing stance,
“1410 men were required to be screened, and 48 men required management (either treatment or surveillance) for each life saved suggesting a significant over-treatment effect.”
For men with prostate cancer, no treatment at all works at least as well as treatment:
- 14,516 men with localised prostate cancer were managed with ‘watchful waiting’ – monitoring without doing surgery or radiation. After 10 years, 94% of these men were still alive (4). Compare this to the results of a Scandinavian study of 695 men, also with early-stage prostate cancer, who were treated with radical prostatectomy (5). Only 90% of men so treated were still alive after 10 years.
- In another study of more advanced prostate cancer, 50 men with a Gleason score of 7 (where 10 is the worst) were assigned to watchful waiting. None had died of prostate cancer after 6 years, but 22% had died of other causes (6).
What’s a man to do?
As the old saying goes, ‘Prevention is better than cure’. PSA screening does NOT prevent prostate cancer – but a plant-based diet, rich in cancer-fighting plant foods; regular moderate exercise; and maintaining or achieving a healthy weight with minimal belly fat, most definitely does.
For exampl
e:
- Tomatoes, strawberries and watermelon contain lycopene, which protects prostate cells from DNA damage (that can eventually lead to cancer) and causes prostate cancer cells to commit suicide (7);
- Pomegranate contains cancer-fighting pumicalgins and ellagic acid. Men with early-stage prostate cancer who drank pomegranate juice each day had a significant rise in their PSA doubling time, meaning their cancers had slowed or stopped their growth altogether (8).
- Brassica vegetables including broccoli, cabbage, Brussels sprouts, cauliflower, rocket and bok choy contain glucosinolates which reduce prostate cancer risk (9).
- Brazil nuts are the richest dietary source of selenium. Men given 200 mcg of selenium per day had a 63% reduced risk of developing prostate cancer (10).
- Vitamin D supplementation reduced PSA level – an indicator of severity of disease – by as much as half in 20% of 26 men with recurrent prostate cancer (11).
- Moderate exercise reduces the risk of developing prostate cancer; while men who do develop prostate cancer are more likely to have lower grade (i.e. less severe) disease if they exercise regularly (12).
The bad guys…
- Obesity increases the risk of developing prostate cancer, and also raises the risk of suffering high-grade (more dangerous) cancer (13), and the risk of dying from prostate cancer (14). Men who have already been treated for prostate cancer are more likely to have it come back again if they are obese (15).
- Dairy products: In the ongoing Physicians’ Health Study, men with the highest intake of dairy products had a 32% greater risk of prostate cancer than men who ate the least dairy foods (15).
- Men who eat the most red meat, especially barbequed or well-done, have a 31% increased risk of developing advanced prostate cancer compared to men who eat the least red meat (17).
Ready for this piece of lunacy?????
One of the PCFA’s more Fellini-esque fundraising initatives is to host a BBQ to raise money for prostate cancer research. That’s right, folks – they want you to invite your mates over to tuck into some prostate-cancer-feeding steaks and snags, in order to raise money to fight prostate cancer!
Could this stubborn refusal to ignore the known dietary causes of prostate cancer have anything to do with the fact that one of the major corporate sponsors of the PCFA is Novartis, a pharmaceutical company that produces Zometa, a drug used to treat advanced prostate cancer? Where is the incentive to focus on TRUE prevention of prostate cancer, by encouraging health-promoting diet and lifestyle, when their corporate donor makes US$1.4 billion annually from sales of Zometa?
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