Prostate cancer: Diet, ADT and bone health

Written by Community Health Network on 2/25/2014 7:00:00 PM

Dr. Jianan Graybill, is a radiation oncologist and certified MD Anderson Cancer Network® physician.

Prostate cancer is the second most common cancer in men worldwide. An estimated 233,000 cases will be diagnosed in 2014. The clinical behavior of prostate cancer ranges from a microscopic, well-differentiated tumor that may never be clinically significant, to an aggressive high-grade cancer that ultimately causes death.

The frequency of a diagnosis of prostate cancer has increased, due largely to the widespread use of serum prostate specific antigen (PSA) screening. Since 1995 the number of incidences of prostate cancer has risen at a rate of about one percent per year.

Almost 80 percent of men currently diagnosed with prostate cancer undergo a biopsy because of a suspicious serum prostate specific antigen (PSA). However, digital rectal examination plays an important role in early detection, as 20 percent of cases have a prostate nodule that prompts the biopsy.

How does my diet impact prostate cancer?
A prostate cancer study published in JAMA (July 22, 2013) reported that diet could help control the spread of prostate cancer. This study analyzed the diet of 4,577 men, specifically the types of fat consumed in various foods. Several other studies have reported a diet high in animal fat may be an important factor in the development of prostate cancer. In particular, intake of large amounts of alpha-linoleic acid and low amounts of linoleic acid appear to be associated with increased risk; this combination is common in red meat and some dairy products. 

Overall it’s important to eat your vegetables. A diet low in vegetables may be another risk factor for prostate cancer. A case-control study found a higher prostate cancer risk in men who consume less than 14 servings of vegetables weekly, compared with 28 or more servings (adjusted odds ratio 1.54). 

Also in the news is the benefit of soy. Although few human studies have been conducted, cohort studies have shown a modest protective benefit of soy intake on prostate cancer. Eating a balanced diet full of colorful fruit and vegetables, avoiding foods high in fat and sugar, is always best.

If androgen deprivation therapy is part of my prostate cancer treatment, should I be concerned about bone health and risk of fractures?
Part of the treatment for prostate cancer may involve androgen deprivation therapy (ADT). This therapy increases bone turnover, decreases bone mineral density, and increases the risk of clinical bone fractures. Longer therapy does come with a higher risk of osteoporotic skeletal fractures.

These fractures may occur in up to 20 percent of men within five years of starting ADT. As a result, these conditions can significantly contribute to poor quality of life after prostate cancer treatments. Part of our treatment approach is to identify lifestyle modifications that can improve bone health. Smoking cessation and decreased alcohol consumption are very important.

We also recommend dietary calcium intake (food and supplements) of 1000 to 1200 mg daily and supplemental vitamin D 800 to 1000 international units daily for all men receiving ADT. Finally, doing regular weight bearing or resistance exercises helps to strengthen the bones and muscles which helps improve balance and avoid the risk of falling.

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