By Howard Wolinsky
One of the most confusing things about being a patient with Gleason 6 “prostate cancer” is what to eat.
When I was diagnosed in 2010, one of my first questions was to ask what is the best diet. I am still waiting for a definitive answer.
A “healthy” diet seems to be the answer overall. Keep your weight in control. Research shows prostate cancer is more common in obese patients than those with “normal” BMIs.
My urologists have told me there is no proven approach to diet and low-risk prostate disease. Yet, I meet patients almost every day who think they have found the cure to a lower PSA and maybe a cure to this slow-growing cancer that odds are won’t kill them anyway.
Factoid: Cardiac disease is our most likely grim reaper. And a low-fat diet can help with that.
My preventive cardiologist, Matthew Sorrentino, MD, of the University of Chicago, has recommended that I follow the Mediterranean diet with lots of vegetables and fruit and limiting dairy and red meat as a means for overall health, not specifically prostate health. (See more below.)
My first urologist, Scott Eggener, MD, of UChicago, knew I was interested in diet. He had me enroll in the MEAL (Men's Eating and Living) study. I was looking forward to some advice and guidance.
I was pissed when MEAL mailed me a measly pamphlet and assigned me to the control group. I wanted help. Personal help. A survey taker checked in regularly. Not an ounce of advice.
I was motivated by that to go on Weight Watchers, a low-fat, heart-healthy diet. My revenge on the study. I lost 40 pounds, and my blood cholesterol fell to normal levels. (Eventually, I added a statin, which by itself, some believe has benefits for prostate cancer.)
The MEAL study wasn’t very useful for anyone in the end.
The Men’s Eating and Living (MEAL) study, published in the Journal of the American Medical Association and led by UC San Diego Moores Cancer Center and Roswell Park Comprehensive Cancer Center investigators, enrolled 478 men aged 50 to 80 years at 91 sites in the United States. (https://ecancer.org/en/news/17183-meal-study-eating-more-produce-will-not-cure-or-stop-prostate-cancer)
“These data indicate that, despite prevailing scientific and public opinion, eating more vegetables will not alter the course of prostate cancer. It will not, to the best of our knowledge, suppress or cure it,” said J. Kellogg Parsons, MD, MHS, Professor of Urology at the University of California San Diego School of Medicine and Moores Cancer Center and study lead investigator. “However, while eating a healthy diet rich in fruits and vegetables and getting more exercise may not cure cancer, it may keep the body stronger and healthier, which may help patients tolerate cancer treatments.”
I wonder if other members of the control group and I messed up the study by being motivated to improve our diets on our own.
Five years before low-risk prostate cancer entered my life, I had what is known as a “widow-maker heart attack.” By all accounts, it should have killed me at age 57 in 2005. In fact, it really didn’t faze me.
I had been a diligent exerciser for 30 years and apparently had created enough collateral blood flow to save my life.
Kerry Courneya, PhD, an exercise researcher at the University of Alberta, caused a lot of buzz in 2021 for his research appearing in the Journal of Urology showing that high-intensity interval training can not only suppress cancer growth in patients on active surveillance but can help manage anxiety and fear of cancer progression. (For more, see Kerry at an AnCan seminar: https://ancan.org/special-presentation-exercise-after-prostate-cancer-active-surveillance-and-beyond/ (It was our best attended weekly meeting in 2021.)
Kerry recently stressed at the meeting of Prostate Cancer Support Canada’s AS group that the benefits of exercise are well documented while those from diet aren’t. Again, that’s no reason not to be careful with your fork and knife to maintain a healthy weight for overall good health.
In 2017, I was diagnosed with type-2 diabetes. I know a lot of patients who have the trifecta of MI, diabetes and low-risk Gleason 6, all inflammatory diseases.
My theory on longevity is to get at least two chronic diseases and take good care of them and yourself. (https://www.medpagetoday.com/special-reports/apatientsjourney/70982)
A cancer diagnosis, even that of a wimpy Gleason 6, is a wake-up call for many of us. We clean upon our acts, change our diets and start exercising.
Many Gleason 6 patients see diet as their salvation and take to it like religious converts who try to recruit others to their way, truth, and light.
We all are seeking a sense of control over these dark passengers within. Your choice on how to do it and whether to do it.
If anyone believes in a good diet and natural healing, it’s Dr. Geo, the naturopath who cares for prostate cancer patients at NYU Langone.
In a column, Geo describes close encounters with diet enthusiasts.
“I was recently in a panel discussion with two diet influencers who promote a plant-based, vegan diet. In their minds, fat and all animal products are evil, unhealthy, and should not be a part of anyone's diet. There was also an environmental argument against animal-based foods,” Geo wrote.
“One of the experts is a nutrition-based medical doctor that has been around for over 50 years promoting a vegan diet. I read many of his books when I first transitioned to a natural lifestyle 25 years ago. But unfortunately, he was offensive to anyone with an opposite opinion to his (only me, in this case) and appeared to be a vegan zealot.”
Geo often offers some food guidance worth reading in his blog.
Personally, I have been on and off the Mediterranean diet, Weight Watchers, and also the keto, low-carb diet, which I fell into while adjusting to metformin for diabetes and lost a ton. A lot anyway. I find diets difficult to stay on for more than two to five years.
Note: Some AS patients take metformin in hopes of controlling their prostate cancer. I did a small poll here that showed that 25% of respondents took metformin to help with their cancer. None had diabetes.
COVID-19-averse, shut in, of late, I haven’t been very careful about my diet. I plan to get back on the wagon sometime soon. Yet, I just got very good news in my annual prostate check-up.
My Prostate Health Index, a type of PSA test, dropped 25%. My wife Judi (jokingly) suggested it was the green mint yeast-raised donuts I had for St. Patrick’s Day here in Chicago.
(Actually, they were so-so. And yes, we dye the Chicago River green on that hallowed day.)
(Green green on the Chicago River—Howard Wolinsky.)
Exercise remains a great idea. Everyone seems to buy into that. (Don’t miss the presentation by Dr. Kerry Kournyea at the AnCan Virtual Support group for AS: https://ancan.org/special-presentation-exercise-after-prostate-cancer-active-surveillance-and-beyond/)
I was on a panel recently with a top doc from the National Cancer Institute. He said that NCI has been looking for 20 years for diet approaches to help patients with prostate cancer. Sadly, they’re still looking.
This irks diet mavens and devotees.
Weigh the NCI view against what the diet gurus say. You decide. Warning: Your doctor in most cases won’t be of much help.
Two experts who have made big news on lifestyle and prostate cancer will share their research on diet, including plant-based and Mediterranean plus other lifestyle choices, including exercise and sleep at an AnCan webinar for all patients with prostate cancer 8-9:30 p.m. Eastern on May 31. Register at: https://bit.ly/3KkxcfC
The webinar, entitled “Optimizing Sleep, Exercise, and Nutrition in Prostate Cancer," features Dr. Stacy Loeb, professor of Urology and Population Health at the New York University School of Medicine and the Manhattan Veterans Affairs Medical Center, and Dr. Justin Gregg, assistant professor of Urology and Health Disparities Research at UT MD Anderson Cancer Center, of UT MD Anderson Cancer Center in Houston.
Loeb and colleagues said in The American Journal of Clinical Nutrition: “Plant-based diets are associated with multiple health benefits and a favorable environmental impact. For prostate cancer, previous studies suggest a beneficial role of specific plant-based foods (e.g., tomatoes) and a potentially harmful role of specific animal-based foods (e.g., meat, dairy). However, less is known about plant-based dietary patterns.
They found that greater consumption of a healthful plant-based diet was associated with lower risks of total and lethal prostate cancer at age 65 and over. Fewer than 1% of participants followed strict vegan or vegetarian diets.
Gregg will speak about his research on diet, including the Mediterranean diet.
He and his colleagues reported on diet, its impact on patients on surveillance and progression in their disease in the British Journal of Cancer: “In localized prostate cancer patients on surveillance, higher diet quality or conformance with United States dietary guidelines at enrollment may lower risk of Gleason grade progression, though additional confirmatory research is needed.”
He and colleagues also reported in the journal Cancer on the Mediterranean diet, a well-established dietary pattern linked to anti-inflammatory and antilipidemic (anticholesterol) properties. It is characterized by a foundation of vegetables, fruits, grains, legumes, and fish; limited intake of meat and dairy; moderate intake of alcohol; and a healthy balance of monounsaturated fat (eg, from olive oil, nuts, and seeds) and saturated fat (eg, from red meat and butter).
Researchers said: “In this cohort, 15% of the men were diabetic, 44% of the men used statins, and 76 men progressed (median follow-up, 36 months). After adjustments for clinical factors, higher adherence to the MD was associated with a lower risk of GG progression among all men … non-White men … and men without diabetes. When joint effects of the MD score and statin use were examined, a similar risk reduction was observed among men with high MD scores who did not use statins in comparison with men with low/moderate MD scores with no statin use.”
We are at 250 registrants. We have room for more. You’ll have the chance to ask questions. Send questions ahead to me at howard.wolinsky@gmail.com.
My take-homes:
—A healthy diet makes sense in general. So stay off the donuts. Unless you really jonesing for them now and again.
—Remember this: If you have slow-growing Gleason 6 “cancer,” it won’t be cancer that gets you in the end.
—Exercise, exercise, exercise.
So take care of your heart, and your prostate and your mind will follow.
Please answer this survey on diet: https://forms.gle/zX3cqyRfhANLazYs6
Attention, all vets.
Veterans Prostate Cancer Awareness and AnCan are launching a new support group focusing on issues affecting veterans.
The group is holding a drop-in organizational meeting at 8 p.m. Eastern Thursday May 26 in the Barniskis Room. Go to https://www.gotomeet.me/AnswerCancer
Contact Joe “Keep the Peace/Attend Support Groups” Gallo for more information: josephcgallo@gmail.com
The group is looking for a name. I suggest the “At Ease, Vets Virtual Support Group.”
Send Joe any ideas you have.
The group will meet regularly on the fourth Thursday of the month at 8 p.m. Eastern.
AnCan is presenting a program on lifestyle choices for patients with all grades of prostate cancer at 8-9:30 p.m. Eastern on May 31. Register at: https://bit.ly/3KkxcfC
We have more than 200 registered. But I am hoping for 300-400 registrants to hear this important program and allow you to ask the experts your questions. You can send questions in advance to Joe Gallo at joeg@ancan.org
The webinar, entitled “Optimizing Sleep, Exercise, and Nutrition in Prostate Cancer," features Dr. Stacy Loeb, professor of Urology and Population Health at the New York University School of Medicine and the Manhattan Veterans Affairs Medical Center, and Dr. Justin Gregg, assistant professor of Urology and Health Disparities Research at UT MD Anderson Cancer Center, of UT MD Anderson Cancer Center in Houston.
Active Surveillance Patients International and the AnCan Virtual Support Group for AS are teaming up for a program on BPH, an enlarged prostate, a not uncommon problem in patients on AS with intact prostates.
It’s a drop-in First Wednesday meeting, June 1 at 8 p.m. EST.. No registration is necessary. Attend the free program, featuring BPH guru, Mount Sinai’s Dr. Steven Kaplan: ancan.org/barniskis
Did you miss the best program on the future of AS to date: “Your Voice in the future of Active Surveillance,” on April 22.? Here’s the link: https://aspatients.org/meeting-videos/
A Who’s Who of experts joined the conversation along with patients and advocates, who were not too shabby either.
Signoff from Twitter. Note Andrew Vickers from MSKCC on the end.
Tweet
Conversation
Said multiples times per day in clinic: “Please don’t spend time stressing about your PrCa, it is literally more harmful to your health than your prostate itself.”
Response from TheActiveSurveillor.com:
Great point. Anxious surveillance can lead some patients to leave active surveillance for unnecessary surgery. Check
http://TheActiveSurveillor.com
Gleason 6 patient describes how his urologist tried to railroad him in for an unnecessary prostatectomy.
Tales of Low-Risk Prostate Cancer: 'Louie' avoids an OR rush to unnecessary surgery
Look for a tip regarding the new IsoPSA test
Replying to @uroegg
Unless it’s becomes a teachable moment re smoking / BMI / exercise etc!
Can we tell patients to “fight their cancer” by losing weight, exercising and eating right even if it isn’t quite true?
aH, DIET. When I was first diagnosed with high cholesterol, and before being placed on medication, I was advised to look carefully at my diet. I did meet with a nutritionist and we reviewed my diet, made some minimal changes (reduced cheese intake, and began what has become a virtual elimination of red meats), and this had no effect: the result--statins. When diagnosed with PC, I looked at a wide variety of dietary issues--and decided to maintain my reasonable diet, with its now minimal red meat content, continued my minimal use of sugar (primarily in the apple crisps I make and love), and absolutely no sugary drinks. But far be it for me to advocate that anyone follow my particular diet, and my PC urologist and primary care doctor both support my diet. Unfortunately I think there is a genetic component at work that might defy any efforts at dieting that goes beyond something like a heart healthy diet.
So, yes, I concur in maintaining a healthy diet (which certainly may vary from person to person, depending upon other health issues one may be facing, like "easy" formation of kidney stones (a problem for me, apparently) and reasonable exercise as the way to good overall health, and undoubtedly what will enable you to outlive your PC and die happily from other causes.
Thanking you Howard! Aways a fresh TidBit to read and learn about my PC!