Prostate cancer is the leading cause of cancer deaths in Jamaican men and in some ways it is an ideal target for prevention. However, its exact cause is unknown so it is difficult to pinpoint a specific method of prevention.
There are two drugs (Finasteride and Dutasteride), used to treat enlarged prostate glands, which have been shown to lower the risk of prostate cancer. A study started in 1997 on the use of Finasteride, reported in 2003 that 18% of men taking the drug were found to have prostate cancer compared to 24% who were given a placebo. But 6.4% of men on the drug developed aggressive prostate cancer compared to 5.1% of those on placebo. The conclusion was that Finasteride reduced the risk of prostate cancer by 25% but it could not be used in the general population for this purpose because of the increased risk of aggressive prostate cancer. A similar finding was found in a study on Dutasteride, a closely related drug.
The finding of increased levels of aggressive cancers may be explained by the drugs’ action of shrinking the glands and making it easier for us to detect these cancers. Nevertheless, although both drugs remain widely used to treat men who have symptoms of bladder obstruction due to a benign enlargement of the prostate gland, they are not currently used in asymptomatic men for prostate cancer prevention.
The use of supplements and herbal products is very popular among men who wish to lower their risk for prostate and other cancers. In 1994 a Finnish study of Vitamin E and Beta Carotene in 29,000 male smokers reported that Vitamin E reduced the risk of prostate cancer. So in 2001 another study involving 35,533 men and 427 centres was done to see if Selenium (200 mcg) and Vitamin E (400IU) alone or in combination could reduce the risk of prostate cancer. Unfortunately, the outcome was that neither prevented prostate cancer. A follow up study of the participants reported in 2011 that there was a 17% increased risk of prostate cancer in those who took Vitamin E. The reason may be that some nutrients which are beneficial may become harmful when taken in high doses so it’s a good idea to seek medical advice before taking nutritional supplements.
Many Jamaican men take Saw Palmetto or products with this ingredient, often in the belief that it may reduce their risk of prostate cancer. This product is extracted from a palm in south Florida and has been promoted for treating or preventing an enlarged prostate gland but not prostate cancer. So it is not recommend for prostate cancer prevention.
Men with a family history are at greater risk for developing prostate cancer. We have long suspected gene abnormalities as a possible link. This year, the movie star Angelina Jolie had her breasts removed because she had a BRCA gene mutation which gave her a 90% risk of developing breast cancer. Later we had a report that Roger Kirby, a well respected UK urologist had removed a 53 year old man’s prostate because he also had a BRCA mutation. In this case the man’s family had a history of breast cancer and had a biopsy proven prostate cancer. Only 1-2% of prostate cancer patients have the BRCA gene mutation and the current cost of the BRCA test is US$3,000 so that it is unlikely that BRCA testing will be widespread in the near future.
The Word Cancer Research Fund (WCRF), a not for profit organisation with headquarters in London funds research and provides information on cancer prevention. WCRF has produced 10 recommendations for cancer prevention. Although these are not specifically aimed at Prostate Cancer they are worthy of our attention and they include:
- Maintenance of a lean body mass (i.e. avoid obesity)
- 60 minutes of moderate exercise daily or 30 minutes of vigorous exercise
- Limit intake of red meat and avoid processed meats
- Eat at least 5 servings (14 oz) of non starchy fruits and vegetables daily
- Avoid dense foods (125 kcal/G) e.g. sugary drinks
- Eat unprocessed cereals/grains and legumes
- Limit salt intake
- Limit alcohol intake - two drinks for men and one for women
A study of 2,212 men who were diagnosed with prostate cancer; reported that those who adhered to less than 4 of the above recommendations had a 38% greater risk of having aggressive prostate cancer compared with those men who adhered to 4 or more. This lends support to other studies which suggest a healthy lifestyle is beneficial.
In summary, in order to lower risk of prostate cancer; men should adopt a healthy lifestyle which includes limiting red meat intake, eating adequate amounts of fruit and vegetables and exercise regularly. Those of us who are interested may wish to read the complete WCRF guidelines (www.wcrf.org).
Dr Robert Wan attended KC from 1957 to 1963. Upon graduation he was awarded the Caribbean Cement Company Scholarship for Medicine and graduated from the Faculty of Medicine, UWI Mona in 1970. He later attained a post graduate degree in urology in Canada in 1976. A past president of the Jamaica Urological Society of Jamaica, Dr Wan has membership in the Medical Association of Jamaica, the Caribbean Urology Association, Socite Internationale D'urologie (1994) and the Royal College of Physicians and Surgeons of Canada. He is also a corresponding and international member of the American Urology Association. An assistant lecturer in the Department of Surgery UWI, he has co-authored several papers on prostate cancer. He currently has a private practice at the Winchester Business Centre in Kingston and is chairman of the Kingston College Choir Committee.