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April 2009 Volume 3 #2
 CAM: Heart health and PCa Buyer beware: CAM's dark side Immunotherapy: An overview CPCN Conference 2009 |
Complementary and Alternative Medicine (CAM): Heart Health and Prostate Cancer  "If I'm going to make any recommendation, it better be good enough that, if I'm wrong, you'll still be in better health." So says Dr. Mark Moyad, renowned specialist in preventative and complementary medicine and speaker at both last year's CPCN national conference and the one to take place in September 2009. Dr. Moyad's new book, Complementary Medicine for Prostate Health, is due out in 2010. Co-written by urologist Ian Thompson, Jr., this book will be essential reading for all men wanting expert advice about "what works and what's worthless" in the maintenance of prostate health.And Dr. Moyad's perspective is the right way to think about complementary or alternative medicine for men with prostate cancer --- it should not only do no harm; it should do some good. Complementary and alternative medicine (CAM) is an attractive proposition for many men diagnosed with prostate cancer. Survival rates are comparatively high, and this disease is often curable by surgery or radiotherapy if it is caught before cancer has escaped the prostate gland. So there will be numerous prostate cancer survivors around for a good number of years after they have completed primary, standard treatments, men looking to protect themselves against recurrence. And some prostate cancers have a long period of latency and are monitored through active surveillance. Men with these slower growing tumours have time to use nutritional supplements and dietary and lifestyle changes to help improve their general health and cancer prognosis. Probably most compelling, however, is the possibility that CAM can affect the survival of men with prostate cancer by improving their general health. An interesting fact: The Prostate Cancer Prevention Trial documented 10 deaths from prostate cancer among 18,000 men, but 1,113 men died of other causes. In fact, according to a series of articles by Dr. Moyad and his colleagues, in the first 10 years after treatment for prostate cancer, one of the leading causes of death was a cardiovascular event. (The series of articles is entitled "Lifestyle recommendations to prevent prostate cancer" and was published in the May 2004 issue of the Urological Clinics of North America journal.) In keeping with Moyad's injunction to leave a man with prostate cancer in better health after complementary therapy, even when that therapy doesn't work as expected, many urologists are now letting their patients know that heart health is a priority. Cardiovascular and Prostate Health "When we recommend CAM to our patients," writes Dr. J. Curtis Nickel, "we will do them a great service by emphasizing approaches that can affect both their cardiovascular and prostate health." Some heart-healthy strategies for the man with prostate cancer include diets that promote the loss of abdominal fat and that lower blood pressure and cholesterol (especially low-density lipoprotein cholesterol or "bad" cholesterol), quitting smoking, engaging in moderate but regular physical activity (including both aerobic exercise and strength training), and increasing the consumption of fruits and vegetables, omega-3 fatty acids, soluble fibre, and, perhaps, phytoestrogens. Research in the lab links prostate cancer cell proliferation with dietary and saturated fat. However, outside the lab, the effect of men following a low fat diet is difficult to gauge. One study looked at whether intensive lifestyle changes, including a low fat vegan diet, would affect the progression of prostate cancer. About 90 men with prostate cancer who had elected active surveillance were divided into two groups; one followed the comprehensive lifestyle intervention program and one did not. After 1 year, the group following the intervention program had a 4% decrease in PSA while the other group had a 6% increase. (See an abstract of this study.) Still, in the large Prostate Cancer Prevention Trial, the only dietary change that had a documented affect on PSA was the reduction of calories. It didn't seem to matter where those calories came from---protein, carbohydrate, or fat. Omega-3 fatty acids (found in fish oil), tomato sauce, and soluble fibre have also been studied in connection with prostate and heart health. A 2006 study of just fewer than 400 men with prostate cancer reported that "fish and tomato sauce may offer some protection against disease progression." And flaxseed, which contains fibre as well as plant estrogens and omega-3 fatty acids, has been shown to reduce cancer proliferation rates in men scheduled for a prostatectomy. This interesting study, which reported in December 2008, assigned men scheduled for prostate cancer surgery to one of four groups: 1) a control group following a usual diet, 2) a group following a flaxseed-supplemented diet, 3) a group following a low-fat diet, and 4) a group following a flaxseed-supplemented, low-fat diet. The conclusion: flaxseed, but not dietary fat restriction, reduced prostate cancer proliferation rates. (Those on the low fat diet did reduce their cholesterol levels, however.) Phytoestrogens, estrogen-like substances found in some plants, have received considerable study as a possible benefit to men with prostate cancer. Most of these studies have involved taking soy supplements. (See a CPCN article about supplements.) But one that looked at a soy-rich diet concluded that eating four slices of a bread rich in HT soy grits favourably influenced the PSA level and the free to total PSA ratio in patients with prostate cancer. (Click here for an abstract of this study.) It should be noted, however, that although there is research supporting the cholesterol-lowering effects of soy, the American Heart Association concluded in 2008 that the main benefit to cardiovascular health may be "in using soy proteins to replace foods high in animal protein that contain saturated fat and cholesterol." A research team out of McMaster University would agree that avoiding animal proteins high in saturated fat is heart healthy. It reported just this week, after analysing the results of over 200 research papers investigating the relationship between food and heart health, that the Mediterranean diet is highly protective against coronary heart disease. And what are the components of that diet? You guessed it: lots of fruits and vegetables and whole grains, healthy fats such as olive and canola oil, and protein from nuts, legumes, fish, or meats lower in fat, such as chicken. According to study co-author Dr. Sonia Anand, here's what to avoid: "Hot dogs, baloney, red meat --- that's associated with an increased risk of heart disease. And that's very, very consistent with what our colleagues in cancer are finding." (To watch a CBC interview with Dr. Anand, visit this web page.) Once again, the connections between prostate and heart health appear to hold up. And one of the most interesting of these possible connections was described just recently. Researchers began investigating why men in prostate cancer prevention and screening trials who took statins, cholesterol-lowering drugs, had lower PSA levels and seemed less likely to develop prostate cancer. (See the CPCN article "PSA tests, statin use, and prostate cancer: Persistent questions" for more information.) Of course, these links between general health, heart health, and prostate health are not surprising. We all have a fairly good idea of which foods and lifestyle choices are good for us and which are not. The trick is to make good choices more often than not! |
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