More than 33,000 American men die from prostate cancer annually. But this type of cancer can also be relatively harmless, growing slowly, if at all, and never spreading beyond the gland itself.

This poses a dilemma: While a life-threatening condition requires aggressive action, the standard treatments for any form of prostate cancer-including the slow—growing kinds-are surgery and/or radiation, and these treatments can result in impotence and/or incontinence in a significant number of men.

For cancer confined to the prostate when diagnosed, one strategy has been watchful waiting—doing nothing unless a patient develops symptoms indicating that the cancer has spread. This was usually reserved for men with limited life expectancy (typically less than 10 years) and those who have significant other health problems or whose medical condition made surgery or radiation inadvisable. But there are two newer, more effective, approaches…

  • Active surveillance, which is for men of any age whose cancer looks unlikely to progress quickly. With this strategy, the situation is closely monitored with regular tests-beyond digital rectal exams and prostate-specific antigen (PSA) tests. If the cancer seems to be growing, treatment is initiated.
  • Active holistic surveillance, which adds diet and lifestyle changes to optimize the odds that a minor prostate cancer will stay that way

Not For Everyone

In December 2011, a panel of experts convened by the National Institutes of Health (NIH) reviewed available research and endorsed active surveillance as "a viable option that should be offered to patients with low-risk prostate cancer."

According to the NIH committee, 100,000 of the 240,000 American men diagnosed annually with prostate cancer might be candidates for active surveillance. (Right now, only 10% of them are treated this way. The other 90% go on to some form of treatment, usually surgery or radiation.)

Active surveillance may be considered an option if the cancer is confined to the prostate, and lab tests and biopsy results indicate the tumor is unlikely to become dangerous. This calculation takes into account the concentration of PSA circulating in the blood...the Gleason score. which is based on the pathologist's reading of the cells and estimates of how aggressive the tumor will be...and the amount of cancerous tissue in the biopsy.

Ultimately, it's a decision for you and your doctor to make together. If you have other chronic diseases that make surgery or radiation especially risky, this can weigh in favor of active surveillance. But if the idea of leaving cancer in your body makes you unbearably anxious despite the low risk that it will progress, the approach is not for you.

Active-Surveillance Strategies

PSA testing every few months is part of active surveillance. A marked increase in PSA indicates the need for more extensive tests.

Many doctors also repeat the prostate biopsy periodically, sometimes as often as every year, to see if the cancer has become more aggressive. But because biopsy is invasive and carries a small risk for infection and inflammation, some opt for an annual MRI or ultrasound instead, performing a biopsy only when rising PSA, MRI findings and/or symptoms, such as increased difficulty urinating, suggest the situation may have worsened. If this is the case, standard treatments for prostate cancer are usually necessary.

Active Holistic Strategies

In addition to keeping tabs on your cancer, you can enhance the body's natural defenses and attack the processes that support the growth of cancer by…

  • Fighting free radicals. These highly active molecules, produced in the course of normal metabolism and increased by toxic chemicals and certain foods, damage healthy cells and allow cancer to flourish. Diet improves the body's own antioxidant system.
  • Reducing chronic inflammation. The immune system produces chemicals and mobilizes cells to attack infection and heal injury. But when inflammation becomes chronic, it creates a steady stream of free radicals that damage cells and promote cancer growth.

Protective Diet

The eating plan to subdue low-risk prostate cancer includes elements of the Mediterranean diet and traditional Japanese diet that are recommended for cardiovascular and brain health as well.

Key elements…

  • Consume plenty of fruits and vegetables. Cruciferous vegetables (such as broccoli and cauliflower), highly colored fruits (especially berries), and garlic and onions are particularly rich in antioxidants and other cancer-fighting chemicals.
  • Include nuts and seeds, which appear to reduce prostate cancer risk.
  • Avoid saturated fats, which promote inflammation, and eliminate or limit red meat, which is associated with higher rates of advanced prostate cancer. Cured meats (such as bacon or salami), processed meat (such as cold cuts) and especially-grilled, charred meats increase cancer risk and should be avoided.
  • Eat fatty fish (such as wild-caught salmon or sardines) at least one or two times a week for its inflammation-fighting omega-3 fatty acids.
  • Substitute whole grains for foods with refined flour and sugar (they promote inflammation).
  • Limit dairy products—high dairy intake corresponds to higher risk for prostate cancer, probably due to its fat and calcium content.
  • Watch your weight—obesity promotes oxidation and inflammation and alters hormones in a way that increases risk for aggressive prostate cancers.

Supplement Power

In addition to diet, nutritional and herbal supplements add protective power. The most important…

  • Vitamin D. Most people don't get enough of this nutrient, which normalizes cell activity and thus may reduce the risk for cancer. Ask your doctor to test your blood level of vitamin D. If it is below 50 ng/ml, take a supplement.
  • Fish oil. It can be hard to get enough omega-3 fatty acids in the diet. Therefore, some men may benefit from fish oil supplements (1 g to 4 g daily). Check with your doctor first if you take a blood thinner.
  • Anti-inflammatory herbs. Certain herbs—such as turmeric, rosemary and holy basil-and green tea have strong anti-inflammatory effects. The supplement products Zyflamend (New Chapter) and ProstaCaid (EcoNugenics), which combine these herbs and others, have been shown to fight prostate cancer. Both products are available online and at health-food stores.

An Ounce Of Prevention

Men with low-risk prostate cancer who followed a program of exercise and stress reduction combined with a low-fat, plant-based diet were significantly less likely to need conventional treatment within the next two years, compared with a control group, according to recent research.

It's not surprising. Exercise reduces inflammation and enhances immune protection. Reducing stress lowers inflammation and promotes cellular repair. What to do…

  • Exercise at least a half hour a day—brisk walking, biking or swimming-at a pace that seems comfortable. Add strength training three times a week to build muscle.
  • Incorporate a stress-reducing activity into your daily schedule. Relaxation exercises, such as yoga or meditation, are ideal, but anything that releases tension (reading, listening to music) will be helpful.

Is It Safe To Wait?

Delaying treatment does not seem to risk a worse outcome. Results from a 2011 multicenter study of 731 men diagnosed with early-stage prostate cancer showed that those who had no initial treatment were no more likely to die in the next 12 years than those who had surgery.

Additionally, in a recent study at Johns Hopkins University, none of 769 participants in an active-surveillance program died of prostate cancer in the 15 years after being diagnosed, and 41% had no need for surgery or radiation.

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