This study examined the relationship between androgen deprivation therapy (ADT) and the risk of falls. Authors present preliminary evidence suggesting that patients receiving ADT may be at increased risk of falls.

This study examined the effect of duration and different types of hormone therapy on the risk of developing type 2 diabetes in prostate cancer patients. Researchers concluded that the type and duration of hormone therapy significantly affected diabetes risk.

What happened when cancer patients were given three-quarters of a cup of canned tomato sauce every day for three weeks?

Below is an approximation of this video’s audio content. To see any graphs, charts, graphics, images, and quotes to which Dr. Greger may be referring, watch the above video.

“Occasionally,… positive things happen in the field of cancer prevention science to popular, good-tasting foods.” Yes, broccoli family vegetables are wonderful, but may be “a hard food for the public to swallow.” By contrast, who doesn’t like tomatoes?

But, studies using high-dose supplements of lycopene, the antioxidant red pigment in tomatoes thought to be the active anticancer ingredient, failed over and over again to prevent or treat cancer, and may even end up promoting it—since at the high levels one can get with supplements, lycopene may actually act as a pro-oxidant. But, lycopene in supplement form doesn’t appear to be effective at lower doses, either. “There is a strong [protective] correlation between the intake of [actual whole] fruit[s] and vegetables and the incidence of certain cancers.” But when we supplement with only a single compound isolated in pill form, we may upset the healthy natural balance of antioxidants.

It does seem to be quite the human hubris to think we can reproduce “the beneficial effects of consuming entire fruits and vegetables” by giving supplements of a single phytochemical, which would normally interact with thousands of other compounds in “the natural matrix” Mother Nature intended. In addition to lycopene, other carotenoids in tomatoes include beta-carotene, gamma-carotene, zeta-carotene, phytofluene, and phytoene, all of which are known “to accumulate in human prostate tissue.” And, “there are also numerous non–carotenoid compounds in tomatoes that [may] have [anti-cancer] activity”—not to mention all the compounds we have yet to even characterize.

But, it’s not about finding the one magic bullet: “The anti-cancer effects of carotenoids and other phytonutrients may reside in [their] combined activity.” For example, at the low concentrations of the tomato compounds phytoene, phytofluene, and lycopene found in most people who eat normal amounts of tomatoes, there’s very little effect on cancer cell growth in vitro, used separately. But combine them all together, and a non-effective dose plus a non-effective dose becomes effectivesomehow, significantly suppressing prostate cancer cell growth.

And, the same synergy can be seen across foods. Curcumin, the yellow pigment in turmeric and curry powder, tomato extracts, and the vitamin E found in nuts and seeds do little to inhibit pro-growth signaling of prostate cancer cells—less than 10%. But all three together suppresses growth signaling like 70%. The whole is greater than the sum of its parts.

So, how about instead of giving cancer patients lycopene pills, we give them some tomato sauce? “Thirty-two patients with localized prostate [cancer]” were given three-quarters of a cup of canned tomato sauce every day “for 3 weeks…before their scheduled radical prostatectomy.” In their bloodstream, PSA levels dropped “by 17.5%.” PSA, prostate-specific antigen, is a protein produced by prostate gland cells, and elevated blood levels are routinely used “to monitor the success of [cancer] treatment. It was surprising to find that,” in just three weeks, a “tomato sauce-based dietary intervention” could decrease PSA concentrations in men with prostate cancer. Also, free radical damage of the DNA in their white blood cells dropped by 21%. Imagine how antioxidant-poor their diet must have been beforehand, if less than a cup of tomato sauce a day could reduce DNA damage by more than a fifth.

Okay, but what did they find in their prostates? “[H]uman prostate tissue [is thought to] be particularly vulnerable to oxidative DNA damage by free radicals, which are thought to play a critical role in all stages of [cancer formation].” This may be for a number of reasons, including “fewer DNA repair enzymes.” Well, the researchers had tissue samples taken before the tomato sauce from biopsies, and tissue samples after the three weeks of tomato sauce from the surgery, and resected tissues from tomato sauce-supplemented patients had 28% less free radical damage than expected. Here’s the DNA damage in the prostate before the tomato sauce, and here’s after. Just 20 days of sauce. And, what’s interesting is that “[t]here was no association between” the level of lycopene in the prostate and the protective effects. Tomatoes contain a whole bunch of things, some of which may be even more powerful than lycopene.

Regardless, in contrast to the lycopene supplements alone, “the whole-food intervention” seemed to help. To see if lycopene played any role at all, one would have to test a lycopene-free tomato—in other words, a yellow tomato. So, what if you compared red tomatoes to yellow tomatoes, which have all the non-lycopene tomato compounds, to straight lycopene in a pill? So, they fed people red tomato paste, yellow tomato paste, lycopene pills, or placebo pills, and then dripped their blood on prostate cancer cells growing in a petri dish.

Compared to those not eating anything, the red tomato serum, the blood from those who ate red tomato paste, significantly decreased the prostate cancer cell’s expression of a growth-promoting gene called cyclin D1. This downregulation of the gene by the red tomato consumption “may contribute to lower prostate cancer risk by limiting cell proliferation.” The red tomato seemed to work better than the yellow; so, maybe the lycopene helped, but not in pill form. “[T]his gene was not regulated by [the lycopene-pill serum],” indicating that maybe it’s something else. And, lycopene alone significantly upregulated “procarcinogenic genes. Therefore, it can be stated that tomato consumption may be preferable.”

So, what’s the best way? A spouse wrote in to the editor of the Harvard Men’s Health Watch saying his or her husband “wants to have pizza…for his prostate”—to which the doctor replied, fine, but how about “cheese-free pizza (with broccoli instead of pepperoni)”, or, he can just drink some “tomato juice.”

This study aimed to find out if androgen deprivation therapy (ADT) is more effective used with docetaxel (Taxotere) or abiraterone (Zytiga). There was no significant difference found between the two treatment options. 

What happens when metastatic prostate cancer patients were taught to increase intake of whole grains, vegetables, fruit, and beans, and to decrease meat, dairy, and junk?

?Below is an approximation of this video’s audio content. To see any graphs, charts, graphics, images, and quotes to which Dr. Greger may be referring, watch the above video.

Dr. Ornish and colleagues were able to show an apparent reversal in the progression of early stage localized prostate cancer with a plant-based diet and lifestyle program, and researchers at the University of Massachusetts and elsewhere showed a similar diet may help slow the progression of even advanced prostate cancer over a period of four months. How about six months? Researchers at UC San Diego found more cancer patients in the same situation, and put them through the same protocol. These were patients who were already treated for “invasive prostate cancer…by [either] radical prostatectomy or radiation therapy,” yet had “rising PSA” levels, suggesting the treatment didn’t work, and the cancer was on the move.

In those with a cancer recurrence, PSA levels typically “rise exponentially…, reflecting the gradual, inexorable growth of the cancer in the body.” “[T]he rate of [this] PSA rise is the single best predictor of…the…development of overt metastatic disease, as well as of overall survival.” The next step would be what’s called “hormonal therapy,” which is chemical or surgical castration, which has a list of side effects, including loss of libido, and sexual function, and strength, and vitality. Therefore, we try to hold off on that for as long as possible. So, if we’re just waiting, might as well give diet a try.

So, “[t]hey were taught to increase intake of whole grains, vegetables, fruit, and [beans], and to decrease meat, dairy, and refined [carbs].” Of all possible lifestyle interventions, why a whole food, plant-based diet? Well, if you look around the world, there are huge differences in prostate cancer rates, with “We’re #1, USA, USA” rates up to a hundred times higher than some places in Asia, for example. And, it’s not just genetic; within one generation of coming to the U.S., cancer rates shoot up, and the grandkids end up with the same top-of-the-pile rates. A whole range of “lifestyle factors” have been looked at, but diet appears to have the greatest influence. Specifically, “[c]onsumption of meat and dairy…appears to increase risk, and consumption of plant…foods appears to decrease risk.” Hence, the plant-based diet.

“A possible mechanism…is arachidonic acid,” an inflammatory compound which we make from omega-6 rich oils, like corn oil, sunflower, safflower, and cottonseed oil, and also comes “preformed in…animal-based foods”—particularly from chicken in the American diet, and also eggs. And, in a petri dish, at least, arachidonic acid appears to stimulate prostate cancer cell growth as much 200%. But, ask men to remove processed and animal foods from their diet for six months, and what happens?

This is the before. This is how fast their PSA levels were rising before starting the study. In the absence of treatment, levels of PSA tend to increase exponentially, but eating healthier, this happened: nine of the ten patients showed an apparent slowing of cancer growth, and four of the nine an apparent reversal in cancer growth. The average “doubling time”—an estimate of how long it takes for their cancer to double in size—slowed from doubling every year, to closer to every ten years.

There’s been other studies using various diets and nutritional interventions, like vitamin supplements, but none have worked as well as this one. And, their compliance wasn’t even all that great. They did good about boosting their whole grain consumption, especially in those first three months, but then backslid a bit. They did eat more vegetables, including a serving of greens, and an extra serving of fruit—at least early on—and at least ate one whole serving of legumes a day, when they started. So, they “did observe some [dietary] recidivism by” the end of the study. The patients started out stronger, but then started to slide back into old habits.

So, the researchers checked to see if maybe they were better able to beat off the disease during that early period, and indeed, at the end of three months, on average, there was PSA reversal. So, “[c]hanges in the rate of [PSA] rise” were like “opposite” that of whole food plant intake, “raising the provocative possibility that PSA may have [been like tracking those changes,] suggesting that [the] adoption of a plant-based diet may have therapeutic potential in the management of [recurrent prostate cancer].”

Their “findings suggest” that without further surgery, radiation, or chemo, “disease progression” can be slowed, or even reversed, despite the “prevailing scientific consensus…that cancer progression is largely irreversible.” They’re “not refut[ing] the benefits of standard therapies,” and not “guarantee[ing] that a plant-based diet and stress reduction will always induce remission. But [the results] do contribute to [this] growing [medical] literature that…in at least some circumstances, cancer may be partly reversible.” Just by modifying “dietary and lifestyle factors”, men “may be able to prevent disease spread”—all without getting their testicles chopped off.

Prognostic factors, including blood tests and radiographic scans, can help establish a patient’s prognosis and determine a treatment path. Experts from MD Anderson Cancer Center, Drs. Jeri Kim and Sumit Subudhi, review factors that are associate with prostate cancer and discuss research underway that could lead to more personalized care. 

Transcript

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The authors aimed to determine the effect of toremifene (Fareston) and raloxifene (Evista) when added to hormone therapy in prostate cancer patients who had not received previous treatments.

The authors concluded that toremifene and hormone therapy significantly improved the rate of biochemical recurrence (BCR, a rise in prostate specific antigen [PSA], a protein elevated when prostate cancer is present).

This study investigated the impact of metabolic disorders on long-term survival after prostate cancer diagnosis. Researchers concluded that men with metabolic disorders are at increased risk of mortality from all causes. 

Dr. Dean Ornish showed that a plant-based diet and lifestyle program could apparently reverse the progression of prostate cancer, but that was for early stage, localized, watch-and-wait cancer. What about for more advanced stage life-threatening disease?

?Below is an approximation of this video’s audio content. To see any graphs, charts, graphics, images, and quotes to which Dr. Greger may be referring, watch the above video.

Dr. Dean Ornish showed that a plant-based diet and lifestyle program could apparently reverse the progression of prostate cancer by making men’s bloodstreams nearly eight times better at suppressing cancer cell growth, But, this was for early-stage, localized, watch-and-wait prostate cancer. What about for more advanced stage life-threatening disease? There had been sporadic case reports in the literature suggestive of benefit. Man, for example, with extensive metastatic disease, given maybe three years to live, goes on a strict plant-based diet. Four years later, it appears the cancer has disappeared. Six years in, he gets a little cocky, and backslides a little bit on the diet. Cancer comes raging back, and he dies. But, that could have been a total coincidence. That’s the problem with case reports, which are kind of glorified anecdotes. You have no idea how representative the outcome is unless it’s formally studied. But throughout the 20th century, all we had were these kinds of case reports—until 2001.

So, we had all this “preliminary evidence,” based on all the case reports “that prostate cancer may be sensitive to diet even after [it metastasizes].” It may prolong survival, and even cause “remission of bone [metastases] in men with advanced disease.” So, researchers decided to put it to the test “in a 4-month [long] intervention.” They figured too much saturated fat, too little fiber, and too much meat may be the biggest players in “tumor promotion and progression.” So, they put people on a whole food plant-based diet of whole grains, beans, seeds, and fruit. Figuring this would be quite the “departure from their [regular] diet,” they included a stress-reduction component, in hopes of improving dietary compliance.

Okay. So, who were these ten men? They didn’t just have prostate cancer; they all had “underwent [a] radical prostatectomy” to remove their primary tumor, and then “subsequently had increasing PSA” levels, indicative of probable metastatic disease. PSA stands for prostate-specific antigen; it’s only made by prostate cells, and they just had their entire prostates removed. So, the level should be zero. The fact that they not only still had some PSA, but that it was rising, suggests that the surgery failed, and the cancer had spread and was making a comeback.

Here’s where they started out before the study began. This is a graph of the speed at which each of their PSAs was going up. So, if after four months of eating healthy, the graph looked like this, it would mean the diet had no effect. The cancer would presumably still be powering away, and spreading just as fast as before. Instead, this happened. In two men, it looks like the cancer accelerated—grew even faster. But in the other eight men, the intervention appeared to work, apparently slowing down cancer growth. And, in three, it didn’t just slow or stop, but appeared to reverse and shrink.

Why the different responses? Well, in the Ornish study, the more people complied with the diet and lifestyle recommendations, the better they did. Dietary changes only work if you actually do them. Just because you tell people to start eating a whole food plant-based diet doesn’t mean patients actually do it. One can use fiber intake as a proxy for dietary compliance, since all whole plant foods have fiber, and Ornish’s patients about doubled their fiber intake, from 31 to 59.

How did this group do? They started out even worse, averaging 14 grams a day, and only made it up to 19 grams a day. That’s not a whole food plant-based diet—that doesn’t even make it up to the recommended minimum daily intake. If you look closely, only four men increased their fiber intake at all. So, maybe that may explain the different responses. Like, how did patient 2 do? The man whose fiber improved the most had the best PSA result, and the man whose fiber intake dropped the most had the worst PSA result. Here’s the graph. And, indeed, it appears the more change they made to their diet, the better their results.

The researchers concluded that “a plant-based diet delivered in the context of [stress management]…may slow the rate of tumor progression,” and unlike other treatments, may give patients some control over their disease. And, as Ornish pointed out, “the only side effects are beneficial ones.”

This study investigated the safety and effectiveness of high-intensity focused ultrasound (HIFU) in treating localized prostate cancer. Researchers concluded that HIFU is an effective treatment option, particularly for men not suitable for surgery or radiation therapy.