Prostate cancer is a significant health concern for men worldwide. It ranks as the second most common cancer among men and the fifth leading cause of cancer-related deaths globally. Approximately 11.6% of all men will receive a prostate cancer diagnosis during their lifetimes. While prostate cancer is most frequently diagnosed in men aged 65-74, understanding the influence of diet and lifestyle factors on its development and progression is crucial. This article provides a comprehensive guide to diet for prostate cancer survivors, incorporating the latest research and expert recommendations.
Why a Healthy Diet Matters
Improved nutrition reduces the risk of heart disease, cancer, diabetes, and obesity, and usually improves overall quality of life. It’s estimated that one-third of cancer deaths of adults in the United States may be linked to poor diet, including diet’s effect on obesity. A healthy diet helps to increase energy levels, facilitate recovery, and enhance the immune system.
It’s important to evaluate diet choices when it comes to risk of prostate cancer. Research is continually being conducted on foods and diets that may reduce or increase the risk of prostate cancer.
Nutrition Before, During, and After Treatment
Diet plays a crucial role throughout the prostate cancer journey, from initial diagnosis to post-treatment recovery.
Nutrition Before Treatment
Recent studies have indicated that the risk of dying from prostate cancer is more than double in obese men diagnosed with the disease compared with men of normal weight at the time of diagnosis. Obese men with local or regional disease have been shown to have nearly four times the risk of their cancer spreading beyond the prostate or metastasizing. Reaching or maintaining a healthy weight is a great goal to have to improve your overall health which can have a positive effect on your prostate cancer journey. Healthy weight and diet that consists of vitamins, minerals, high-fiber, low sugar, and hydration is a great goal to have before beginning prostate cancer treatment.
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Nutrition During Treatment
Prostate cancer treatment may affect your appetite, eating habits, and weight, but it is important for you to maintain a healthy weight, get essential nutrients, and remain as physically active as possible.
Diet and nutrition tips while in treatment:
- Maintain a healthy weight. For some men, this means avoiding weight loss by getting enough calories on a daily basis. For men who are overweight and are obese, this may mean losing some weight. If you are trying to lose weight, it should be moderate, meaning only about a pound a week.
- Get essential nutrients the body needs, such as protein, carbohydrates, fiber, vitamins, minerals, and water. Not only will your body function better, you will feel better. Protein can be especially important during some treatments. Get your protein from foods such as fish, egg whites, cheese, beans, or high protein smoothies.
- Be as active as you can, such as taking a daily walk. If you sit or sleep too much, you may lose muscle mass and increase your body fat, even if you are not gaining weight.
- Discuss the nutrition-related side effects for your chosen treatment with your doctor, dietitian, or nutritionist. Some side effects may be treated with medication.
Each treatment can present different nutritional side effects. It’s important to discuss these side effects and understand them prior to treatment. It is possible for the side effects of surgery, radiation therapy, and chemotherapy to cause you to lose your appetite, eat less, and lose weight. If you have difficulty eating due to side effects from treatment, there are ways to make eating more comfortable.
Treatment and Diet-Related Side Effects
Surgery/prostatectomy: Protein and micronutrient consumption is required for healing. Micronutrients are the vitamins and minerals that our bodies do not produce, with the exception of Vitamin D. These vitamins and minerals need to come from our diets. Getting nutrients from the source is recommended over supplements.
Radiation therapy: Consider probiotic and/or anti-diarrheal medication to lessen gas and diarrhea. Always consult your care team to confirm use and dosages. Modify fiber and fat intake to help against rectal urgency and loose stool.
Hormone therapy/androgen deprivation therapy (ADT):
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- Bone loss: Consume 1000-1200mg of calcium daily. Maintain adequate Vitamin D level (>30ng/ml). Ask care team about daily vitamin D supplements to maintain normal levels.
- Weight gain, increased risk of diabetes, and heart disease: Weight management interventions with diet and physical activity to reduce cardiovascular risk. Monitor need to regulate carbohydrates intake.
- Hot flashes: Maintain healthy weight, add moderate aerobic exercise, and limit or avoid hot beverages, spicy foods, alcohol, caffeine, and smoking to reduce severity of symptoms.
- Loss of muscle: Consider protein supplements. Preliminary evidence suggests that supplementation may assist with muscle protein synthesis, especially when combined with resistance exercise.
- Anemia: Talk to your care team about maximizing iron absorption and consuming adequate iron.
Chemotherapy: Chemotherapy can cause nausea, mouth sores, and taste changes that may make it difficult to eat or drink. If water tastes unpleasant to you, take in more liquid though items such as soup, tea, milk or milk alternatives, a sports drink, or flavor your water by adding fresh cut fruit. If food tastes bland, try seasoning it with flavorful spices such as garlic, cayenne, dill, and rosemary. Eat several small meals throughout the day instead of trying to eat large amounts of food at one time. Suck on mints, chew on gum, or try fresh citrus fruits if you have a metallic taste in your mouth. Brushing your teeth before eating, using plastic utensils, and cooking in glassware can also help. If you have mouth sores or a gum infection, use a blender to make vegetables and meats smooth. Try making smoothies with both fruits and veggies.
Nutrition After Treatment
Once you have finished treatment, it is just as important to maintain a healthy diet and weight as it was before and during treatment. After treatment, continue to follow a diet of fresh fruits and vegetables and other unprocessed, low-fat foods to help you regain strength. Healthy eating can also reduce the risk of heart disease, high blood pressure, obesity, and diabetes.
Recent research suggests that making healthy food choices in your survivorship may lower your risk of recurrence and help you live longer. According to many experts, the types of foods that may help prevent prostate cancer are the same ones that may protect against prostate cancer recurrence. These experts recommend:
- plant-based foods (such as fruits, vegetables, and whole grains)
- lean protein
- low-fat dairy products
- avoiding highly processed foods and red meats as much as possible
The Role of a Registered Dietitian/Nutritionist (RDN)
Meeting with a registered dietitian/nutritionist (RDN) can be very helpful for you and your caregiver(s). RDNs can help you plan what to eat and what foods to limit or avoid. They can also provide help if you are losing or gaining weight due to treatment. RDNs can be beneficial for caregivers as a resource to provide practical education and support, including meal plans and healthy recipes to make (or request from friends) if their loved one is unable to do so.
Key Dietary Recommendations for Prostate Cancer Survivors
You should try to have a healthy diet when you have prostate cancer. This is important for your general health as well as helping you recover from cancer. There isn’t any strong evidence that you should eat or avoid particular foods. Treatment for prostate cancer can cause problems with your diet, such as diarrhoea after radiotherapy. And some men might find it difficult to maintain a healthy weight. You might be over or underweight.
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General Guidelines
- Emphasize Plant-Based Foods: This amounted to eating just one or two more servings per day of healthy foods, particularly vegetables, fruits and whole grains, while eating fewer animal products, like dairy and meat. Plant-based diets include fruits, vegetables, whole grains, nuts, legumes, vegetable oils, tea and coffee. Aim for at least 5 portions of fruit and vegetables each day. Try to have a range of different colours of fruit and vegetables.
- Choose Whole Grains: Aim to eat starchy foods every day. Don’t forget pulses such as beans, lentils and peas. To get more fiber, choose breads with three or more grams of fiber per slice. The first ingredient on the label should be whole or sprouted grain flour, not white flour or unbleached white flour.
- Limit Red and Processed Meats: Avoid or reduce processed meats in your diet. Limit the amount of red and processed meat to between 700 to 750 grams raw meat per week.
- Use Healthy Fats: Use healthier unsaturated fats like vegetable, olive and sunflower oil.
- Minimize Sugar Intake: Limit the amount of simple sugar in your diet. Simple sugars should be consumed in limited amounts. Avoid sweets such as candy, cookies, cakes and pies.
- Stay Hydrated: Your body needs an adequate amount of fluid. Drink plenty of water daily to help meet fluid needs. Note that caffeine acts as a diuretic, increasing water loss. If you have problems with passing urine, it is better to avoid caffeine.
Specific Foods and Nutrients
- Lycopene: Studies have shown that lycopene, a powerful antioxidant found abundantly in tomatoes, has may be linked to a reduced risk of prostate cancer development. Lycopene helps neutralize free radicals, which are unstable molecules that can damage healthy cells and contribute to cancer development. Research suggests that lycopene, particularly when consumed through cooked tomatoes, may help slow the growth of prostate cancer cells.
- Cruciferous Vegetables: Cruciferous vegetables such as broccoli, cauliflower, kale, brussels sprouts, and cabbage are rich in compounds like sulforaphane and indoles. These compounds may be linked to reduced prostate cancer risk and enhance the body’s defense mechanisms.
- Green Tea: Green tea is known for its high concentration of polyphenols, particularly catechins, which have demonstrated anti-cancer properties. These compounds can help inhibit the growth of cancer cells and reduce inflammation. Research suggests that drinking green tea regularly may offer protective benefits against prostate cancer.
- Omega-3 Fatty Acids: Omega-3 fatty acids, found in fatty fish such as salmon, mackerel, sardines, and anchovies, as well as in flaxseeds and walnuts, have been shown to have anti-inflammatory effects and may help prevent the spread of prostate cancer. Omega-3s play a role in regulating inflammation pathways, which are often dysregulated in cancer.
- Vitamin D: Vitamin D, obtained through sunlight exposure and certain foods like fortified milk and fatty fish, plays a vital role in cellular growth and immune function. Research has suggested a link between low vitamin D levels and an increased risk of prostate cancer. Some studies indicate that adequate vitamin D levels may help slow the progression of prostate cancer, potentially by enhancing the body’s immune response and influencing cancer cell death.
- Soy Products: Soy products, including tofu, tempeh, soy milk, and edamame, are rich in isoflavones, plant-based compounds that have been shown to have potential anti-cancer effects. Isoflavones, particularly genistein, may help reduce the growth and spread of prostate cancer cells. Several studies have suggested that a diet rich in soy products may reduce the risk of prostate cancer and may also be beneficial for men undergoing prostate cancer treatment.
- Nuts and Seeds: Nuts and seeds, particularly almonds, walnuts, and flaxseeds, are excellent sources of healthy fats, fiber, and antioxidants. These foods have been linked to a lower risk of various types of cancer, including prostate cancer. Walnuts, for example, contain polyunsaturated fats and a variety of antioxidants that may help reduce inflammation and slow cancer cell proliferation.
- Pomegranate: Pomegranate is a fruit rich in antioxidants, particularly punicalagins and anthocyanins, which have shown promise in slowing prostate cancer growth. Some studies suggest that pomegranate juice may help inhibit the growth of prostate cancer cells and reduce the risk of cancer recurrence after treatment.
Foods to Limit or Avoid
- Red Meat: Reduce or eliminate consumption of red meat, milk and other dairy products. Limit use of butter, mayonnaise, baked goods and regular salad dressing due to their high saturated fat and total fat content. Consider rice vinegar, balsamic vinegar, lemon juice or salsa as alternative salad dressings. Limit cheese consumption.
- Processed Meats: Avoid processed meats (lunch meats) that contain nitrates, and charred meat, which have been shown to have cancer-promoting properties.
- Trans Fats: Limit use of hydrogenated fats found in products such as margarine, fried foods and processed foods, which are high in harmful trans fatty acids. When you read that a product contains "hydrogenated" or "partially-hydrogenated" oils, you may want to consider putting it back on the shelf.
- Excessive Calcium: Some studies suggest that eating a lot of calcium might increase the risk of your prostate cancer growing and spreading. If you’re on hormone therapy, you’ll need extra calcium to protect your bones. This is because hormone therapy can cause bone thinning, which means your bones are more likely to break if you fall over. Men on hormone therapy should aim for 1200-1500mg of calcium (about 2-3 portions of dairy) each day. Choose lower-fat options such as skimmed or 1% fat milk and reduced-fat cheese.
- Alcohol: The government guidelines state that there is no level of drinking that can be considered completely safe.
The Western Diet and Prostate Cancer
Epidemiological evidence indicates that high body mass index and obesity are not only associated with an increased risk of developing prostate cancer, but also with disease progression. There is a strong association between obesity and the Western diet.
While the optimal ratio between omega-6 and omega-3 fatty acids should be 3:1, the Western diet is abundant in omega-6 fatty acids with a ratio of up to 30:1. Several clinical and preclinical studies have shown a correlation between obesity and diets rich in omega-6 fatty acids and chronic diseases, including cancer.
Specific Dietary Components and Their Impact
Fats
Fats form part of every cell and are vital for energy, physiological and biological processes. Fatty acids are divided into saturated and unsaturated fatty acids. Although the body can manufacture most of the fats needed, there are two groups of fatty acids that the body cannot manufacture. These are termed essential fatty acids and include the omega-6 fatty acids and the omega-3 fatty acids.
In general, high intake in dietary fat is associated with increased risk of prostate cancer. A diet low in fat, particularly low in saturated fats may be beneficial.
Flaxseed
Flaxseed oil contains alpha-linolenic acid (ALA) and linoleic acid (LA) and is a rich source of dietary lignans and phenolic compounds. While ALA is an essential fatty acid with anti-inflammatory properties, lignans exert anti-mitotic, anti-angiogenic and antioxidant effects. In addition, plant lignans may inhibit tyrosine kinase and topoisomerase and interfere with cellular proliferation.
Proteins
Proteins are macromolecular polypeptides composed of many peptide-bonded amino acids. The human body requires 20 amino acids for protein synthesis. There are nine amino acids the body cannot synthesize in sufficient quantities, which are termed essential amino acids. In general, humans consume proteins in form of animal proteins, plant-based proteins and dairy products . In Western countries, the consumption of meat is one of the main animal-derived products in the diet. Animal meat is not only composed of protein, but also fat and cholesterol.
Meat Preparation Methods
Certain ways of preparing and processing animal meat, such as cooking at high temperatures, grilling and barbequing can increase carcinogenesis. Carcinogens include N-nitroso compounds and can be formed in meats preserved with nitrates or nitrites, such as in sausages or cured meat, or can be produced endogenously by the reaction of amines from red meat with nitrosating agents in the intestines. Preparing meat at high temperatures may result in increased levels of heterocyclic amines. The prostate gland can metabolize those chemicals into activated carcinogens, resulting in DNA damage and prostate cancer carcinogenesis.
Fish and Omega-3 Fatty Acids
Fish consumption has been suggested to prevent both development and progression of prostate cancer. The rationale for the preventative effects of fish on prostate cancer has been attributed to the content of long-chain omega-3 polyunsaturated fatty acids. The omega-3 fatty acids found in fish contain eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA). These fatty acids exhibit anti-inflammatory properties through their impact on prostaglandin synthesis.
Eggs
Eggs are frequently consumed worldwide and have a high nutritional value, being rich in vitamins, minerals, proteins, and mono- and polyunsaturated fats. It is believed that the high content in cholesterol and choline may play a role in the development of sex-hormone-related cancers, such as prostate cancer. Cholesterol serves as a precursor for the biosynthesis of sex hormones, such as androgens, that promote cell proliferation. Choline has been reported to contribute to the proliferation and progression of prostate cancer through cell membrane synthesis.
Poultry
The consumption of skinless poultry is not associated with an increased risk of developing aggressive prostate cancer or progression of existing disease.
Dairy Products
Dairy products, such as milk, cheese or yogurt, are another source of protein. A significant consumption of dairy products, especially whole milk, has been proposed to increase the risk of prostate cancer. The exact components of dairy products leading to an increased risk of prostate cancer are unknown.
Soy Products and Isoflavones
Soy and soy-based products are rich in protein and isoflavones. Due to their high estrogen activity, isoflavones are characterized as phytoestrogens and exhibit estrogenic effects in prostate tissue. Isoflavones accumulate in the prostate gland, where they exhibit a cytotoxic effect and block the cell cycle, induce apoptosis, inhibit angiogenesis and inhibit 5-alpha-reductase.
Carbohydrates
Carbohydrates are the primary fuel for energy production. Monosaccharides and disaccharides, which are abundant in fruits, dairy products and sugar, are rapidly metabolized in the body. Overconsumption can lead to obesity and hyperinsulinemia, resulting in overproduction of IGF-1 and consequent inflammation, increasing the risk of prostate cancer development and growth.
Vitamins
Vitamins are carbon-containing compounds that are essential to the body for normal growth and function. With the exception of vitamin D, the body cannot produce vitamins. Therefore, humans are required to obtain vitamins from the diet.
Practical Tips for Implementing Dietary Changes
- Start Small: Making small changes in one’s diet each day is beneficial.
- Read Food Labels: Look at the labels on packaged foods to find out how many calories (energy), and how much fat, salt and sugar are in them. You can then compare different products to find the healthiest ones.
- Set Realistic Goals: Set yourself realistic goals and start by making small changes that you feel comfortable with.
- Make it Enjoyable: If you decide to improve your diet, remember that food is an enjoyable and often social part of life. A healthy diet doesn’t need to be boring. In fact, it’s good to eat a variety of different foods so that you get a range of nutrients.
- Consult Professionals: If you want help to improve your diet, ask your doctor to refer you to a dietitian, they can help you make healthy changes to what you eat.
Additional Lifestyle Factors
In addition to diet, other lifestyle factors play a crucial role in prostate cancer management and overall health.
- Physical Activity: Be as active as you can, such as taking a daily walk. If you sit or sleep too much, you may lose muscle mass and increase your body fat, even if you are not gaining weight.
- Smoking Cessation: Some research shows that men who smoke are also less likely to survive prostate cancer, compared to men who do not smoke. Stopping smoking is also better for your overall health.