Prostate Cancer: Diet and Dietary Supplements

Stephanie Portes-Antoine, Brandel France de Bravo, MPH, Caitlin Kennedy, PhD, Anna E. Mazzucco, PhD, and Laura Gottschalk, PhD, Cancer Prevention & Treatment Fund

Prostate cancer is the most common cancer in men in North America. In 2008, approximately 186,000 men in the United States and 25,000 men in Canada were diagnosed with prostate cancer, which accounts for 25% of all cancers in men.[1][2]

Compared to most cancers, prostate cancer usually progresses very slowly, and many men live with it for years and even decades. Once diagnosed, some men decide to undergo treatment to halt the progression of the disease, and others refrain from treatment, preferring instead to closely monitor the cancer’s progression. Those who choose “watchful waiting” do this because the medical and surgical treatments for prostate cancer can cause debilitating side effects, and because most men with prostate cancer will die from something else. This strategy is especially likely for older men in the earliest stage of the disease.

At one time, it was unheard of to suggest that diet might have a role to play in battling prostate cancer. But there is now evidence that certain foods and dietary supplements have an impact on prostate health—both positive and negative. Some foods or supplements appear to promote prostate health and prevent cancer cells from developing, but others should not necessarily be taken by men who already have prostate cancer.

The role of diet drew researchers’ attention when they noticed that prostate cancer rates vary greatly from one country to another, with the highest rates appearing in countries where people tend to eat a lot of fat. Studies also show that men who are obese or have a high fat diet are more likely to have prostate cancer.[2] Diets high in saturated fats, such as the animal fats found in red meat, may pose the greatest risk. The lowest rates of prostate cancer are found in Asian countries where men eat a lot of soy foods, a rich source of naturally occurring phytoestrogens. It was hoped that by increasing men’s intake of phytoestrogens, they might reduce their risk of prostate cancer, slow its progression, or reduce the risk of prostate cancer recurring, but at least three studies have failed to find any protective benefit from phytoestrogens.[4][5][6]

As more and more people take dietary supplements containing antioxidants, studies have been conducted to determine their effect on reducing the risk and growth of cancers, including prostate cancer. Three antioxidants that have received attention with regard to prostate health are vitamin E, selenium, and vitamin D.

Studies comparing men who live in areas of the country with high levels of selenium to men in areas with low levels suggest that this mineral protects against prostate cancer. Selenium is believed to reduce the risk of developing prostate cancer because it keeps cells from proliferating or dying off in a rapid or unusual way. An analysis in 2002 of the Nutritional Prevention of Cancer Trial revealed that the men who took selenium supplements daily were half as likely to be diagnosed with prostate cancer.[7] However, in 2008, the Selenium and Vitamin E Cancer Prevention Trial (SELECT) indicated that neither selenium nor vitamin E, alone or in combination, was effective for the primary prevention of prostate cancer.[8][9]  In fact, a 2014 report showed that after several more years of observing the men from the SELECT trial, taking vitamin E supplements actually increased the risk of prostate cancer by 17%.[10]  This result led the researchers to discourage men over 55 from taking amounts of vitamin E higher than the recommended dietary allowance (RDA), which is 15 mg of alpha-tocopherol, especially for supplements which contain only the alpha-tocopherol type of vitamin E.

So do antioxidants prevent prostate cancer or not? The case of selenium is an interesting one that helps shed light on this question. Based on the newest research by Philip Kantoff, June Chan, and their colleagues at the Dana-Farber Cancer Institute in Boston, it seems that higher selenium levels in the blood may worsen prostate cancer in many men who already have the disease.[11]

In his earlier research, Dr. Kantoff had found that the risk of developing prostate cancer was modified by a strong interaction between a mitochondrial enzyme (SOD2) and selenium.[12] In his most recent study published in 2009, Dr. Kantoff and his research team measured selenium in the blood of men with prostate cancer and determined which of the two forms of SOD2 the men had: AA or V.9 Among the men with the AA genotype, those with a higher level of selenium in their blood had a lower risk of aggressive prostate cancer. In contrast, the men with the much more common V genotype who had higher levels of selenium in their blood were at an increased risk for aggressive prostate cancer. Unless a man knows which of the two genotypes he has, he may want to avoid taking supplements with selenium, particularly if he has already been diagnosed with prostate cancer.

But what about men who don’t have prostate cancer—should they take selenium?  In 2014, the SELECT trial  found that for men who already had high levels of selenium, taking selenium supplements increased their risk of prostate cancer by 91%.10 Clearly, men should avoid having too much selenium.  As a result of this trial, the researchers have encouraged men over 55 to limit their intake of selenium to the recommended dietary allowance (RDA) of 55 mcgs.

The SELECT findings on selenium don’t mean that antioxidants have no role to play in preventing cancer or slowing its spread. Scientists still have much to learn about antioxidants. Some antioxidants may be helpful and yet some may actually encourage small cancers to grow larger.  A 2013 study by researchers at the Bedford and Addenbrooke’s Hospitals in the U.K. tested the effect of Pomi-T, a supplement that contains broccoli, pomegranate, green tea, and turmeric on the health of men with prostate cancer. After six months, they found that the men taking Pomi-T had a smaller increase or sometimes even a decrease in PSA, a protein that becomes elevated with prostate cancer, as compared to men with prostate cancer who didn’t take Pomi-T. Also, fewer supplement-taking men went on to receive treatment or surgery than non-supplement-taking men. The researchers suggest that the unique blend of polyphenols and antioxidants in the supplement had a beneficial effect on health of these prostate cancer patients.[13]

A study published in 2016 brought yet another antioxidant, vitamin D, into the prostate cancer discussion. Vitamin D is well known for its role in helping build strong bones and teeth, but it may also contribute to the fight against cancer. Higher levels of vitamin D have previously been linked to better breast cancer outcomes (read more here). The prostate cancer study looked at the levels of vitamin D in men who had their prostates removed due to cancer. They found that men who had the most aggressive forms of prostate cancer had lower levels of vitamin D in their blood compared to men with less aggressive forms of cancer.[14] It is not yet known whether higher levels of vitamin D prevent more aggressive forms of prostate cancer or if aggressive prostate cancer lowers levels of vitamin D. Since it is impossible to know if low levels of vitamin D is a cause or effect of aggressive prostate cancer, and since high levels of vitamin D can be dangerous, more research is needed before experts will know if men diagnosed with prostate cancer should try to take more vitamin D.

More studies are needed in order to determine exactly how diet and dietary supplements can be used to prevent prostate cancer and slow its spread. Meanwhile, men should reduce saturated fats as much as possible. While the jury is still out on phytoestrogens, men may benefit from eating more soy products—especially if they are eating them in place of red meat!

For more on cancer and antioxidants, read here.

All articles are reviewed and approved by Dr. Diana Zuckerman and other senior staff.

References

  1. American Cancer Society: Statistics for 2008. Available at http://www.cancer.org. Accessed July 31, 2009.
  2. Canadian Cancer Society: Canadian Cancer Statistics 2008. Available at http://www.cancer.ca
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  4. Ganry O. Phytoestrogens and prostate cancer risk. Preventive Medicine. Vol (41) 2005:1-6.
  5. Ward H, Chapelais G, Kuhnle GC, Luben R, Khaw KT, Bingham S. Lack of Prospective Associations between Plasma and Urinary Phytoestrogens and Risk of Prostate or Colorectal Cancer in the European Prospective into Cancer-Norfolk Study. Cancer Epidemiology Biomarkers & Prevention Vol (17) 2008: 2891-2894.5
  6. Bosland MC, Kato I, Zeleniuch-Jacquotte A, Schmoll J, Rueter EE, Melamed J, Kong MX, Macias V, Kajdacsy-Balla A, Lumey LH, Xie H, Gao W, Walden P, Lepor H, Taneja SS, Randolph C, Schlicht MJ, Meserve-Watanabe H, Deaton RJ, & Davies JA. Effect of soy protein isolate supplementation on biochemical recurrence of prostate cancer after radical prostatectomy. JAMA 2013; 310(2): 170-178. doi: 10.1001/jama.2013.7842
  7. Duffield-Lillico AJ, et al. Baseline characteristics and the effect of selenium supplementation on cancer incidence in a randomized clinical trial: A summary report of the Nutritional Prevention of Cancer Trial.Cancer Epidemiology, Biomarkers, and Prevention. Vol (11) 2002: 630-639.
  8. Lippman SM, et al. Effect of selenium and vitamin E on risk of prostate cancer and other cancers: The Selenium and Vitamin E Cancer Prevention Trial (SELECT). Journal of American Medical Association. Vol (301)2008: 39-51.
  9. Klein EA, et al. SELECT: The next prostate cancer prevention trial-Selenium and Vitamin E Cancer Prevention Trial. Journal of Urology. Vol (166) 2001:1311-1315.
  10. Kristal AR, et al., Baseline Selenium Status and Effects of Selenium and Vitamin E Supplementation on Prostate Cancer Risk.  Journal of the National Cancer Institute, 2014.
  11. Chan JM et al. Plasma Selenium, Manganese Superoxide Dismutase, and Intermediate-or High-Risk Prostate Cancer. Journal of Clinical Oncology. Vol (27) 2009: 3577-3583.
  12. Li H, et al. Manganese superoxide dismutase polymorphism, pre-diagnostic antioxidant status, and risk of clinical significant prostate cancer. Cancer Research. Vol (65)2005:2498-2505.
  13. Thomas RJ, Williams MMA, Sharma H, Chaudry A, & Bellamy P. A double-blind, placebo RCT evaluating the effect of a polyphenol-rich whole food supplement on PSA progression in men with prostate cancer: The U.K. National Cancer Research Network (NCRN) Pomi-T study. Results presented at the 2013 Annual Meeting of the American Society of Clinical Oncology. Abstract retrieved on July 12, 2013 from: http://meetinglibrary.asco.org/content/112921-132
  14. Nyame Ya, et al. Associations between serum vitamin D and adverse pathology in men undergoing radical prostatectomy. J Clin Oncol. 2016 Feb 22.