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The prostate plays an important role in the male reproductive system, and monitoring prostate health is key for related disease prevention as men age. Common noncancerous conditions of the prostate include benign prostatic hyperplasia (enlargement of the prostate) and prostatitis (inflammation of the prostate). Cancer of the prostate is the second most frequently encountered malignancy in men worldwide.1 An estimated one in eight men in the United States will be diagnosed with prostate cancer during their lifetime,2 and Black men are more likely than other racial groups to develop prostate cancer overall, to develop more aggressive forms, and to die from the disease.3,4
Prevention strategies include identifying prostate issues by early cancer detection screening and tracking a patient’s symptoms and progression of any prostate problems. Measuring levels of prostate-specific antigen (PSA), a protein produced by healthy as well as malignant cells of the prostate gland, is a major part of screening. Of important note, rising PSA levels may be indicative of benign or malignant health conditions, and other considerations, such as recent medical procedures, certain medications, race, age, and even individual prostate gland function, can affect test measurements.5 How do lifestyle factors impact PSA levels? What lifestyle-based therapeutic approaches may help lower prostate cancer risk and optimize prostate health?
Prostate Cancer Risk, PSA Levels, & Lifestyle-Based Approaches
Observational studies have shown that individuals with increased insulin resistance have a higher prevalence of prostate cancer.6 In addition, higher glucose levels have been associated with increased prostate cancer risk,7 as well as with the development of more aggressive forms of the malignancy.8 Glucose is an important energy source for tumor cell proliferation, and researchers speculate that a hyperglycemic environment is linked to carcinogenic processes such as DNA damage, oxidative stress, and chronic inflammation that may also drive rapid tumor progression.8 Studies indicate that total serum cholesterol is also associated with an increased risk of high-grade prostate cancer diagnosis.9,10 Investigations into the beneficial impact of modifiable lifestyle factors on general prostate health and prostate cancer screening continue; however, as a baseline, maintaining a healthy weight, engaging in regular physical activity, and eating a variety of colorful fruits, vegetables, and whole grains while limiting highly processed foods are all standard recommendations for reducing the risk of prostate cancer and improving overall health.11
Nutrition and Fasting
Research continues to accrue both on dietary risk factors for prostate cancer12 and those dietary patterns and supplements most efficient in downregulating PSA concentrations, a component of a patient’s prostate cancer risk profile.13,14 A 2021 observational study using data from the National Health and Nutrition Examination Survey (NHANES) database (n=1,399 men, median age 54 years) found that higher consumption of a plant-based diet was significantly associated with decreased odds of having an elevated PSA (OR=0.47, CI: 0.24-0.95).15 Increased fruit and vegetable intakes and decreased red meat and saturated fat intakes have been suggested to decrease risk of prostate malignancy and to increase progression-free and overall survival.16,17 A 2017 meta-analysis (n=2,130,753 participants) of randomized controlled trials, cohort studies, and case-control studies investigated specific associations between the Mediterranean diet and risk of cancers.18 Among the benefits reported, the following were mentioned:18
- Cohort and case-control study results found that a higher adherence to a Mediterranean diet was inversely associated with risk of prostate cancer development (RR=0.96; CI: 0.92-1.00).
- Cohort study results found that a higher adherence to a Mediterranean diet was inversely associated with risk of overall cancer mortality (RR=0.86; CI: 0.81-0.91).
- Investigators suggested that the protective effects may be most attributable to increased consumption of fruits, vegetables, and whole grains.
While there is currently limited research on the relationship between therapeutic fasting interventions and prostate cancer outcomes, initial studies have highlighted potential prostate health benefits. For example, a small 2020 clinical trial (n=14 healthy men 36-60 years old) investigated the effects of water-only fasting on lower urinary tract function, the concentration of sex hormones, and the symptoms of prostate diseases.19 After eight days of fasting, maximal urinary flow rate and International Prostate Symptom Score values improved.19 Among other lab results, decreases in blood levels of total PSA were noted.19 A 2021 case-control study (607 prostate cancer cases and 848 population controls) reported nonsignificant yet compelling trends.20 Those who fasted for more than 11 hours overnight had reduced odds of developing prostate cancer (OR=0.77; CI: 0.54-1.07), and a longer overnight fast plus an early breakfast was also associated with a lower risk of prostate cancer compared to a short overnight fast and later breakfast (OR=0.54; CI: 0.27-1.04).20
Exercise & Movement
Physical activity is also at the heart of optimal health, and studies have suggested associations between greater amounts of physical activity and both decreased prostate cancer risk and decreased all-cause and cancer-specific mortality after a prostate cancer diagnosis.21 In addition to exercise, getting enough movement during the day may also be important for prostate health. A 2022 umbrella review and meta-analysis summarized the current data on sedentary behavior (i.e., total sitting, occupational sitting, recreational sitting, and TV-viewing time) in relation to cancer incidence and mortality.22 Results indicated that high sedentary behavior levels (study averages were noted as 5.5 hours/day or higher) increased the risk for developing several cancers, including prostate cancer (RR=1.08; CI: 1.00-1.17) and increased overall cancer mortality risk (RR=1.18; CI: 1.09-1.26).22 Also, of interesting note, a recent randomized clinical trial (n=52 men; mean age 63.4 years) investigated the impact of physical activity on the PSA levels of patients with prostate cancer.23 Investigators found that compared to usual care, those patients in a high-intensity interval training (HIIT) group experienced decreased PSA levels (-1.1 microgram/L, CI: -2.1-0.0), PSA velocity, and prostate cancer cell growth.23
Stress Management & Sleep
Chronic stress negatively affects many systems of the body, from the endocrine to the immune, potentially influencing prostate health. Additional research is needed to detail the direct impact of mind-body therapies for stress management on prostate cancer risk; however, studies continue to suggest the positive effect of yoga, mindfulness, and meditation on cortisol balance24,25 and their benefits for the overall health and wellness of patients with prostate cancer.26 In addition, observational studies illustrate an association between increased cortisol levels from stressful life events and higher PSA levels,27,28 which provides additional insight into the potential relationship between psychological stress and prostate health.
Adequate sleep is another component to consider for a healthy prostate. Overall, research studies indicate that poor sleep, which may include sleep disorders or disturbances, may increase prostate cancer risk.29-31 A 2022 prospective study of 213,999 men explored the influence of seven sleep traits (sleep duration, chronotype, insomnia, snoring, napping, difficulty getting up in the morning, and daytime sleepiness) on the incidence of prostate cancer.29 Among the results, a “usually napping” response was associated with a lower risk of prostate cancer, with a 9% reduction in risk compared with a response of “never/rarely napping” (HR=0.91; CI: 0.83-0.99).29 In addition, a response of “usually experienced insomnia” had a 1.11 times higher risk of developing prostate cancer compared with those who responded with “never or rarely experienced insomnia” (HR=1.11; CI: 1.04-1.19).29
In the context of an individual patient’s health story, lifestyle behaviors may be among those underlying contributors to prostate cancer risk. Multimodal therapeutic approaches from nutrition and exercise to stress management and sleep may help support optimal prostate health. Learn more about men’s health and how functional medicine tools help create and deliver personalized, effective, and sustainable therapeutic treatments through IFM’s Hormone Advanced Practice Module (APM) course.
- Rawla P. Epidemiology of prostate cancer. World J Oncol. 2019;10(2):63-89. doi:10.14740/wjon1191
- American Cancer Society medical and editorial content team. Key statistics for prostate cancer. American Cancer Society. Revised January 12, 2022. Accessed June 3, 2022. https://www.cancer.org/cancer/prostate-cancer/about/key-statistics.html#:~:text=About%201%20man%20in%208,at%20diagnosis%20is%20about%2066
- Butler EN, Kelly SP, Coupland VH, Rosenberg PS, Cook MB. Fatal prostate cancer incidence trends in the United States and England by race, stage, and treatment. Br J Cancer. 2020;123(3):487-494. doi:10.1038/s41416-020-0859-x
- Press DJ, Shariff-Marco S, Lichtensztajn DY, et al. Contributions of social factors to disparities in prostate cancer risk profiles among Black men and non-Hispanic white men with prostate cancer in California. Cancer Epidemiol Biomarkers Prev. 2022;31(2):404-412. doi:10.1158/1055-9965.EPI-21-0697
- What is screening for prostate cancer? Centers for Disease Control and Prevention. Reviewed August 23, 2021. Accessed June 3, 2022. https://www.cdc.gov/cancer/prostate/basic_info/screening.htm#:~:text=Digital%20rectal%20examination%20(DRE)%20is,anything%20abnormal%2C%20such%20as%20cancer
- Saboori S, Rad EY, Birjandi M, Mohiti S, Falahi E. Serum insulin level, HOMA-IR and prostate cancer risk: a systematic review and meta-analysis. Diabetes Metab Syndr. 2019;13(1):110-115. doi:10.1016/j.dsx.2018.08.031
- Murtola TJ, Vihervuori VJ, Lahtela J, et al. Fasting blood glucose, glycaemic control and prostate cancer risk in the Finnish Randomized Study of Screening for Prostate Cancer. Br J Cancer. 2018;118(9):1248-1254. doi:10.1038/s41416-018-0055-4
- Arthur R, Møller H, Garmo H, et al. Association between baseline serum glucose, triglycerides and total cholesterol, and prostate cancer risk categories. Cancer Med. 2016;5(6):1307-1318. doi:10.1002/cam4.665
- Jamnagerwalla J, Howard LE, Allott EH, et al. Serum cholesterol and risk of high-grade prostate cancer: results from the REDUCE study. Prostate Cancer Prostatic Dis. 2018;21(2):252-259. doi:10.1038/s41391-017-0030-9
- Murtola TJ, Kasurinen TVJ, Talala K, Taari K, Tammela TLJ, Auvinen A. Serum cholesterol and prostate cancer risk in the Finnish Randomized Study of Screening for Prostate Cancer. Prostate Cancer Prostatic Dis. 2019;22(1):66-76. doi:10.1038/s41391-018-0087-0
- The American Cancer Society medical and editorial content team. Can prostate cancer be prevented? American Cancer Society. Revised June 9, 2020. Accessed June 6, 2022. https://www.cancer.org/cancer/prostate-cancer/causes-risks-prevention/prevention.html
- Campi R, Brookman-May SD, Subiela Henríquez JD, et al. Impact of metabolic diseases, drugs, and dietary factors on prostate cancer risk, recurrence, and survival: a systematic review by the European Association of Urology Section of Oncological Urology. Eur Urol Focus. 2019;5(6):1029-1057. doi:10.1016/j.euf.2018.04.001
- Grammatikopoulou MG, Gkiouras K, Papageorgiou ST, et al. Dietary factors and supplements influencing prostate specific-antigen (PSA) concentrations in men with prostate cancer and increased cancer risk: an evidence analysis review based on randomized controlled trials. Nutrients. 2020;12(10):2985. doi:10.3390/nu12102985
- Mongioì LM, Cimino L, Condorelli RA, et al. Effectiveness of a very low calorie ketogenic diet on testicular function in overweight/obese Men. Nutrients. 2020;12(10):2967. doi:10.3390/nu12102967
- Mouzannar A, Kuchakulla M, Blachman-Braun R, et al. Impact of plant-based diet on PSA level: data from the National Health and Nutrition Examination Survey. Urology. 2021;156:205-210. doi:10.1016/j.urology.2021.05.086
- Ballon-Landa E, Parsons JK. Nutrition, physical activity, and lifestyle factors in prostate cancer prevention. Curr Opin Urol. 2018;28(1):55-61. doi:10.1097/MOU.0000000000000460
- Lin PH, Aronson W, Freedland SJ. An update of research evidence on nutrition and prostate cancer. Urol Oncol. 2019;37(6):387-401. doi:10.1016/j.urolonc.2017.10.006
- Schwingshackl L, Schwedhelm C, Galbete C, Hoffmann G. Adherence to Mediterranean diet and risk of cancer: an updated systematic review and meta-analysis. Nutrients. 2017;9(10):1063. doi:10.3390/nu9101063
- Letkiewicz S, Pilis K, Slezak A, et al. Eight days of water-only fasting promotes favorable changes in the functioning of the urogenital system of middle-aged healthy men. Nutrients. 2020;13(1):113. doi:10.3390/nu13010113
- Palomar-Cros A, Espinosa A, Straif K, et al. The association of nighttime fasting duration and prostate cancer risk: results from the Multicase-Control (MCC) Study in Spain. Nutrients. 2021;13(8):2662. doi:10.3390/nu13082662
- McTiernan A, Friedenreich CM, Katzmarzyk PT, et al. Physical activity in cancer prevention and survival: a systematic review. Med Sci Sports Exerc. 2019;51(6):1252-1261. doi:10.1249/MSS.0000000000001937
- Hermelink R, Leitzmann MF, Markozannes G, et al. Sedentary behavior and cancer—an umbrella review and meta-analysis. Eur J Epidemiol. 2022;37(5):447-460. doi:10.1007/s10654-022-00873-6
- Kang DW, Fairey AS, Boulé NG, Field CJ, Wharton SA, Courneya KS. Effects of exercise on cardiorespiratory fitness and biochemical progression in men with localized prostate cancer under active surveillance: the ERASE randomized clinical trial. JAMA Oncol. 2021;7(10):1487-1495. doi:10.1001/jamaoncol.2021.3067
- Pascoe MC, Thompson DR, Ski CF. Yoga, mindfulness-based stress reduction and stress-related physiological measures: a meta-analysis. Psychoneuroendocrinology. 2017;86:152-168. doi:10.1016/j.psyneuen.2017.08.008
- Koncz A, Demetrovics Z, Takacs ZK. Meditation interventions efficiently reduce cortisol levels of at-risk samples: a meta-analysis. Health Psychol Rev. 2021;15(1):56-84. doi:10.1080/17437199.2020.1760727
- Abrams DI. An integrative approach to prostate cancer. J Altern Complement Med. 2018;24(9-10):872-880. doi:10.1089/acm.2018.0169
- Gidron Y, Fabre B, Grosman H, et al. Life events, cortisol and levels of prostate specific antigen: a story of synergism. Psychoneuroendocrinology. 2011;36(6):874-880. doi:10.1016/j.psyneuen.2010.11.011
- Woods-Burnham L, Stiel L, Martinez SR, et al. Psychosocial stress, glucocorticoid signaling, and prostate cancer health disparities in African American men. Cancer Health Disparities. 2020;4:e1-e30. doi:10.9777/chd.2020.1005
- Lv X, Li Y, Li R, et al. Relationships of sleep traits with prostate cancer risk: a prospective study of 213,999 UK Biobank participants. Prostate. 2022;82(9):984-992. doi:10.1002/pros.24345
- Chung WS, Lin CL. Sleep disorders associated with risk of prostate cancer: a population-based cohort study. BMC Cancer. 2019;19(1):146. doi:10.1186/s12885-019-5361-6
- Lozano-Lorca M, Olmedo-Requena R, Vega-Galindo MV, et al. Night shift work, chronotype, sleep duration, and prostate cancer risk: CAPLIFE study. Int J Environ Res Public Health. 2020;17(17):6300. doi:10.3390/ijerph17176300