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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.^3-5

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.⁶ 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.⁷ In addition, higher glucose levels have been associated with increased prostate cancer risk,⁸ as well as with the development of more aggressive forms of the malignancy.⁹ 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.⁹ Studies indicate that total serum cholesterol is also associated with an increased risk of high-grade prostate cancer diagnosis.^10,11 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.¹²

Nutrition and Fasting

Research continues to accrue both on dietary risk factors for prostate cancer¹³ and those dietary patterns and supplements most efficient in downregulating PSA concentrations, a component of a patient’s prostate cancer risk profile.^14,15 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).¹⁶ 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.^17,18 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.¹⁹ Among the benefits reported, the following were mentioned:¹⁹

• 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.²⁰ After eight days of fasting, maximal urinary flow rate and International Prostate Symptom Score values improved.²⁰ Among other lab results, decreases in blood levels of total PSA were noted.²⁰ A 2021 case-control study (607 prostate cancer cases and 848 population controls) reported nonsignificant yet compelling trends.²¹ 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 odds of prostate cancer compared to a short overnight fast and later breakfast (OR=0.54; CI: 0.27-1.04).²¹ 

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.²² 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.²³ 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).²³ 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.²⁴ 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.²⁴

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 balance^25,26 and their benefits for the overall health and wellness of patients with prostate cancer.²⁷ In addition, observational studies illustrate an association between increased cortisol levels from stressful life events and higher PSA levels,^28,29 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.^30-32 A 2022 prospective study with a median follow-up period of 10.45 years (n=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.³⁰ 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).³⁰ 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).³⁰ 

Conclusion

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.

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References

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