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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

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 (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.¹⁵ 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.¹⁶ Among the benefits reported, the following were mentioned:¹⁶

• Cohort and case-control study results found that a higher adherence to a Mediterranean diet was inversely associated with risk of prostate cancer development.
• Cohort study results found that a higher adherence to a Mediterranean diet was inversely associated with risk of overall cancer mortality.
• 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^17,18 such as improvement of maximal urinary flow rate and International Prostate Symptom Score values and lower odds of prostate cancer development.

Exercise & Movement

Physical activity is also at the heart of optimal health, and getting enough movement during the day may be important for prostate health. Studies have suggested associations between greater amounts of physical activity and decreased prostate cancer risk as well as improved metabolic health after a prostate cancer diagnosis.^19-21 A 2022 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.²¹ 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 and increased overall cancer mortality risk.²¹

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.^22,23 In addition, studies suggest an association between increased cortisol levels from stressful life events and higher PSA levels,²⁴ 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.^25-27 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.²⁵ 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.”²⁵ 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.”²⁵

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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2. American Cancer Society medical and editorial content team. Key statistics for prostate cancer. American Cancer Society. Revised January 19, 2024. Accessed May 22, 2024. https://www.cancer.org/cancer/types/prostate-cancer/about/key-statistics.html
3. 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:1038/s41416-020-0859-x
4. Wadhwa A, Roscoe C, Duran EA, et al. Neighborhood deprivation, race and ethnicity, and prostate cancer outcomes across California health care systems. JAMA Netw Open. 2024;7(3):e242852. doi:1001/jamanetworkopen.2024.2852
5. Chowdhury-Paulino IM, Ericsson C, Vince R Jr, Spratt DE, George DJ, Mucci LA. Racial disparities in prostate cancer among black men: epidemiology and outcomes. Prostate Cancer Prostatic Dis. 2022;25(3):397-402. doi:1038/s41391-021-00451-z
6. Centers for Disease Control and Prevention. Screening for prostate cancer. Published February 23, 2024. Accessed May 22, 2024. https://www.cdc.gov/prostate-cancer/screening/?CDC_AAref_Val=https://www.cdc.gov/cancer/prostate/basic_info/screening.htm
7. 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:1016/j.dsx.2018.08.031
8. 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:1038/s41416-018-0055-4
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12.  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:1016/j.euf.2018.04.001
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14.  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:3390/nu12102967
15.  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:1016/j.urology.2021.05.086
16.  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:3390/nu9101063
17.  Letkiewicz S, Pilis K, ?l?zak 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:3390/nu13010113
18.  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:3390/nu13082662
19.  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:1249/MSS.0000000000001937
20.  Andersen MF, Midtgaard J, Bjerre ED. Do patients with prostate cancer benefit from exercise interventions? A systematic review and meta-analysis. Int J Environ Res Public Health. 2022;19(2):972. doi:3390/ijerph19020972
21.  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:1007/s10654-022-00873-6 
22.  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:1016/j.psyneuen.2017.08.008
23.  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:1080/17437199.2020.1760727
24.  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:9777/chd.2020.1005
25.  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:1002/pros.24345
26.  Chung WS, Lin CL. Sleep disorders associated with risk of prostate cancer: a population-based cohort study. BMC Cancer. 2019;19(1):146. doi:1186/s12885-019-5361-6
27.  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:3390/ijerph17176300