Integrative Support During Prostate Cancer Treatment and Beyond

The information presented here represents recommendations for supportive care in breast cancer and are not meant to be a replacement or substitute for standard oncologic care.

The information detailed below should be utilized as: 

  •  Supportive for potential preventive lifestyle changes to reduce prostate cancer risk.

  • Safely support ongoing cancer therapies 

  • Diet, nutrition and exercise recommendations that in survivorship might potentially reduce recurrence risk.

There are a number of current options for treating localized prostate cancer including active surveillance, radiation and/or surgery in combination with hormone blockers. Over time however, prostate cancer cells become resistant to hormone blockade and are considered androgen independent, allowing cancer growth and disease progression.

Much of the following information is from animal and laboratory studies while some is based on patient clinical patient treatment.

The intent of this article is to provide supportive information, using natural substances and lifestyle changes, that hopefully will allow your oncology treatments to be more effective 

With a diagnosis of prostate cancer and the ensuing treatments it can feel like your individual input is limited. During long term treatment, and even during active surveillance, personal involvement with a supportive diet, supplementation and lifestyle changes can offer a level of empowerment that can potentially provide opportunities for a better quality of life and a reduction of the risk of recurrence.

Important–During treatment and beyond, supportive care can impact quality of life. These recommendations should only be considered and actuated when recovery and the repair of the body are progressing. 

Initially, seeking professional guidance as to the approach to recovery of basic activities required for daily living, fatigue, digestion, sleep, often take precedence to establish the body's equilibrium first. Was recovery is commencing, these additional recommendations should be considered.

Dietary Guidelines for Reduced Prostate Cancer Risk

Are a summary of recommendations offering self directed dietary and nutritional recommendations that are focused on prevention and healing and recovery associated with treatment.

Prostate cancer is a disease that 1 in 8 men, 12%, will be diagnosed with over a lifetime. In 2025, the American Cancer Society predicts 313,000 new cases and 35,000deaths. Six of ten of these cases will occur in men >65 with a greater risk occurring in African men or Caribbean men of African ancestry. 

At diagnosis, 75% of men have localized cancer and the five year survival is nearly 100% based on emphasizing increased awareness in combination with early detection and advanced treatments.

A Plant Based Diet can be a positive preventive measure that has been shown to reduce prostate cancer risk.

 It emphasises plant based products and healthy fats

From the name it can be deduced that this diet is derived from plants and includes: 

  • Fruits and vegetables offer a combination of minerals, antioxidants, vitamins, fiber and flavors and a variety of foods.

  • Nuts and seeds are rich in essential fatty acids, micronutrients and protein coming from almonds, walnuts, chia, flax and pumpkin, pecan and walnuts. 

  • Oils from plants should be used in limited amounts and primarily olive, avocado and coconut.

  • Whole grains are composed of 3 parts, the kernel, the bran, the endosperm which indicate minimal processing, preserving and retaining its nutrients. These include, brown rice,oats, quinoa, whole wheat and barley should be avoided if you can't eat gluten.

  •  Legumes which are seeds grown inside pods and include beans, peas, lentils, peanuts, soybeans, chickpeas, lupins and carob.

The Mediterranean Diet is a plant based diet which allows the moderate use of animal products making it more flexible for some allowing small amounts of animal products but coming with the recommendation of less than 16 oz of animal protein/ week. Some might include dairy and eggs as well as and tofu or seitan for plant based protein

Plant Based Diet Studies

  • A study of 3500 health professionals with nonmetastatic prostate cancer were followed from 1986-2016 and started seven years from diagnosis /treatment with food questionnaires. The average age was 68 and almost half had prostate surgery and a third had radiation. Following their quality of life scores, those eating a plant based diet had better urinary control, sexual functioning, bowel function and vitality.

  • In a study of 2000 men with non metastatic prostate cancer followed from 1999-2018, those with the highest intake of plant based foods on a plant based diet had a lower risk of prostate cancer progression compared with those having

the lowest intake

  • In a study of 48,000 men, 6600 had prostate cancer. In men less than 65, those on a plant based diet had lower advanced, lethal and fatal prostate disease.

  • Mediterranean diet patterns in men after diagnosis of non metastatic prostate cancer are associated with lower mortality.

  • A small study using a plant based diet, in men with prostate cancer, showed that it slowed the rate of rise of the PSA, the doubling time which is used as a marker of cancer cell growth.

Diet and Lifestyle Modifications 

  • The pioneer physician Dean Ornish did a small study on utilizing intensive changes in lifestyle and diet to assess its effect on prostate cancer progression, which revealed decreased PSA and improved prognosis. 

  •  In 2008 Dr Ornish did another investigation into diet and lifestyle effects on prostatic genetic expression in patients who were under active surveillance of their prostate cancer without any intervention. The beneficial effects showed improved immune and metabolic functions. 

  • They also reported that patients that had been under active surveillance for early cancer for two years, and were following a low fat plant based diet, exercise and modifications of lifestyle had been able to avoid conventional treatment.

  • At the other end of the spectrum, an Iranian study of men who ate ultraprocessed foods, indicative of poor nutrition and high carcinogen load, showed a 2.81 higher association with developing prostate cancer between the highest and lowest intake. Foods associated with ultraprocessed foods include, soda and sweet drinks, packaged snack chips, instant noodles, processed meats and pastries and desserts.

Vegan Diets

Lower the risk of prostate cancer by approximately one third.

High saturated fat

Diet is a major risk factor for prostate cancer. Fats are molecules composed of a glycerol molecule bonded with fatty acids..The fatty acids are connected to neighboring carbon atoms in the molecule; if there is a single bond it is called a saturated fat. Examples are red meat, lamb and pork. If there are two bonds with a neighbor it is called unsaturated and is commonly a plant based liquid as an oil. If there is only one double bond it is considered mono unsaturated, olive oil, or if there are multiple double bonds it is called polyunsaturated, like canola oil.

Trans fats are artificially hydrogenated, semi solid, and used in processed foods like fast foods, margarine, some peanut butters and shortening.

While the data is inconclusive there is a suggestion of a link between high intake of trans fats and prostate cancer. 

  • In research with mice, a high saturated fat diet was shown to promote inflammatory prostate cancer growth by upregulating a gene that stimulated histamine biosynthesis. Histamine produces pro-inflammatory responses by recruiting immune cells to the tumor via mast cell effects. Pro-inflammatory responses then promote cancer progression. This effect of histamine on cancer growth can be blocked by using the commonly used allergy medication fexofenadine, allegra.

  • There is also research information that suggests high fat diets also create gut dysbiosis or imbalance which increases the passage of damaged bacterial cell components, LPS, lipopolysaccharides, into the circulation promoting tumor growth. 

Insulin-like Growth Factor, IGF-1

IGF-1 binds to a receptor on prostate cancer cells causing increasing cellular growth and progression. In increased amounts it encourages prostate cancer cell survival, resistance to programmed cell death and promotes androgen therapy resistance. IGF-1 is increased in obesity, high intake of dairy products and large amounts of animal fats. 

  • Milk was studied to assess whether IGF-1Influences prostate cancer. A study reviewed 31 articles on the relationship of milk and IGF-1 and 132 studies on the relationship between IGF-1 and prostate cancer. 

IGF is a hormone associated with insulin release which promotes growth and metabolism. The milk proteins, whey and casein, contain branched chain amino acids (BCAA) which stimulate insulin release and via the hypothalamic-pituitary axis, IGF-1 synthesis. Milk also has tryptophan which increases growth hormone and influences IGF-1.

Their results suggest moderate evidence that elevated IGF-1 does promote prostate cancer growth and progression.

  • Another study that reviewed 10,000 prostate cancer cases and 13,000controls also concluded that there was strong evidence of an association between prostate cancer risk and IGF-1.

SOY

  • Researchers reviewed 22 articles which included almost a million and a half participants to evaluate the use of soy products and risk reduction of prostate cancer. It appeared that including it in the diet reduced the risk in low grade or localized prostate cancers but had no effect on high grade or non localized disease. 

Soy also reduced risk for African American men and Latinos but not Chinese, Japanese or Whites. It also only was effective in non fermented soy, not fermented soy, and eating large amounts or in high frequency could have a negative impact on reducing risk, more is not better!

  • In a study of 1294 men with prostate cancer but no recurrence or progression 2 years after diagnosis those that consumed the greatest amount of eggs or poultry with skin, from the amino acid Choline, had double the risk of adverse cancer events compared to those eating lesser amounts.

  • Men at high risk of prostate cancer progression had a four fold increased risk of progression or recurrence based on high poultry intake, which included skin, compared to low risk prostate cancer patients with low poultry intake. Dietary fat consumption did not have an effect. Eating processed or unprocessed red meat or skinless poultry was not associated with recurrence or progression.

The Effect of Exercise in Prostate Cancer

Aerobic and resistance exercise can and should be one of the cornerstones for cancer risk reduction and for potential improvement of outcomes. Often few specific recommendations are offered as guidelines for people in treatment or when being followed in surveillance programs which realistically requires expertise in planning each individual’s program to determine the amount, the specific type, and the intensity of workouts which will allow the best opportunity to achieve the goals and its potential cancer benefits, while reducing risk of injury. 

While involved in ongoing cancer treatments, or upon conclusion, and often for many months thereafter, people are debilitated with fatigue, malnutrition, loss of weight, muscle mass and strength and combined with other side effects can prevent a robust exercise program, many also have just lost their mojo to work out. When confronted with these issues it becomes difficult, initially, to exercise at high levels, and attempting to, could be harmful and prolong recovery.

So beginning a planned exercise program, when ready, needs to start slowly, with very gradually increasing increments and always individually determined. A one size exercise plan is not feasible and can have a negative impact.. Pursuing advice from a physical therapist or physical trainer experienced in rehabilitation is needed to provide the needed guidance and correct instruction.

The study topics discussed reflect current ideas of exercise for prostate cancer patients. For many years the philosophy was to rest and recover from radiation and surgery. These contemporary studies are supported by many in each category but the goal is to reflect current thinking in the field.

  • A clinical study divided men with prostate cancer receiving androgen deprivation therapy. In men, androgens support muscle mass and strength, so blocking them with medication diminishes these traits. In this study, 60 men on androgen blockade were divided into 30 performing resistance training in a therapeutic situation and 30 controls. Various types parameters revealed that with resistance testing muscle strength and mass improved in the treatment group and decreased in controls.

  • In men with urinary incontinence that can occur following prostate surgery. Men who had supervised pelvic floor exercise, but not self practiced pelvic floor exercises had improvement of their urinary incontinence.

  • Radiation therapy for prostate cancer diminishes quality of life and physical activity. It has been shown that exercises reduces fatigue

  • In a review of 6 randomly controlled studies, including almost 400 men with prostate cancer at various stages and gleason scores showed exercise benefited cardiovascular fitness, and improved muscle function and urinary symptoms, but not digestive or sleep issues.

  • Exercise was studied by reviewing randomized control studies, six, involving 332 men under active surveillance for their prostate cancer. They use different exercise types and followed improved diets which showed they had improved cardiovascular fitness, possibly improved quality of life with a POSITIVE effect on PSA levels.

  • Exercise was evaluated in advanced prostate cancer in a supervised exercise environment. It was determined the exercise increased myokine, a cytokine released by skeletal muscle which is associated with affects on significant prostate cancer suppressive pathways.

Common Supplements for Supportive Care in Prostate Cancer

DIM, Diindolmethane

  •  It is the active form of I3C, Indole-3 carbinol. It is a naturally occurring glucosinolate that is found in brassica vegetables like cabbage, broccoli and other cruciferous vegetables and produces a bitter flavor that is designed to be unattractive to pests and pathogens.

The prostate cancer cell line, PC3 studied in the lab does not have androgen receptors that can be blocked by hormones, which is an essential prostate treatment modality. DIM inhibited replication of this cancer cell line suggesting a benefit from the intake of brassica vegetables or DIM. 

  • DIM also affects the prostate cancer cell by its interaction with cannabinoid receptors CB1 and CB2, the brain and CNS, to enhance programmed cancer cell death. 

Agarius Mushrooms

  • A study evaluated the effect of Agaricus mushroom powder in patients with prostate cancer and a continuously rising PSA, indicating possible recurrent cancer. There were 36 patients and 36%, 13 patients had their PSA decrease below baseline levels and 2 patients had undetectable PSA which remained so for almost 3 years. The authors concluded that Agaricus had decreased immunosuppressive factors allowing prostate cancer growth.

The Most Impressive Study to Date On Modified Citrus Pectin

Relapsing non metastatic prostate cancer in men, after local therapy, poses a concern as to what level of therapy is needed to control the cancer growth.

A phase 2 patient clinical trial using the combined data of multiple hospital oncology departments tested the supplement modified citrus pectin (MCP) on 49 patients in this situation.

MCP inhibits Galactin -3 protein which is associated with cancer progression and development. Galactin 3 promotes cancer cell adhesion, invasion and metastasis, stimulates new blood formation and assists the cancer to evade the immune system.

The MCP blocks galactin 3, enhances the immune response and detoxifies heavy metals. 

The study at 6 months showed an improvement in PSA doubling time by 75%, indicating slowed growth. At 12 months, patients without progression after the initial 6 months were followed while continuing on MCP for 18 months. At that juncture, 85% had a long term response with 62% having decreased the PSA or remained stable and 90% had improved PSA doubling time and all had negative scans.

Curcumin

Curcumin is a supplement that has been demonstrated to show anti tumor effects in animal and laboratory testing. It is the main component of turmeric. 

The following are Curcumin’s effects on multiple signaling pathways, in the laboratory, on human prostate cancer cell lines.

It is recognized as having the overall effects of being anti-inflammatory, anti angiogenic, antioxidant and anti cancer. In support with prostate cancer these individual studies indicate:

  • Curcumin tested in mice using human prostate cancer cell lines decreased intra tumor testosterone production which is a major contributor to hormone resistant disease.

  • Curcumin altered cell cycle replication of prostate cancer cell growth.

  • In mouse models, it inhibited prostate cancer growth and promoted programmed cell death, apoptosis via inhibition of the JNK signaling pathway.

  • The Notch1 signaling pathway involves gene expression which affects continued cell replication and reduces cancer cell death, both of which are inhibited by Curcumin and showed it also inhibited prostate cell survival and metastasis.

EGCG

There are multiple studies on the use of green tea Epigallocatechin (EGCG) in prostate cancer. 

  • One study used cultured prostate cancer cells to evaluate the effects of EGCG on fatty acid synthase. Fatty acid synthase (FAS) is an enzyme family which enhances the synthesis of fatty acids and in prostate cancer, is known to affect prostate cancer growth and cell survival. EGCG inhibited FAS activity and decreased lipid synthesis, inhibition of cell growth and cancer death.

  • Prostate cancer is an androgen (male hormone) dependent disease and prostate cancer cells depend upon them for growth in both localized and advanced disease. Androgen blocking drugs are a foundation of treatment but in time patients become refractory to its effects. 

EGCG has been shown to antagonize androgen action by inhibiting or downregulating micro RNA’s (MiRNA) that upregulate gene expression that increases prostate cancer growth and diminishes programmed cell death. EGCG also upregulates or enhances tumor suppressor genes.

  • In castration resistant prostate cancer that has metastasized, indicating that androgen blocking hormones are no longer effective, utilizes chemotherapy as an additional treatment. A study using prostate cancer cells treated with docataxel (Taxotere) alone and one with Taxotere plus the addition of EGCG and Quercetin, showed that this combination with Taxotere was more effective than Taxotere alone in inhibiting tumor invasion.

  • Taking green tea catechin supplements equivalent to 6 cups of freshly brewed green tea decreased the development of prostate cancer in men with precancerous lesions, while 7 cups or more produced the greatest reduction compared to the lowest number. 

  •  Other studies have found moderate doses of EGCG having increasing beneficial effects but at high end dosages it potentially had detrimental effects. Therefore, prescribing should involve an experienced healthcare practitioner.

EGCG and Prevention

  • Multiple studies of human prostate cancer cells in mice both in cancers that are hormone sensitive and insensitive showed that EGCG induced apoptosis, or programmed cell death, and inhibited growth and cell replication.

  • Other studies have shown EGCG also inhibited VEGF, a protein that stimulates new blood vessel growth and MMP-2 & 9, matrix metalloproteinases, which when excessive in cancer break down the collagen and protein supportive framework between cells allowing cancer invasion.

Melatonin

Melatonin is widely used in solid tumor cancers in the integrative medical community, but not in blood cancers. It possesses

  • Antioxidant effects, inhibits angiogenesis or new blood vessel formation which supports metastatic spread, and also stimulates cell death, apoptosis.

  • It inhibits cancer’s pro survival signaling mechanisms.

  • Reinforces chemotherapy and decreases side effects

  • Studies suggest it is useful in prevention and supportive treatment in breast, prostate, colon, colorectal and gastric cancers.

Melatonin in Prostate Cancer

 A recent 2023 study described the mechanisms of how melatonin can modulate or control prostate cancer beneficially: 

  • Control cancer cell cycle replication.

  •  Reduce androgen signaling needed for growth.

  • Decrease angiogenesis, the formation of new blood blood vessels that can be used for metastasis.

  • Increase cancer cell programmed death.

  • Create genetic stability

  • Improve sleep via regulation of the circadian rhythm.

Melatonin should be a consideration in prostate cancer patients but requires expertise in determining optimum dosage for each individual.

Sulphorophane

Sulphorophane is the active phytochemical derived from its precursor glucoraphanin found in the brassica family of vegetables which include broccoli and broccoli sprouts, kale, cauliflower, brussel sprouts and cabbage. It is a different compound than DIM, but both are found in brassica vegetables. Multiple studies have shown its ability to prevent and decrease progression of prostate cancer.

  • A double blind study of 49 men diagnosed with localized prostate cancer, who were under surveillance, were given broccoli soup to assess the impact of different amounts of glucoraphanin on gene expression in the prostate. Each received 300ml of broccoli soup/day for 12 months. One group received commercial soup, one had soup with 3x the and one group with 7x the amount of glucoraphanin. Gene expression prior to after the broccoli soup treatment was quantified for each patient.

The control group taking commercial broccoli soup showed an increased level of gene expression that was related to increased risk of cancer progression, while the therapeutic soups showed moderate reduction of gene expression in the 3x group and total suppression of gene expression associated with increased cancer progression androgen in the highest concentration.

  • A clinical study was done with 42 men who were scheduled for prostate biopsies. One group received placebo, one group glucoraphanin supplement, broccomax, and a third allin from garlic for 4 weeks. The biopsy tissues showed high concentrations of sulphorophane in the biopsy tissue indicating its penetration .

Pomegranate

The studies on the beneficial effects of this fruit are very interesting. The data comes from lab and animal testing but can be a simple addition to the diet.

 Its major active ingredient is ellagitannin which is broken down in the gut to ellagic acid, which has generalized cancer effects that are recognized as interfering with cell replication and inducing apoptosis.

Initially, prostate cancer is responsive to drugs that block androgen receptors on the cancer cells. Androgens or male hormones are an essential in the development, growth and progression of prostate cancer, but ultimately prostate cancer becomes androgen independent and resistant to hormone blocking drugs.

  • Engineered prostate cell lines that are androgen dependent and androgen independent but over overexpressing androgen receptors were treated with pomegranate juice or pomegranate extract which reduced the expression of genes that produce androgens which would fuel prostate cancer growth.

  • Another study, in mice, using human prostate cancer lines that involved all stages of prostate cancer, when treated with pomegranate showed a decrease in testosterone levels and a reduction in PSA.

  • Using POM Wonderful, a commercial pomegranate extract juice, it was shown, in a lab setting, to have cytotoxic effects on metastatic castration resistant, (unresponsive to androgen blocking) prostate cancer.

  • Using immunodeficient mice, transplanted with androgen dependent cells, pomegranate inhibited tumor growth and reduced PSA.

  • Insulin like growth factor, IGF-1, a cancer growth stimulant is reduced with ellagic acid, a polyphenol found in pomegranate and other fruits, especially berries, vegetables and some nuts. It was shown to inhibit VEGF, vascular endothelial growth factor, which allows prostate cancer to migrate through new blood vessels.

Cranberry

Cranberry has been shown to impact cancer by increasing immune function and its components are known to act against multiple cancer types.

  • One study showed cranberry decreased radiation cystitis in prostate cancer from external beam radiation compared to controls along with urinary burning and pain.

  • Prior to surgery for prostate cancer, it was shown that cranberry capsules lower the PSA by 20% by down regulating androgen receptor genes.

Aspirin Use In Prostate Cancer 

Studies looking at the incidence and distribution of prostate cancer along with interventional studies suggest that aspirin, ASA, can reduce its development, progression and recurrence by affecting the inflammatory cascade of the cyclooxygenase pathway. In African American men, taking ASA is associated with a reduction of both advanced disease and recurrence.

It is recommended that men discuss the safety and possible use of ASA with their physicians as a method to modify prostate cancer risk in combination with surgery and radiation therapies. However, if there are no contraindications and follow up with your doctor occurs regularly, if you are African American and have a family history of prostate cancer this should be an important consideration.

Not All Supplements Are Beneficial, Know What You Are Taking

  • A double blind randomized control study combined lycopene, selenium and green tea catechins in patients having multifocal high grade intraepithelial neoplasia, a precancerous condition, and together they increased the risk of developing prostate cancer. 

Just a reminder that even high dose supplements have the potential to produce approach to their cancer support.

Chinese Herbal Support in Prostate Cancer

At Zibo Central Hospital in Shandong province in China, 60 prostate cancer patients, thirty being treated with hormone therapy alone, thirty with hormone therapy and Chinese herbal formulas. They were followed for 4 years following PSA and Free PSA as tumor markers. Both treatments showed lowering of both markers, but the combined group had a significant lowering of these markers compared to hormone treatment alone.

The combined group also had lower incidence of hormone independent cancer, implying the hormones were no longer effective and the time to develop hormone unresponsiveness was also prolonged.

  • A laboratory study on human prostate cancer cells utilized the Chinese herb, Huang Qi, Astragalus, to study its effect on CD8, cytotoxic T cells and CD4, helper T cells and the PD-L1 protein, the programmed cell death ligand that restricts the activity of the immune system. The results showed that Astragalus modulates or reduces the the PD-L1 effect as well as improves immune function and initiates apoptosis suggesting further research should be undertaken to explore its effects.

  • Men with low grade prostate cancer are often placed under surveillance but these cancers will eventually need treatment as the disease begins to progress. This study, in mice, evaluated the efficacy of the Chinese herbal formula “Deep Immune” for its immune stimulating activity and whether it will affect prostate cancer progression.

The data looked at 84 immune modulating genes and inflammatory markers. In the study this formula, decreased prostate tumor size with lower histologic scores, suggesting lower aggressiveness of the cancer, increased tumor killing by macrophages, and increased CD8 T cells that were cytotoxic for the prostate cancer.

Bladder, Bowel and Sexual Symptoms

With both surgical and radiation therapies for prostate cancer there occur side effects of the treatment that affect the digestive, urinary and genital functions. The clinical skills of experienced practitioners in supportive cancer care can offer personalized individual Chinese herbal formulas for each system experiencing dysfunction. It will not provide rapid relief but has the potential to reduce many symptoms and improve quality of life to a greater degree following these prostate cancer treatments.

References

Plant-based diet associated with better quality of life in prostate cancer survivors

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High-fat diet promotes prostate cancer growth through histamine signaling

Makoto Matsushita, Kazutoshi Fujita, Koji Hatano, Takuji Hayashi, Hisako Kayama, Daisuke Motooka, Hiroaki Hase, Akinaru Yamamoto, Toshihiko Uemura, Gaku Yamamichi

https://onlinelibrary.wiley.com/authored-by/Hayashi/Takuji

Richman EL, Stampfer MJ, Paciorek A, Broering JM, Carroll PR, Chan JM. Intakes of meat, fish, poultry, and eggs and risk of prostate cancer progression. Am J Clin Nutr. 2010;91(3):712-721.

Richman EL, Kenfield SA, Stampfer MJ, Giovannucci EL, Chan JM. Egg, red meat, and poultry intake and risk of lethal prostate cancer in the prostate-specific antigen-era: incidence and survival. Cancer Prev Res (Phila). 2011 Dec;4(12):2110-21. doi: 10.1158/1940-6207.CAPR-11-0354. Epub 2011 Sep 19. PMID: 21930800; PMCID: PMC323229