When Shakespeare?s Prince Hamlet declares ?What a piece of work is man,? he conveniently forgets to mention a body part where the workmanship?s more questionable. I?m referring to that little walnut- size gland called the prostate that sits between the bladder and rectum. For much of a guy?s life, the prostate just quietly does its job, manufacturing the fluid that transports and nourishes sperm. For that, it deserves our everlasting thanks. But in almost every man, this blessed little wonder will eventually reveal its dark side, and sometimes pour out a whole sack of woes.
See, in the conventional view, the longer men live?and the whole species lives longer now?the more likely they?ll be plagued by prostate cancer or benign prostatic hyperplasia (BPH). If they?re ?lucky,? prostate cancer won?t kill them, but the treatment may leave them incontinent or impotent or both. As common in older men as questionable golf attire, BPH means a prostate so outsized that it hinders a man?s ability to pee. And that?s just the start of the trouble, which can culminate in total urinary retention, urinary tract infection, or serious bladder and kidney damage. So much for ?I?m not getting older, I?m getting better.?
Nor do young men always get away scot-free. While they?re waiting in the docket for prostate cancer or BPH to strike, they might get nailed by prostatitis, an inflammation of the gland that can happen at any age. Prostatitis can cause pain in the genitals or back, frequent and urgent urination, pelvic discomfort, and a literal pain in the butt.
Here?s the overall picture, by the numbers. The worst of the three big prostate conditions is, of course, prostate cancer, with an estimated 234,460 new cases in the US each year. About 27,350 men a year die from the disease?although on an optimistic note, the death rate is falling. BPH, the prostate condition most likely to plague men, occurs in more than half of all US males between the ages of 60 and 70, and?help!?up to 90 percent between ages 70 and 90. Prostatitis? The odds come down to a coin toss, since half of all guys will suffer this condition sometime in their life.
But no need to panic quite yet?the alternative medical world offers a number of validated preventive strategies, and research into other natural therapies continues apace. From herbs to supplements to lifestyle changes, research at major institutions such as Columbia University points towards a more hopeful, preventive approach that just might head off prostate trouble at the, uh, pass. Better yet, many of these same lifestyle tweaks might prevent heart disease, colon cancer, diabetes, and bunches of other nasties that also lurk in the shadows.
Gender is Not Destiny
You begin to see past the prostatic doom and gloom when you look closely at the risk factors for prostate cancer. Take one of the biggest, ethnicity and nationality. Being an African-American man notoriously puts you at high risk for the disease compared to Caucasian men. Yet, curiously, prostate cancer is less common in Africa than in North America and northwestern Europe.
Now consider the Japanese and other Asians. A study published in 2004 by the Urological Sciences Research Foundation showed that there?s as much as a 10-fold greater occurrence of prostate cancer in the US than in Japan and other Asian countries. Yet, when Asian men move to Western countries and start living that fatty, flabby Western lifestyle, they start getting prostate cancer at more Western-like rates. The effect shows up within one generation. Prostate cancer is less widespread in Central and South America than in Europe and North America, too.
Finally, note the purely Western risk factor of poor eating habits. A wealth of data has established that a diet high in red meat and/or high-fat dairy products increases the risk for prostate cancer. We also know that men with these dietary habits tend to eat fewer fruits and vegetables.
These phenomena await scientific explanation, but they point in an obvious direction, which is why there?s been an explosion of interest by researchers in lifestyle-related causes of prostate cancer and other prostate problems. They?re looking in two directions: First, what specific aspects of our Western way of being are harming men?s prostate health? Second, what specific aspects of African, Latin American, and Asian living might be providing some sort of protective effect? Throw it all in a blender and we just might end up with a regimen that prevents all these terrible things that happen to men, or at least drops the risk several notches.
Feed Your Prostate Right
Aaron Katz, MD, author of Dr. Katz?s Guide to Prostate Health, looks like a more serious Adam Sandler on his book cover and sounds like him on the phone. But there?s nothing Hollywood-esque about his current pursuit. After first helping to pioneer the prostate cancer treatment called cryosurgery, Katz has forged a second career as a guru about natural prevention and treatment of prostate problems.
Director of Columbia?s Center for Holistic Urology, Katz tends not to make general recommendations, especially on the treatment side. ?It has to be tailored to the individual patient,? he tells me. But prevention by its very nature is much less specific, so he does lay out a kind of one-size-fits-all preventive routine, based on a concept called ?chemoprevention.?
Simply stated, chemoprevention means regularly consuming certain foods, herbs, and other natural substances that appear to protect against prostate problems, or at least slow their progression. They do this by targeting two bodily processes?oxidation and inflammation?which Katz feels underlie all prostate disease.
Oxidation describes a chain reaction that occurs when we metabolize our food. If we don?t get sufficient antioxidants in our diet, or if we eat poorly or expose ourselves to too much stress or certain oxidation-promoting pollutants, we get unhealthy levels of oxidation in our body. Inflammation is linked to oxidation, because unhealthy levels of inflammation feed the oxidation chain reaction and help push it to unhealthy levels, too. ?In healthy bodies, inflammation occurs acutely in response to threats such as infection,? Katz explains. ?When the immune system defeats the threat, the inflammation subsides.? But for some reason (Katz and other experts suspect diet and genetics are largely to blame), inflammation becomes chronic in some people and that?s when the problems start?and not just in the prostate, apparently, because chronic inflammation as well as oxidation are now being seen by the medical community as keys to cardiovascular disease, also.
To counteract oxidation and chronic inflammation, Katz recommends a dizzying array of supplements, herbs, and food products, with much of his advice well-supported by clinical research. But his sermon begins with an all-out assault on the American diet, especially the good ol? boy staples of red meat, fried foods, sugar, and simple starches such as white flour. It?s a diet that hikes your prostate risk factors in several ways, he says: ?Start with the fact that a ?real man?s? diet will make you fat. Being overweight has been tied to much higher rates of prostate cancer all by itself.? Other downsides to the diet include the carcinogens from pesticides and herbicides, the boost American foods give to oxidation, and the high levels of omega-6 fatty acids?from oils and animal products?in the diet, which spur inflammation. Finally, guys that eat this way probably aren?t eating prostate-protecting foods such as deeply colored vegetables and whole grains either. ?When you look at all the problems with the American diet, the average American male is digging a real hole for himself.? Katz notes.
No single person is likely to act on every suggestion Katz makes. The list is so long that you?d have to build new kitchen cupboards just to hold all the preventive products. But base your chemoprevention regimen around the following, he suggests:
- Saw palmetto. This popular herb suffered a blow to its reputation when a recent study found it no more effective than a placebo in relieving BPH patients? urinary symptoms. The study shook Katz?s faith, too, but not so much that he doesn?t still think that taking the herb is justified. All the studies of it, favorable and not, can be picked apart for this or that flaw, he notes. As with any herb, buy it in an effective form. ?It?s not only the herb itself but how it?s extracted,? says Katz. ?I think it?s important to use an ethanol extraction or something like that. I think you should have the entire component, the whole herb, in the product.?
- Selenium. A study at the University of Arizona, based on subjects taking 200 mcg per day of a selenium supplement, showed that this trace mineral dramatically reduced not only prostate cancer risk but cancer risk overall. The study used a fermented form of selenium made by combining yeast with selenium salt. ?Fermentation makes the selenium more biologically active, and that makes it more effective against cancer,? Katz says.
- Vitamin E. A large Finnish study backs this antioxidant?s power to ward off prostate cancer. Katz says men should take at least 240 IU daily.
- Lycopene. Another antioxidant associated with low prostate cancer risk, lycopene is best consumed in cooked tomato products like pasta sauce, especially sauce that includes oil.
- Green tea. This antioxidant- and anti-inflammatory-loaded beverage may be a key to the low prostate cancer rates in Asia. Several studies suggest that either the whole tea or various components of it act against prostate cancer.
- Zyflamend. Katz has personally conducted research with this anti-inflammatory herbal compound and likes what he?s seen. ?We?ve had patients in our clinical trial that have biopsies showing PIN [a pre-cancerous prostatic condition],? Katz says. ?They?ve taken Zyflamend?three pills a day?and their PSAs have gone down 20 percent and they have no PIN on repeat biopsies at six, 12, and 18 months.?
- Soy compounds. Experts suspect that Asians? profuse consumption of soy contributes to their lower rates of prostate cancer. Katz is particularly impressed with Genistein Combined Polysaccharide (GCP), a fermented supplement that contains genestein, a major component of soy. Katz?s lab has found that GCP seems to inhibit prostate tumor cell growth. Big downside: A month?s supply costs anywhere from $275 to $600. Soy burgers, anyone?
- Prostabel. This herbal blend combines two exotic herbs, one of which has long been used by tribes in the Amazon rain forest to boost the immune system. ?This is ongoing in our clinical trials right now,? Katz says, ?but in our lab data, it seems to be very powerful in preventing cancer.?
?There?s much more research to be done,? Katz cautions. ?But regardless of the specifics, I think chemoprevention may be an approach that can not only prevent prostate problems but also reverse some problems such as cancer or BPH that have started to develop.?
The Heart of the Matter
?There?s a joke I start off every conference with now,? says Mark Moyad, MD, MPH. ?I say I heard about the new Alzheimer?s prevention plan. It?s exercise, eat better, and reduce cholesterol and blood pressure. And then I saw the breast cancer prevention plan and it?s exercise, eat better, and reduce cholesterol and blood pressure. I do this for two minutes with different diseases, and people start laughing because they realize these diets are all the same.?
Moyad, senior research associate in urology surgery at the University of Michigan?s medical school, essentially agrees with Aaron Katz on most of his recommendations, but he approaches prostate disease prevention in a more global?in fact, a startlingly global?way. Backed up by gathering evidence on a number of fronts, Moyad strives in every place he works or speaks to communicate some basic but uncommon messages?uncommon because, as he sees it, medical specialties such as urology have led us to see the trees but not the forest.
First message: Men who want to avoid prostate problems should actually forget about the prostate and look to improve their heart health. Sound crazy? Consider that cardiovascular disease (CVD) is the number one killer of men in the US. Prostate cancer doesn?t come close to CVD?s body count. When patients come to Moyad for prostate prevention, he?s most likely to send them out for a comprehensive cardiovascular health evaluation?cholesterol, triglycerides, weight, blood pressure, body mass index?and then through lifestyle changes, work to drop their cardiac risk in each category to zero. ?We use this saying that heart healthy equals prostate healthy,? Moyad says. ?If you keep that in mind, you?ll always do pretty well.?
?I?ve always said it never makes sense to move a patient out of the way of an oncoming truck just to let them move in the way of an oncoming car,? Moyad adds. ?Which means I?ve never understood the point of a man getting surgery for prostate cancer if five or 10 years after that surgery he?s going to die of a heart attack or stroke or colon cancer. And depending on whose data you?re looking at, [one of those diseases has] become a number-one risk factor for death within 10 years after prostate treatment. That tends to get missed.?
Another message that Moyad drives home everywhere he goes is moderation. That is, more is not better, and sometimes it?s worse. For instance, consumers bought millions of dollars of selenium supplements after a notable clinical trial showed selenium had value as a preventive for prostate problems. Yet that same trial showed that the highest risk of death for subjects in the trial was, again, cardiovascular disease, not prostate cancer, and that taking too much selenium increased the risk.
People assume that if something is good for you, then you can?t get too much of it, but that ain?t necessarily so, says Moyad: ?I?m starting to see the opposite effects in what I call the ?high dose? generation. We see these foods and supplements do the opposite of what we intended them to do.? Good example: flax seed, which Moyad advocates in its ground form because an important clinical trial showed potentially significant benefits for prostate health. But in the study, subjects took only three tablespoons. If that?s what the trial showed, says Moyad, then that?s what you should take if you want the same results?and don?t want to become a girly-man.
Like soy, flax seed contains a plant form of the female hormone estrogen, which may well explain its benefits for the prostate (although it?s also loaded with anti-inflammatory omega-3 fatty acids). When it?s consumed in moderate amounts, Moyad says, the extra estrogen flax seed pumps into guys won?t even register on a blood test. But he also cites the case of a 32-year-old male who suffered erectile dysfunction after gulping down 12 servings a day.
Studies show this remarkable food dramatically improves subjects? cholesterol numbers, too. And that gets back to another one of Moyad?s favorite sayings: ?Even if I?m wrong, I?m right,? meaning that even if some of his advice about the prostate ultimately proves to be off-base, those same steps will improve men?s cardio well-being, which is more important from a probable threat standpoint anyway.
So maybe this little gland isn?t a curse, after all. Maybe it?s a ticket to better overall heath. And an introduction?to the delicious, nut-like taste of ground flax seed, the buffet of flavor possibilities with soy, and the soothing, Eastern aesthetics of a perfectly prepared cup of green tea.
In Dr. Katz?s Guide to Prostate Health, Aaron E. Katz, MD, reports on two products, Zyflamend and Prostabel, and a couple of phytonutrients that have shown great promise in treating benign prostate hyperplasia and even prostate cancer. The products contain herbs that seem to work synergistically to reduce inflammation and oxidation.
- Holy basil (Ocimum sanctum). Also know as tulsi in ayurvedic medicine, this is a nonculinary type of basil that is high in ursolic acid.
- Ginger (Zingiber officinale). Long a treatment for motion sickness and nausea, this herb has significant anti-inflammatory properties.
- Turmeric (Curcuma longa). A traditional spice in Indian cuisine that contains curcumin, a powerful anti-inflammatory.
- Green tea (Camellia sinensis). An ancient beverage from the Far East that contains more antioxidants than any other food.
- Oregano (Origanum spp.). This staple of Italian cooking contains as many as 31 anti-inflammatory compounds, plus antioxidants.
- Rosemary (Rosmarinus officinalis). Another common culinary herb that inhibits COX-2, a major culprit in inflammation.
- Hu zhang (Polygonum cuspidatum). A traditional Chinese medicinal herb that?s rich in resveratrol, a potent heart protector.
- Chinese gold thread (Coptus trifolia) and barberry. An herbal combo that?s chock full of berberine, another anti-inflammatory.
- Scutellaria baicalensis. A traditional Chinese herb that directly interferes with the biochemical process of inflammation.
- Pao pereira. South American indian tribes used the bark of this Amazonian rain forest tree to improve their immune systems.
- Rauwolfia vomitoria. The root bark from a tropical African plant used in numerous herbal remedies.
- Beta-sitosterol. In vitro studies show this phytosterol (plant fat) inhibits the division of prostate cancer cells.
- Inositol hexaphosphate (IP6 with inositol). This nutrient found in soy, rice, sesame, and whole grains has shown strong inhibitory action against prostate cancer.
By Alan Reder