6 things men need to know about prostate cancer

For men diagnosed with prostate cancer or who are concerned about their risk, it can be a daunting task to navigate the latest research news.

On Saturday, prostate cancer experts shared their knowledge about screening, treatment and clinical trials at the fourth annual symposium for patients and families held at Fred Hutchinson Cancer Research Center. The event was hosted by the Institute for Prostate Cancer Research ― a joint program of Fred Hutch and UW Medicine.

IPCR's more than 40 scientists and clinician-scientists collaborate to understand the causes of prostate cancer and its progression, develop new ways to prevent and diagnose the disease, and create new treatments to improve survival and quality of life.

To help distill their latest recommendations and research, here are six things men need to know.

1. Will changing my diet lower my risk of prostate cancer?

To lower the risk of cancer, including prostate cancer, men should focus on eating a diet that includes lots of fruits, vegetables, whole grains, low-fat dairy, lean meats and non-meat protein sources such as nuts and beans. They should also avoid added sugars and refined grains, said Dr. Marian Neuhouser, a Fred Hutch nutritional epidemiologist. (Not sure if a food has added sugars or refined grains? Learn how to read food labels.)

“Don’t think of foods as having a magical attribute,” she stressed, warning men away from assuming that having Brussels sprouts for dinner somehow cancels out the hot dog and chips they had for lunch, or that taking supplements or eating a so-called “superfood” can make up for poor overall eating habits.

“That’s what the evidence is starting to tell us,” she said. “The whole is greater than the sum of its parts.”

Neuhouser’s recommendations drew from the World Cancer Research Fund International’s report on diet, nutrition, physical activity and prostate cancer, released in fall 2014, and the Scientific Report of the 2015 Dietary Guidelines Advisory Committee, released in February 2015. (Neuhouser served on the committee that drafted the February report.)

What if a man already has prostate cancer ― is there a diet that can improve his outcomes? There’s no good evidence yet to answer this question, Neuhouser said, but prostate cancer researchers at Fred Hutch and UW are engaged in research to help answer this question.

2. Should I get yearly PSA testing to screen for prostate cancer?

Most men who’ve never had prostate cancer probably don’t need yearly PSA testing, said Dr. John Gore, a UW urologic oncologist. PSA testing refers to a blood test for prostate-specific antigen, a protein produced in the prostate which, when present in high levels, may signal the presence of cancer.

In 2012, the U.S. Preventive Services Task Force issued a recommendation against routine PSA-based screening for prostate cancer in men without the disease, saying the risks of screening outweighed the benefits. The guideline’s authors emphasized the test’s high false-positive rates and the harms of being treated for a prostate tumor that is too slow-growing to be deadly.

Gore said that while the task force’s concerns with the test were legitimate, his research with the Hutch’s Dr. Ruth Etzioni, Roman Gulati, and other collaborators found that PSA screening has contributed to a drop in prostate cancer deaths since the 1980s. In July 2014, their team published research showing that discontinuing PSA testing completely in the U.S. would cause tens of thousands of additional deaths over a 12-year period.

Instead, their research has pointed toward a more nuanced approach to PSA testing, one that screens low-risk men less often or uses a higher PSA cutoff for deciding whether an older man should pursue subsequent prostate biopsy. (Olden men may have higher PSA numbers for harmless reasons such as prostate enlargement.)

This approach is more in line with the guidelines issued by other advisory groups, which recommend that doctors and patients make PSA testing decisions based on the patient’s age, health status and values. (For example, see the prostate cancer screening recommendations of the American Urological Association.)

Gore also pointed out that wider adoption of a conservative approach to treatment, as appropriate ― sparing men the urinary and sexual side effects of aggressive approaches unless absolutely necessary ― would reduce the harms caused by screening.

3. How does genetics affect my risk of prostate cancer?

A family history of cancers ― not only prostate cancer ― may increase a man’s risk of developing prostate cancer, said Dr. Heather Cheng, an oncologist and researcher at UW and Seattle Cancer Care Alliance, Fred Hutch’s treatment arm.

Shared genetics is part of this story, she said, pointing to recent research on BRCA2, a gene originally discovered and named for its role in breast and ovarian cancer risk. Harmful mutations in BRCA2 may increase the risk for breast and ovarian cancer, and can increase a man’s risk of developing prostate cancer and of dying from it.

A small, but important, fraction of men with prostate cancer have inherited BRCA2 mutations, Cheng said. But there currently are no clear guidelines for identifying men who might benefit from genetic screening or for advising men who test positive for cancer-risk mutations. There also are no genetically targeted treatments for prostate cancer, as there are for breast and ovarian cancers. Research in all these areas is underway.

A man with a family history of cancer should talk to his doctor to see whether screening for BRCA mutations might make sense for him, she said. And, it’s important to keep the conversation going over the years, she said ― a new diagnosis of cancer in the family might change the doctor’s previous recommendations.

4. I’m in active surveillance for my prostate cancer. Do I really need all these biopsies?

Right now, biopsies are still standard of care ― but stay tuned.

In active surveillance, doctors use regular biopsies to check the progress of prostate tumors in men with a very low risk of dying from their cancer. If a doctor finds that the cancer is progressing into a more dangerous form, the patient can then begin treatment. If the tumor is stable (or if there’s no evidence of cancer), then he stays on surveillance.

Taking an active surveillance approach protects men from treatment side effects if there’s no cause to treat the cancer ― but not every biopsy reveals useful information, and each one carries risks, including bleeding and infection.

Researchers with the Canary Prostate Active Surveillance Study, led by Dr. Daniel Lin of Fred Hutch, recently published an online biopsy risk calculator for more-personalized medicine in patients undergoing active surveillance. The tool is designed to guide patient-doctor decisions about follow-up biopsies based on the likelihood that a given biopsy will yield signs of disease progression.

The researchers developed the calculator based on data from 859 men participating in the Prostate Active Surveillance Study, a long-term study involving hundreds of men with prostate cancer that seeks to develop better ways to distinguish between those who would benefit from aggressive treatment and those who would be better served by monitoring.

With the help of the calculator, which the researchers continue to develop, doctors and patients will potentially be able to tailor a biopsy plan that makes the most sense for each man and, if possible, spare him from unnecessary risk and cost.

5. I was diagnosed with prostate cancer but I’m worried about side effects from treatment. How can I find a balance?

“Doctors woefully underestimate patients’ problems with side effects from treatment for prostate cancer,” said Gore, citing research showing that men’s cancer specialists are not aware just how much their patients are bothered by incontinence, a frequent need to urinate, sexual dysfunction, and other quality-of-life issues commonly caused by treatments for prostate cancer.

But men often have treatment options. Gore cited a research-based decision tool for prostate cancer, published last year by the Agency for Healthcare Research and Quality, meant to help patients with localized cancer talk through treatment options with their doctors based on their values, preferences and medical histories.

Gore noted, however, that while decision aids are helpful, they cannot tell an individual man with much certainty how he’ll fare after treatment. Research funded by the men’s health-focused Movember Foundation is underway to collect data on post-treatment quality-of-life outcomes from men undergoing treatment for prostate cancer, with the goal of developing better guides for choosing a course of treatment and managing post-treatment symptoms.