The prostate gland is a part of the male reproductive system. It’s usually compared in size and shape to a walnut. It helps make semen and surrounds the urethra, the tube that carries urine from the bladder through the penis.
Prostate cancer is a very common cancer diagnosis in American men. It is generally a disease of older age. It is rare for a man to be diagnosed with prostate cancer before the age of 50 or to die from it before the age of 60. It is more common among African-American men and those with a family history of the disease.
Prostate cancer grows slowly. The prognosis for treatment is good, especially if the cancer is caught early.
Whether alcohol is a risk factor for being diagnosed with prostate cancer is widely studied and not definite.
A recent review of studies around the world found “little indication” of a link between alcohol and the risk of prostate cancer. But the researchers did note that the link was stronger in studies conducted in North America. In that case, the risk increased with the amount a man drank. The researchers concluded that the question of alcohol and the risk of prostate cancer deserved more study.
“When it comes to a clear link between alcohol and prostate cancer, there really isn’t one,” says Christopher Filson, MD, an assistant professor in the Emory University department of urology and a staff physician at the Atlanta Veterans Administration Medical Center.
Whether a man should drink after being diagnosed with prostate cancer is even more complicated. It depends many factors. They include how advanced the prostate cancer is and the amount of alcohol involved.
In a simple case, a doctor may recommend that an early diagnosis of prostate cancer does not need any treatment at all. In that case, alcohol might be okay.
“What I tell my patients is, alcohol in general and in moderation is okay,” Dr. Filson says. With a simple diagnosis of prostate cancer, “they should not have to cut alcohol completely out of their lives.”
A trickier question arises when someone is being treated for a prostate cancer. “Alcohol can affect how well certain chemotherapies or certain medications can work. Patients will have to have that conversation with their medical oncologist,” Dr. Filson says.
For example, alcohol seems to increase the risk of prostate cancer among men who take certain drugs often prescribed for an enlarged prostate. The drugs finasteride and dutasteride both seem to lower the risk of prostate cancer among men. Alcohol seems to lower or eliminate that benefit. These drugs belong to a class called 5-ARIs, suggesting that men avoid alcohol if they are taking this kind of medication.
Someone who is avoiding alcohol may also miss the social aspects of sharing a drink. One option is to replace the liquor in a drink with soda or another mixer. Consider a Virgin Mary, the nonalcoholic version of the Bloody Mary. Another popular alternative is the half-lemonade and half-iced tea Arnold Palmer.
Prostate cancer can exist for years with few or no symptoms. Among the most common tools to diagnosis prostate cancer is a test for prostate-specific antigen (PSA). PSA is a chemical that usually is elevated in the presence of prostate cancer. A doctor also is likely to perform a digital rectal exam, which can reveal the size and shape of the prostate gland. Both of these tests usually are part of man’s routine physical exam.
A doctor who suspects prostate cancer may want to take a biopsy, in which a small piece of tissue from the prostate is removed and examined for any abnormalities.
The right treatment for prostate cancer depends on how severe the disease is and how well someone is functioning with the disease. A person’s age and many other factors are also important. All treatment options have pluses and minuses that should be discussed with your doctor.
Because prostate cancer grows so slowly, your doctor may recommend just watching it with frequent PSA tests and digital rectal exams.
Carefully watching the prostate for changes is considered the most reasonable option for low-risk cancers and men with a life expectance of 20 years or less.
A radical prostatectomy removes the prostate, vessels associated with the production of semen, and lymph nodes in the pelvis. The organs can be removed conventionally or through a laparoscope, a small illuminated tube inserted into the body.
Several different kinds of radiation therapy are available to treat prostate cancer. In brachytherapy, small pellets of radioactive material are placed under the skin near the tumor. External beam radiation, as the name suggests, sends radiation to the prostate from outside the body. A doctor may use radiation along with types of treatment.
One of the newer radiation therapy drugs is Xofigo. It is injected into the body and travels to the site of the tumor. It was approved by the Food and Drug Administration in 2013 for advanced prostate cancer and tumors that do not respond to other forms of treatment.
Androgen deprivation therapy
Androgen is a male hormone that stimulates the growth of prostate cancer. Suppressing androgen can make a rapid and dramatic improvement course of the disease. In the long-term, androgen deprivation therapy loses its effectiveness. In that case, other options have to be considered.
A wide variety of drugs are available to attack prostate cancer directly. They are used either alone or in combination, in a treatment referred to as chemotherapy. Some common ones:
- docetaxel with prednisone
- cabazitaxel with prednisone
- abiraterone acetate with prednisone
Advanced prostate cancer often travels, or metastasizes, to the bone. A doctor may prescribe drugs to slow or prevent bone loss and lessen the pain that often comes with it:
Studying the effect of diet and lifestyle changes on prostate cancer is difficult because the tumor grows so slowly. Usually, researchers look at changes in prostate-specific antigen (PSA). It is a good but not perfect substitute for measuring the risk of disease or death from prostate cancer.
A recent review identified three studies that tried to fix some of the common shortcomings in such studies. These studies found that:
- A capsule containing pomegranate seed, green tea, broccoli, and turmeric was associated with a reduced increase in PSA levels.
- Flaxseed slowed the increase in the number of cancer cells in men preparing for radical prostatectomy. But the flaxseed did not have a particular effect on other measures of prostate cancer.
- A supplement consisting of soy, lycopene, selenium and coenzyme Q10 boosted follow-up PSA measures among men undergoing radiotherapy or radical prostatectomy.
Another review found various dietary effects on prostate cancer markers:
- A low-fat diet decreased PSA.
- Margarine fortified with vitamin E slowed the increase of PSA over time.
- A diet heavy in plant-based estrogens and supplemented with soy grits lowered PSA compared to a wheat diet.
- Supplements of lycopene, a chemical found in tomatoes, grapefruit, and other plants, improved PSA markers and mortality.
Prostate cancer is common, especially among older men. It grows slowly, and the best protection against it comes from regular testing. If it’s diagnosed early, a doctor may first recommend monitoring the disease instead of immediate treatment. A diet that is low in fat and high in plant-based estrogens might help protect against prostate cancer.