Lower Prostate Cancer Risk

Judy Siegel-Itzkovich

Did Methuselah, the grandfather of Noah who – according to Genesis – lived for 969 years, contract prostate cancer before meeting his Maker? If human health in biblical times was similar to that today, he probably did, because the main factor behind malignancy of the prostate, is aging. Thus, men who live long lives are unlikely to escape some problem with the prostate, such as benign prostatic hyperplasia (non-cancerous enlargement of the gland that makes urination difficult) if not actual cancer.

(While women around the world and through the ages don’t have to worry about this malady, they have had their own problems, including death from childbirth, gynecological cancers, autoimmune disease and depression.)

The prostate is a walnut-sized gland located near the bladder and just in front of the rectum. The urethra runs through the center of the prostate, letting urine flow out of the body. The prostate also secretes fluid that nourishes and protects sperm.

Prostate cancer is the most common cancer in Israeli men and among the most common in men in the rest of the Western world. There were 2,064 cases diagnosed last year, and this country is 11thin the world in the incidence of the tumor. Fortunately, over the past decade, prostate cancer survival in Israeli men has increased from 92.5% to 95.6%

Every year, the International Prostate Cancer Awareness Month is marked in September, and in Israel, a special awareness day – initiated to the Israel Cancer Association (ICA) – is marked here to make men, and their families, better informed about the condition.

The ICA, headed by director-general Miri Ziv, regularly publishes updated recommendations in a booklet called “Prostate Cancer – Prevention and Diagnosis” that is distributed free of charge.

The risk of prostate and other cancers can be reduced by adopting a healthful lifestyle, including eating plenty of vegetables and fruits and foods high in fiber; avoiding high-calorie foods rich in sugar and fat; reducing the intake of processed foods (smoked, fried, salted and canned), eating less red meat, and drinking water instead of sweetened beverages and alcohol.

Positive behaviors that lower prostate cancer risk include the regular consumption of tomatoes, especially after they are cooked and the pigment lycopene is produced.

One should also keep a normal body weight, with a body/mass index of between 18.5 and 24.9. Perform exercise daily for at least 30 minutes; such as fast walking, running, cycling and swimming

In addition, do not smoke. Complete abstinence from cigarette smoking in particular, and all tobacco products, including hookahs (water pipes) can reduce the risk of death from all kinds of cancer. It is recommended that you avoid second-hand smoke and third-hand smoke, which includes exposure to toxic and carcinogenic particles that cling to clothes, hair, drapes and carpets.

At present, ICA and Health Ministry policy does not include a recommendation for screening prostate cancer among healthy men by taking a PSA (prostate-specific antigen) blood test, as this has not been shown to be effective in reducing prostate cancer mortality.

Men at high risk for the tumor because they have a first-degree male relative who had prostate cancer should consult with their doctor about the pros and cons of performing prostate cancer diagnostic tests.

Any man who is diagnosed with prostate cancer should decide with his physician what approach to take – immediate medical treatment, active surveillance or passive monitoring. It is also important to hear and understand the various therapeutic options and choose the one that best suits the patient’s medical condition and preference.

A total of 28,249 Israeli men were diagnosed with invasive prostate cancer since 1990; of these, 9,994 were diagnosed in the last five years; a total of 466 men died in Israel in 2015,” said Prof. Lital Keinan-Boker, deputy director of the Israel Center for Disease Control in the Health Ministry. The majority of deaths from invasive prostate cancer were men aged 75 years old or older.

The risk of prostate cancer is higher among Jewish men and “others” in the country than among Arabs, and it increases with age. The main morbidity (sickness) rate among all population groups is among those aged 65 and over. Since 2008, there has been a significant reduction in the risk of the disease, with an annual rate of change of 7%. In Arab men, the trends are similar.

The survival rate from the disease for five years is very high among Jews (over 95%) and tends to rise in those diagnosed when they are older. Even in Arab men, the survival rate is high (86%) but lower than for Jews, and there is no increase in survival in those diagnosed in later years. These differences may reflect a different rate of overdiagnosis in both population groups, the ICA said.

Israel’s National Cancer Registry is collaborating with the Concord project of the London School of Hygiene and Tropical Medicine, which aims to continuously monitor the relative survival in 71 countries from prostate cancer after five years. According to the findings, from cancer survival among Israeli men diagnosed between 2000 and 2004 of 92.5%, there was an increase to 95.7% among patients diagnosed between 2009-2011.

Well-known survivors of the disease include former US Secretary of State Colin Powell, former US presidential candidate Bob Dole, former New York mayor Rudolph Giuliani, actor Ben Stiller, mogul Warren Buffett, former US secretary of state John Kerry and actor Ryan O’Neill.

Among those who died of prostate cancer were Gary Cooper and Dennis Hopper, the late Venezuelan president Hugo Chavez, former US general Norman Schwarzkopf and the late French president Francois Mitterrand.

While tests for early detection of prostate cancer in healthy men is not recommended, the ICA does recommend paying attention to symptoms that require a medical examination, such as difficulty in urinating; difficulty starting urination; poor urine flow; urination that takes longer or stops and starts again; drips after urination; frequent urination; the sudden need to urinate during the night that did not exist in the past; the urgent need to urinate; pain or a burning sensation during urination;  blood in the urine or the seminal fluid; or a decrease in sexual function.

The ICA emphasizes that these symptoms should not be accepted as a natural phenomenon of age. Instead, consult a physician, preferably a urologist, for clarification.

In recent years, several blood and urine tests have been developed based on genetic changes characteristic of prostate cancer. Using them may indicate increased odds of finding it, and some may even predict a cancer with more aggressive characteristics that will require treatment. These tests use profiles of different genetic changes and are in fact in the process of development and learning. The ICA stresses that the tests are currently not included in any guidelines

A study by researchers at Harvard University and Duke University in the US has examined whether there is a link between alcohol consumption and the risk of prostate cancer, For the study, 650 American men of diverse ethnic backgrounds aged 49 to 89 underwent prostate biopsies from 2007 to 2018. The men completed a survey of demographic and medical questions as well as questions about the average alcohol consumed per week. A total of 328 of men were diagnosed with prostate cancer – 238 with low-grade prostate cancer and 88 with aggressive prostate cancer.

The findings showed that men who consumed more than seven alcoholic beverages per week between the ages of 15 and 19 were 3.21 times more likely to develop high-grade prostate cancer than men who did not drink at all. High consumption of alcohol between the ages of 20 to 29 increased the risk of aggressive prostate cancer by 3.14. High consumption between the ages of 30 and 39 increased the risk by 3.09, and high intake between the ages of 40 and 49 increased the risk of aggressive prostate cancer by 3.64.

Men of all ages who consumed an average of more than seven alcoholic drinks a week were 3.2 times more likely to have high-grade aggressive prostate cancer than men who had no alcohol at all. The study suggests that high alcohol intake at an early age in life and cumulatively throughout life increases the risk of prostate cancer.

In the US, scientists have noted a link between the consumption of sugars from sweetened beverages and desserts and the risk of prostate cancer. The study included 22,720 American men of diverse ethnic origin, including Hispanics and Asians aged 55 to 74.

According to statistical analysis, the association between high sugar intake and this cancer was very significant for the category of sweetened beverages. There was no direct link between consumption of natural fruit juices and desserts and the risk of prostate cancer.

If you want an Israeli expert to answer your medical questions, write to Breaking Israel News health and science senior reporter Judy Siegel-Itzkovich at [email protected] with your initials, age, gender and place of residence and details of the medical condition, if any.

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