People & Lifestyle article, April 2006
| LIFESTYLE AND
THE PROSTATE
|
 |
“Lifestyle” is currently a buzz word, but very few urologists who deal with prostate-related illness pay sufficient attention to this important aspect of their patients’ problems. However, evidence is now accumulating that lifestyle and diet are important components in both the causes and treatment of prostate disease.
More and more men nowadays are overweight(1) and the typical “pot belly” obesity that they exhibit is strongly linked with the metabolic syndrome and diabetes mellitus (fig 1). Cholesterol levels in males are also often too high carrying increased risks of cardiovascular disease and premature death. Obesity has also been proposed as a risk factor for prostate cancer in a paper by Ribeiro et al published in Prostate Cancer and Prostatic Diseases(2), and it also undoubtedly increases the risks of complications during and after surgical intervention for the disease.
An increased waist circumference and/or body mass index (BMI) is significantly associated with increased cardiovascular risk as well as all the other deleterious components of the metabolic syndrome including diabetes mellitus. Encouragement to adopt a more sensible diet and to increase the amount of regular exercise may therefore be in order. If urologists feel uneasy with this new stance they might be encouraged by the recent finding of Giovannucci et al(3) that men who undertook more than 3 hrs of vigorous exercise per week reduced their risk of developing advanced prostate cancer or dying from the disease by around 70%.
If total and LDL cholesterol are significantly raised there is good evidence that lowering these with a statin will result in a significant reduction in cardiovascular risk. A recent meta-analysis revealed that a 1 mmol/L reduction in LDL cholesterol translated into an 18% reduction of heart attack or stroke(4). Intriguingly, there is also emerging evidence that statins may not only reduce PSA levels(5) but also offer some chemopreventative protection against prostate cancer(6)
All of these observations lead to the conclusion that the urologist of the future should develop a broader, more holistic view of his or her role as a specialist in Men’s Health(7). Instead, of focussing on the prostate in isolation, more attention should be paid to other concomitant medical issues, which may in fact pose a greater threat to quality of life and longevity than the prostate problem itself, and which can be easily remedied with some lifestyle advice and the judicious introduction of a statin, as and when clinically indicated.
| Figure 1 - Features of the metabolic syndrome |
References:
1. Vasan RS, Pencina MJ, Cobain M et al. Estimated risks for developing obesity in the Framingham Heart Study. Ann Intern Med 2005 143: 473-480.
2. Ribeiro R, Lopes C, Medeiros R The link between obesity and prostate cancer: the leptin pathway and therapeutic perspectives. Prostate Cancer and Prostatic Diseases 2006; 9:19-24.
3. Giovannucci EL, Liu Y, Leitzmann MJ et al A prospective study of physical activity and incident and fatal prostate cancer. Arch Int Med 2005,165:1005-10.
4. Cholesterol Treatment Trialists Collaborators. Efficacy and safety of cholesterol-lowering treatment: prospective meta-analysis of data from 90056 participants in 14 randomized trials of statins. The Lancet 2005; 366:12671278.
5. Shannon J, Tewoderos S Garzotto M et al Statins and prostate cancer risk: a case control study. Am J Epidemiol 2005, 162:318-25.
6. Cyrus-David M, Weinberg A, Thompson T, Kadmon D. The effect of statins on serum prostate specific antigen levels in a cohort of airline pilots: a preliminary report. J Urol 2005; 173:1923-1925.
7. Kirby RS, The urologist as an advocate of men’s health. BJU Int 2005; 95:929.