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Prostate Cancer: Prevention and Early Detection are Keys

Prostate cancer is the third most common cancer in Malaysia1, and the most commonly diagnosed cancer in male throughout the world2. Situated under the bladder and adjacent to the urethra, the prostate is a small gland found in a man’s lower abdomen in the pelvis at the base of the penis. The prostate gland requires androgen (testosterone) to function optimally and therefore the male hormone testosterone determines its growth3. It functions to produce fluid that constitutes about 30% to 35% of the semen4. Semen is the substance containing sperm that exits the urethra during ejaculation. This prostatic portion of the semen nourishes the sperm and delivers alkalinity, which helps afford a high pH environment.

 

Risk Factors

The known major risk factors that may increase the likelihood of developing malignancy include older age of 50 and above, ethnicity, increased obesity, persistently elevated testosterone levels, and a positive family history2,5.

 

Signs & Symptoms

Early prostate cancer comes mostly without symptoms, however the following can occur, including frequent urination, nocturia (night time urination), difficulty starting and maintaining a steady stream, hematuria (blood in urine), and dysuria (painful urination)2,6. There are no initial or early symptoms in most cases, but late symptoms may involve fatigue due to anemia, bone pain, paralysis from spinal metastases, and renal failure from bilateral ureteral obstruction2. Other conditions can cause some symptoms of prostate cancer, such as benign prostatic hyperplasia (BPH), so if you have any of the aforementioned signs or symptoms, do not hesitate to call your doctor for further evaluation.

 

Tomato Extract

Adding healthy, prostate-friendly supplements can help reduce the risk of prostate cancer risk. Tomatoes contain powerful antioxidant, namely lycopene. The anticancer properties of lycopene may occur through inhibition of the NF-κB signaling pathway, beginning at the early stage of cytoplasmic IKK kinase activity, which then leads to reduced NF-κB-responsive gene regulation/ mutation producing cancerous prostate cells7.

A prospective study in male health professionals revealed that consumption of two to four servings of lycopene-rich tomato sauce per week was associated with about a 35% risk reduction of total prostate cancer and a 50% reduction of advanced (extraprostatic) prostate cancer8.

A dose-response meta-analysis demonstrated that higher lycopene consumption was linearly and directly associated with a reduced risk of prostate cancer with a threshold between 9 and 21 mg/day9,10.

Another study comprised 49,898 male health professionals in 24 years follow-up nested case-control study concluded a reduced risk of prostate cancer in those with higher lycopene intake as compared to those with lower lycopene intake11.

 

Saw Palmetto Extract

Most prostate cancers rely on testosterone for growth at the very initial stages of development; thus inhibiting testosterone production or blocking its action may be useful approaches in early treatment or prevention of prostate cancer. Saw palmetto contains phytosterols such as beta-sitosterol, campesterol, stigmasterol that are responsible for the inhibition of 5α-reductase12. 5α-reductase is the enzyme that converts testosterone into the more potent androgen dihydrotestoterone which binds to receptors with up to 10-fold affinity compared to testosterone13, giving rise to the growth of prostate cancer cells. Its anticancer properties may happen via blockage of growth of prostatic cancer cells and thereafter the induction of apoptosis (cell death)14. Saw palmetto appears to have efficacy similar to that of medications like finasteride15, which shows similar level effects of prostate epithelial involution16.

 

 

Conclusion

We understand the stigma behind prostate cancer in men. Some view the disease as “an emasculating journey,” while others are hesitant to talk about their concerns or a diagnosis in their homes and communities. Through this article, we discussed openly about the risk factors and signs and symptoms with the intention of bringing it to light to encourage prevention and early detection of prostate cancer. Fortunately, most prostate cancers have a tendency of slow growth rate and are low-grade with relatively low risk and limited aggressiveness17, especially at the early stage when it is localized it is potentially curable18.

 

 

References:

  1. Lim J, Malek R, Jr S, Toh CC, Sundram M, Woo SYY, Yusoff NAM, Teh GC, Chui BJT, Ngu IS, Thevarajah S, Koh WJ, Lee SB, Khoo SC, Teoh BW, Zainal R, Tham TM, Omar S, Nasuha NA, Akaza H, Ong TA, M-CaP Study. Prostate cancer in multi-ethnic Asian men: Real-world experience in the Malaysia Prostate Cancer (M-CaP) Study. Cancer Med. 2021 Nov; 10(22): 8020-8028. doi: 10.1002/cam4.4319. Epub 2021 Oct 9.
  2. Stephen W. Leslie, Taylor L. Soon-Sutton, Hussain Sajjad, Larry E. Siref. Prostate Cancer. Treasure Island (FL): StatPearls Publishing; 2022 Jan-. https://www.ncbi.nlm.nih.gov/books/NBK470550/
  3. Alukal JP, Lepor H. Testosterone Deficiency and the Prostate. Urol Clin North Am. 2016 May; 43(2): 203-8.
  4. Toivanen R, Shen MM. Prostate organogenesis: tissue induction, hormonal regulation and cell type specification. Development. 2017 Apr 15; 144(8): 1382-1398.
  5. Gann PH. Risk factors for prostate cancer. Rev Urol. 2002; 4 Suppl 5: S3-S10.
  6. Wang G, Zhao D, Spring DJ, DePinho RA. Genetics and biology of prostate cancer. Genes Dev. 2018 Sep 01; 32(17-18): 1105-1140.
  7. Assar EA, Vidalle MC, Chopra M, Hafizi S. Lycopene acts through inhibition of IκB kinase to suppress NF-κB signaling in human prostate and breast cancer cells. Tumour Biol. 2016 Jul;37(7):9375-85.
  8. Giovannucci E. A review of epidemiologic studies of tomatoes, lycopene, and prostate cancer. Exp Biol Med (Maywood). 2002 Nov;227(10):852-9.
  9. Chen P, Zhang W, Wang X, Zhao K, Negi DS, Zhuo L, Qi M, Wang X, Zhang X. Lycopene and Risk of Prostate Cancer: A Systematic Review and Meta-Analysis. Medicine (Baltimore). 2015 Aug; 94(33):e1260.
  10. Gann PH, Ma J, Giovannucci E, Willett W, Sacks FM, Hennekens CH. Lower prostate cancer risk in men with elevated plasma lycopene levels: results of a prospective analysis. Cancer Research. 1999; 59:1225-1230.
  11. Zu K, Mucci L, Rosner BA, Clinton SK, Loda M, Stampfer MJ, et al. Dietary lycopene, angiogenesis, and prostate cancer. A prospective study in the prostate-specific antigen era. J Natl Cancer Inst. 2014; 106(2).
  12. Penugonda K, Lindshield BL. Fatty Acid and Phytosterol Content of Commercial Saw Palmetto Supplements. Nutrients. 2013 Sep; 5(9): 3617–3633.
  13. Iehlé C., Délos S., Guirou O., Tate R., Raynaud J.P., Martin P.M. Human prostatic steroid 5α-reductase isoforms—A comparative study of selective inhibitors. J. Steroid Biochem. Mol. Biol. 1995;54:273–279. doi: 10.1016/0960-0760(95)00134-L.
  14. Bonnar-Pizzonor RM, Littman AJ, Kestin M, White E. Saw palmetto supplement use and prostate cancer risk. Nutr Cancer. 2006;55(1):21-7. doi: 10.1207/s15327914nc5501_3.
  15. ANDREA E. GORDON, M.D., AND ALLEN F. SHAUGHNESSY, PHARM.D. Saw Palmetto for Prostate Disorders. Am Fam Physician. 2003;67(06):1281-1283.
  16. Marks LS, Partin AW, Epstein JI, Tyler VE, Simon I, Macairan ML, et al. Effects of a saw palmetto herbal blend in men with symptomatic benign prostatic hyperplasia. J Urol. 2000; 163:1451-6.
  17. Roberts MJ, Teloken P, Chambers SK, Williams SG, Yaxley J, Samaratunga H, Frydenberg M, Gardiner RA‘. Prostate Cancer Detection. In: Feingold KR, Anawalt B, Boyce A, Chrousos G, de Herder WW, Dhatariya K, Dungan K, Hershman JM, Hofland J, Kalra S, Kaltsas G, Koch C, Kopp P, Korbonits M, Kovacs CS, Kuohung W, Laferrère B, Levy M, McGee EA, McLachlan R, Morley JE, New M, Purnell J, Sahay R, Singer F, Sperling MA, Stratakis CA, Trence DL, Wilson DP, editors. Endotext [Internet]. MDText.com, Inc.; South Dartmouth (MA): Jun 11, 2018.
  18. Wilt TJ, Brawer MK, Jones KM, Barry MJ, Aronson WJ, Fox S, Gingrich JR, Wei JT, Gilhooly P, Grob BM, Nsouli I, Iyer P, Cartagena R, Snider G, Roehrborn C, Sharifi R, Blank W, Pandya P, Andriole GL, Culkin D, Wheeler T., Prostate Cancer Intervention versus Observation Trial (PIVOT) Study Group. Radical prostatectomy versus observation for localized prostate cancer. N Engl J Med. 2012 Jul 19; 367(3): 203-13.
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