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Cancer-proof your prostate

from men's health magazine

It's one of those weird anatomical-arboreal coincidences: the human prostate is about the size and shape of a walnut. But what if it really were a walnut? For one thing, you'd never get prostate cancer. Which sounds great, until you realise that you could get “walnut curculio” or “walnut-husk maggot” instead. Better to deal with the devil you know. And what a devil it is. The latest research shows it to be the leading cancer in males worldwide, ahead of lung, colon and brain. The lifetime risk of developing prostate cancer is one in 24 (count Nelson Mandela, Arch-bishop Desmond Tutu and Robert De Niro among those ranks). And South Africa ranks right near the top in terms of incidence, especially whites and coloureds who have the highest rates in the world bar the USA. Black males compare with those reported in other developing countries, while rates in South African Asian males are almost five times those reported in Bombay, India. These are grim statistics, but there's reason to be optimistic. Make that eight reasons. What follows is the latest, hot-out-of-the-lab research on how you can prevent, detect and treat the disease. Putting this science into action (read: more sex, more wine) won't confer absolute immunity, but it will make your prostate one tough nut to crack.


Love thyself As if masturbation didn't already provide enough of a pay-off, a recent Australian study found that DIY sex may also help prevent prostate cancer. The study of 2 338 men showed that the guys who masturbated five or more times a week were 34 percent less likely to develop prostate cancer by age 70 than those who handled matters less often. “Seminal fluid contains substances that are carcinogenic,” says Dr Graham Giles, the lead study author. “Regular ejaculation may help flush them out.”

And in case you're wondering, no, masturbating more than once a day won't offer more protection, and yes, straight-up sex works, too. But before you have unprotected nookie with your partner, be sure she's been tested for cytomegalo-virus, a type of herpes recently found in cancerous prostate tissue.

Be happy you're going bald Turns out the hair-loss drug Propecia has one impressive side effect. In a US National Cancer Institute (NCI) study of 18 882 men, researchers found that the men who took five milligrams (mg) of Propecia, aka finasteride, daily for seven years had a 25 percent lower risk of prostate cancer than those taking a placebo. Finasteride blocks production of dihydrotestosterone, a hormone that triggers hair loss and prostate growth. You can buy Propecia in the UK here.

“It's the first study to prove that prostate cancer is preventable,” says Dr Peter Green-wald, the NCI's director of cancer prevention – and one of those 18 882 men. “My prostate's normal,” he adds. One caution: men on finasteride had a slightly greater chance of being diagnosed with a more aggressive form of the disease than did the placebo takers. More research on the drug is needed, but if you're concerned about prostate cancer, discuss these findings with your doctor.

Wine and dine There's a good reason Western European men have lower prostate-cancer rates than we do. And it has nothing to do with Speedo thongs. New research suggests that certain staples of the Mediterranean diet have prostate-cancer-fighting properties. For starters, a recent study published in the Journal of the National Cancer Institute shows that men who eat more than 10 grams (g) of garlic or spring onions (that's about three cloves of garlic or two tablespoons of spring onions) daily have a 50 percent lower risk of prostate cancer than those who eat less than two grams. (Give credit to the organosulfur compounds, which are common to both vegetables.) Then there's red wine; red grapes are flush with resveratrol, an antioxidant found in some plants that may help inhibit the growth of prostate cancer, according to a report from the University of Texas.

A glass or two of red wine daily should suffice. “If you drink too much,” says the lead study author, Dr Catherine O'Brian, “you can neutralise the beneficial effects.”


Lower the bar Here's a PSA (Public-Service Announcement) regarding your PSA (Prostate-Specific Antigen): using a score of 4.1 or greater as the alarm for prostate cancer could prove fatal. A recent study of 6 691 men, published in the New England Journal of Medicine (NEJM), showed that this traditional threshold for ordering a follow-up biopsy may be missing 82 percent of prostate-cancer diagnoses in men under 60. “The threshold of 4.1 that's being used has never been rigorously studied,” says one of the study's authors Dr Karen Kuntz. And while critics say a lower threshold will lead to unnecessary biopsies, Dr Rinaa Punglia, another of the study authors, believes that the broader standard could be worth it. “It's a trade-off,” she admits. “But it could save lives.” So how low should you go? Punglia recommends that when you have your PSA level checked (annually beginning at age 50 – or 45 if you have a family history), you observe a threshold of 2.6, especially if you're under age 60. According to the NEJM study, following this guideline doubled the cancer-detection rate, from 18 percent to 36 percent.

Calculate your risk Let's say your PSA is 2.6. You still may not need a biopsy. Instead, ask your doctor to use a nomogram. This needle-free analysis turns a patient's age, PSA density (PSA divided by the volume of the prostate), digital-rectal-exam result and transrectal-ultrasound result into a score that helps determine whether a biopsy is really warranted. “We can say whether or not, for your prostate, that's a high PSA,” says Dr Mark Garzotto, director of urologic oncology at the Port-land VA Medical Centre. In a study of 1 200 men, Garzotto found that if a nomogram had been used in every case, it would have spared 24 percent of the men from unnecessary biopsies. If your doctor can't crunch the numbers, ask for copies of your test results; you can find the same nomogram below in this article, and do the maths yourself.


Head for tomatoes Researchers at the Centre for Holistic Urology at Columbia-Presbyterian Medical Centre in New York City recently found that a blend of herbs including ginger, oregano, rosemary and green tea reduced prostate-cancer cell growth by 78 percent in the lab. But if the spice rack's not your game, you can safely head for tomatoes.
A study at Harvard University, over six years and on 47 894 men, found a reduction in advanced prostate cancer risk by 53 percent in those taking tomatoes or tomato products. The key ingredient here is lycopene, a red chemical found mainly in tomatoes and tomato-based products. High levels of lycopene have consistently been found to correlate negatively with the risk for prostate cancer – the higher the intake, the lower the risk. One of the best-known products out there is the herbal remedy Gardian.
Scientist and lead researcher for the Cancer Association of South Africa, Dr Carl Albrecht, says all tomato products are good for treating prostate cancer, except for “tomato juice, which does not have the same beneficial effects since the tomato product needs to be cooked for the lycopene to be absorbed by the body.”

Use CAD (Computer-Assisted Doctor) The radical prostatectomy recently became a lot less radical, thanks to a new robotic version of the procedure. With the da Vinci system, doctors use three-dimensional imaging to direct two nimble robotic hands through a few small slits in the patient's abdomen to remove the cancerous prostate. According to data from the Vattikuti Urology Institute at the Henry Ford Health System in the US, 90 percent fewer men became incontinent and 50 percent fewer became impotent with the da Vinci system than with manual gland removal. “It's like playing golf with a titanium driver versus a wooden driver,” says chief of urology Dr Mani Menon. Another plus: patients spent an average of 1.5 days in the hospital, compared with 2.3 days for open surgery.

Rehab your erections Unless you're David Beckham, this one's a no-brainer: take a nerve graft from your ankle and save your sex life. The cavernous nerves, aka the boner bugle corps, are often a casualty of prostate removal if cancer has spread outside the gland. But by replacing the cavernous nerves with the sural nerve that runs along the ankle, as many as 9 000 men a year could recover erectile function, says one of the developers of the procedure and chairman of urology at Memorial Sloan-Kettering Cancer Centre in New York City, Dr Peter Scardino. “If you've got only one [cavernous] nerve left, you're firing on four cylinders, but if I do a graft, it's like you're firing on seven out of eight.” And don't worry; a slight numbness in your foot is the only side effect. Talk to your urologist about where to find a surgeon experienced in sural-nerve grafting.
By Matt Bean

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