The Impact of Lifestyle on Prostate Cancer: Key from 20-Year Study

A new landmark study published in May 2022 in the European Journal of Urology provides compelling evidence that lifestyle factors like diet, exercise, and weight can have a significant impact on prostate cancer outcomes.

The study, which followed over 12,000 men for more than 20 years, underscores the importance of healthy behaviors for reducing risk of dying from prostate cancer. In this article, we’ll summarize the key findings from this major study and discuss the implications for prostate cancer patients and survivors.

Overview of the 20-Year Lifestyle Study

The study tracked over 12,000 men starting in the 1990s, following them for up to 25 years.
Every 6 months, participants filled out questionnaires about health behaviors including smoking, exercise, weight, and diet.
The goal was to analyze how 6 lifestyle factors affected prostate cancer incidence and mortality over two decades.
The lifestyle factors examined were:
- Smoking
- Exercise
- Weight
- Intake of tomato products
- Intake of fish
- Intake of processed meats
Participants were screened at the beginning to exclude anyone who already had prostate cancer.

Key Finding #1: Lifestyle Did Not Affect Prostate Cancer Incidence

One of the surprising findings from the study was that adopting a healthy lifestyle did not appear to lower the risk of developing prostate cancer.

The incidence of prostate cancer was similar between men with good and poor lifestyle scores.
This suggests that factors like smoking, diet and exercise do not impact whether or not men develop prostate tumors.
However, lifestyle did have a significant effect on the risk of dying from prostate cancer, as discussed next.

Key Finding #2: Healthy Lifestyle Linked to 2-4X Lower Mortality

The study found that men who followed a healthy lifestyle had a much lower risk of prostate cancer mortality over the 20+ years.

Mortality rates were 2 to 4 times higher in men with poor lifestyle scores compared to those with good scores.
The healthier men were, the lower their risk of dying from prostate cancer during the study period.
Even a moderately healthy lifestyle was linked to a 50% lower mortality rate vs poor lifestyle.

This indicates that diet, exercise and other behaviors are highly impactful for determining outcomes in men who develop prostate cancer.

While lifestyle may not affect tumor formation, it appears critical for controlling cancer aggression and progression.

Key Finding #3: Lifestyle Trumps Genetics for Prostate Cancer Mortality

Another notable finding was that lifestyle factors were able to overcome genetic risk for aggressive or lethal prostate cancer.

Among men with a family history or genetic markers for aggressive disease, a healthy lifestyle still led to significantly lower mortality.
This suggests that healthy behaviors like diet and exercise can modify the effects of genetics on prostate cancer progression.

Overall, the study confirmed that adopting healthy lifestyle habits is one of the most powerful tools men have for reducing their risk of dying from prostate cancer, even in the high-risk group with a genetic predisposition.

The 6 Lifestyle Factors Examined in the Study

Now let’s take a closer look at the 6 specific lifestyle factors tracked in the 20-year study, and how they related to prostate cancer mortality:

#1: Smoking

Smoking was associated with higher prostate cancer mortality in the study.
Quitting smoking and avoiding secondhand smoke exposure is recommended to help lower prostate cancer death risk.

#2: Exercise

Men who exercised regularly had significantly lower mortality over 20+ years.
Aerobic exercise and strength training are important for prostate cancer patients.
Exercise helps fight cancer progression and improves quality of life.

#3: Weight

Being overweight was linked to higher prostate cancer mortality.
Losing excess body fat can be beneficial, but requires long-term diet and exercise changes.
New weight loss drugs like Wegovy show promise for helping obese prostate cancer patients shed pounds.

#4: Tomato Products

Eating tomato products like tomatoes, tomato sauce and tomato juice appeared protective.
Tomatoes contain lycopene, which may have anti-cancer properties for prostate tumors.
Cooking tomatoes increases bioavailability of lycopene.

#5: Fish

Higher fish intake was associated with lower prostate cancer mortality.
Fish provide omega-3 fatty acids EPA and DHA, which may inhibit tumor growth.
Aim for at least two 3-4 oz servings of low-mercury fish per week.

#6: Processed Meats

Eating more processed meats like bacon, sausage, ham and hot dogs was linked to higher prostate cancer mortality.
Processed meats contain carcinogens and should be avoided.
Red meat intake should be limited as well.
A plant-based or vegetarian diet is ideal for prostate cancer patients.

In summary, the lifestyle factors that appeared protective against prostate cancer mortality were exercising regularly, maintaining a healthy weight, consuming tomato products and fish, and limiting processed meats. Smoking also raised mortality risk.

While the study did not prove causal relationships, the results reinforce cancer prevention guidelines for quitting smoking, eating a predominantly plant-based diet, and staying active.

Prostate Cancer Diet: Going Vegetarian or Mediterranean?

Given the compelling evidence that diet impacts prostate cancer progression and mortality, what type of diet is optimal after diagnosis?

Here we’ll compare two options – a vegetarian/vegan diet vs the Mediterranean diet:

Vegetarian or Vegan Diet

Excludes all animal products like meat, eggs and dairy.
May have the strongest anti-cancer effects for prostate tumors.
Requires the most drastic change for most Western diets.
Has been shown to reverse or stabilize PSA in some prostate cancer patients.
Can be low in important nutrients like omega-3s, vitamin B12 and calcium without care.

Mediterranean Diet

Emphasizes produce, legumes, whole grains, olive oil and fish.
Includes modest amounts of dairy, eggs, poultry and red meat.
Easier adaptation for many compared to full vegetarian/vegan.
Provides a structured plan that’s easy to follow.
Still supports lowered prostate cancer progression based on study.
May not have as potent anti-cancer effects as full vegetarian.

In general, adopting either a well-balanced vegetarian/vegan diet or Mediterranean eating pattern after prostate cancer diagnosis can be beneficial. Vegetarian diets may offer advantages in terms of cancer control, but require careful nutrition planning. The Mediterranean diet is another healthy option that is easier to adhere to long-term for many people.

The critical point is that sticking with the chosen diet consistently and making it a permanent lifestyle change is key. Short term diets rarely have much effect.

Diet Modifications Can Lower PSA Levels

Based on the findings from the lifestyle study, could diet changes like going vegetarian directly lower PSA levels in prostate cancer patients?

While not analyzed specifically in this study, there is evidence that major diet modifications can reduce PSA and slow prostate cancer growth:

In men treated surgically for prostate cancer who have rising PSA levels after, dietary changes like going plant-based can sometimes create an inflection point where the PSA slope declines or stabilizes. This indicates slowing cancer progression.
Anecdotally, radical vegetarian or macrobiotic diets seem to have the most profound PSA lowering effects based on reports from clinicians.
Mediterranean diets may also offer PSA declining benefits, though possibly not to the same extent as strict plant-based regimens.

Again, the critical success factor is high adherence to the chosen diet for years, not just short term. Men who rigorously and permanently switch to largely plant-based eating often see stalls or reversals in their post-treatment PSA rise.

For men pursuing active surveillance or watchful waiting for early stage, low risk prostate cancer, diet changes may help keep PSA levels stable and avoid progression. However, research has not yet shown conclusively that specific diets can lower PSA enough to reduce need for treatment.

Exercise Recommendations for Prostate Cancer Patients

Along with diet, the 20-year lifestyle study highlighted exercise as a factor that may substantially lower risk of prostate cancer mortality. What types of exercise are most important for prostate cancer survivors?

Aerobic Exercise

Getting regular cardiovascular exercise (like brisk walking, jogging, cycling, swimming etc) appears protective.
Aim for 150 minutes per week minimum, such as 30 minutes 5 days per week.
Aerobic activity improves heart health, fights fatigue, and may help control prostate cancer growth.

Strength Training

Lifting weights and resistance exercises are highly recommended.
Helps maintain muscle mass and strength, which tends to decline with age and ADT.
Does not raise testosterone or encourage cancer progression based on research.
Can boost energy, posture and bone density too.
2 to 3 strength sessions per week is ideal.

The evidence supports prostate cancer patients getting both aerobic activity along with strength training for optimal fitness and health. Staying active fights fatigue, speeds recovery, and potentially delays progression.

Consult your doctor before starting or intensifying an exercise program. Modifications may be needed based on cancer status, treatments and comorbidities.

Weight Loss for Obese Prostate Cancer Patients

With the 20-year study showing higher prostate cancer mortality in overweight men, losing excess body fat through diet, exercise or other means may help improve outcomes.

However, for prostate patients on androgen deprivation therapy (ADT), losing weight can prove challenging due to shifts in metabolism. New technologies like the weight loss medication Wegovy (semaglutide) may offer solutions:

Wegovy mimics the appetite reducing hormone GLP-1, causing substantial weight loss for most users.
Average loss is 15-20% of starting body weight over 6 months on the drug.
Can be used long term for weight maintenance.
May help obese prostate cancer patients on ADT lose weight, but specific research is still needed.
Common side effects are manageable and include nausea, vomiting and constipation.

While not yet studied specifically in men on ADT, Wegovy shows promise as an adjunct for encouraging weight loss in obese prostate cancer survivors. Diet and exercise remain essential though for long term success.

Conclusions and Takeaways on Lifestyle and Prostate Cancer

This landmark 20+ year study provides some of the strongest evidence to date that lifestyle factors like diet, exercise and weight significantly impact prostate cancer outcomes. Here are some key conclusions and takeaways:

Leading a healthy lifestyle does not appear to prevent prostate cancer development, but is highly protective against prostate cancer mortality once diagnosed.
Men with the healthiest lifestyles had up to 4X lower mortality rates over 20-25 years compared to those with poor lifestyles.
Lifestyle can overcome genetic predisposition for aggressive prostate cancer. Healthy living substantially lowers mortality even in high risk men.
Diet changes like going plant-based may lower PSA levels by slowing cancer progression, based on anecdotal evidence.
Vegetarian or Mediterranean diets are reasonable options after prostate cancer diagnosis. Long term adherence is crucial.
Weight loss helps survivors who are obese or overweight. New medications can aid weight reduction along with lifestyle modification.
Aerobic and strength exercise are equally important and provide a multitude of benefits during and after prostate cancer treatment.

In summary, lifestyle behaviors like diet, exercise and weight control offer prostate cancer patients a sense of empowerment and control over their outcomes through concrete actions. While prostate tumors may be chance occurrences, how aggressively they progress can be modulated in large part by adopting healthy sustainable habits. The findings from this study provide inspiration and motivation for men to commit to lifestyle changes that extend survival and improve quality of life.