Life, behavior, and prostate cancer risk: should you be shedding a few pounds?


The capacity of the average male human to do things that are probably not very good for his health (and to not do things that probably would be good for his health) is considerable. At the most basic level, for example, most of us here in the US don’t eat very wisely and don’t take anything like enough exercise.

In a newly published paper by Liss et al. in Prostate Cancer and Prostatic Diseases, the authors have actually quantified this failure in a cohort of men with low-risk prostate cancer who were enrolled in the Prostate Active Surveillance Study (PASS), which is a large, multi-center study designed to investigate the potential of a series of actual and possible biomarkers for risk of prostate cancer and its progression.

We know that being overweight or obese is a risk factor for diagnosis with incident prostate cancer. We also know that this is a risk factor for disease progression and mortality among men already diagnosed with prostate cancer. One might think that — in particular — men with a high body mass index (BMI), who were diagnosed with low-risk prostate cancer, and who were good candidates for management on active surveillance would actually want to take some relatively simple steps (e.g., shedding a few excess pounds) to lower their risk for progression of their cancer. And that was the researchers’ hypothesis too. So they monitored the weight and the BMI for 1 year from initial diagnosis for 442 patients enrolled in PASS.

Turns out … the answer was a resounding, “NOT!”

Here are the basic data from the study at 1 year of follow-up on active surveillance:

  • 33/442 patients (7.5 percent) had lost ≥ 5 percent or more of their initial, on-study weight.
  • 34/442 patients (7.7 percent had gained > 5 percent of their initial, on-study weight.
  • The proportion of men who lost ≥ 5 percent of their initial on-study body weight was similar across categories of baseline BMI at
    • 8 percent among men who had an initial BMI of < 25 (normal or underweight)
    • 6 percent among men who had an initial BMI of 25 to 30 (overweight)
    • 10 percent among men who had an initial BMI > 30 (obese)
  • Results were comparable for patients enrolled in the study at 1 year or 6 months after diagnosis.

The authors conclude that:

Given that obesity is related to [prostate cancer] progression and mortality, targeted lifestyle interventions may be effective at this ‘teachable moment’, as men begin [active surveillance] for low-risk [prostate cancer].

An alternative conclusion might be that many men simply find it near to impossible to modify their behaviors — even in significantly changed circumstances.

Editorial note: Your sitemaster should be clear that he may have a personal bias on this subject. Mrs. Sitemaster is a very good cook, and, having reached the age of 68, the sitemaster does not take anything like the amount of exercise that he used to take in his 40s and 50s. Consequently, late in 2015, he realized that his BMI had increased to 28 and so he made a conscious effort to drop his body weight by 9 percent so that his BMI is now back under 25. Being significantly overweight or obese is not one of the world’s smartest ideas for all sorts of reasons — not just because of the risk associated with a diagnosis or progression of prostate cancer.

7 Responses

  1. I agree with your comments except “want to take some relatively simple steps (e.g., shedding a few excess pounds”.

    For any given individual the relative ease of weight loss is well established prior to cancer. Post-diagnosis is the opposite time from relatively easy. I will give you it is relatively wise, but not relatively easy.

    Any advice to lose weight needs to consider how relatively poor the timing of the advice is. Modification and reinforcement of the standard advice is a necessity.

  2. Hi Mike

    I monitor a few different prostate cancer forums and I have noticed a consistent theme of men who modified their diet and increased the amount of activity; they felt remarkably better. (Go figure!) I have also noticed that it often a concerned spouse helping with these changes.

    I agree it is difficult for most men to change their eating habits, and I don’t believe you need to go vegan, but some common-sense eating and a moderate exercise program will generally make a person feel better. I have no idea if it helps with the prostate cancer but I believe it good for anyone.

    Best regards

    Bill

  3. Allow me another chance to make the point I probably failed to make before.

    Rather then the usual follow-up of treatment options, etc., etc., would not a simple introduction into lifestyle be as cost productive in the long term?

    There is an initial compulsion to just “do something” after diagnosis. A shock compulsion that leads to as much unnecessary treatment as PSA testing. Maybe the first step, particularly for a high BMI, towards active surveillance should be a simple prescription for four sessions with a physical therpist for a simple treadmill walk — a physical therpist rather than a gym because patients will show up for a “medical” appointment and skip the gym. The cost would be offset by skipping hours of physician’s explanations of treatment options. It would buy time to get over the cancer shock and become comfortable with active surveillance.

  4. OK. Good for you. Save your big clothes. …

  5. Successfully Achieved Significant Weight Reduction, Even While on ADT

    Thanks again Sitemaster for picking out a report that is relevant to the challenges faced by so many of us! I’ll add my own story of a success I did not believe possible for years.

    I was on ADT intermittently (almost always IADT3) from December 1999 through April 2014. I recorded my weight daily throughout most of that period (also recorded what I ate and exercise/physical activity).

    Weight gain is a common side effect of ADT therapy, though diet and exercise, if properly implemented, have been reported as effective countermeasures, a claim which I believe. My own experience was that I typically gained 5 to 10 pounds when on the ADT part of the intermittent cycle, but my peak weight was 166, which gave me a BMI of 26 and included significant belly fat.

    During most of this time I exercised, ate a good diet (almost entirely Mediterranean and avoided excessive portions) and consumed a lot of green tea, almost always brewed from eight or more bags a day, steeped with lemon juice, and stirred, also almost always consuming more than 100 ounces of liquid in some form daily (much of it in the form of that tea). While my weight sometimes climbed even on this regimen, I was rarely hungry. I might need food – though I would not sense it directly – and feel the effects of low blood sugar, but rarely sensed any hunger pangs. While I always enjoyed food and eating, I did not crave food or beverages. My hunch is that the lack of craving and absence of hunger pangs were due to the total amount of liquid and the rather high volume of green tea I was consuming (see leads to evidence below).

    I more or less assumed that my weight gain on ADT was inevitable until encouraged by some leading doctors to lose weight and by the realization at that time that I had weighed in the 130s and 140s years earlier, when I was exercising more regularly and rigorously. I was surprised that several experts in ADT asserted that weight gain was not inevitable, and that possibility was a breakthrough for me. My first change to decrease weight was to reduce the volume of cereal at breakfast. I was surprised that I rather quickly knocked off several pounds. Then, again under advice from Charles Myers, MD — well known to many of us, I tried a regimen of branched chain amino acid pills in the morning, no food until lunchtime, and vigorous exercise before lunch, which I was able to pull off on 2 to 3 days per week. I found I had complete control of my weight, actually decreasing to the upper 130s and deliberately staying there, while on ADT, until a consultation with Dr. Myers during which he did body fat analysis and advised me to put on a few pounds. (The easiest medical advice to implement that I ever had!)

    I have now lost about 20 pounds from my peak weight, and have successfully maintained that lower level for years. My weight has been more or less stable around 146 to 147 pounds, which gives me a healthy BMI of a bit under 24, with a little extra belly weight; I’m confident I could lose that too, but I am a caregiver and cannot do as much vigorous exercise as I would like to. I rarely need to use the branched chain amino acid pills now to knock back a temporary increase. I average a good amount of physical activity (including exercise) daily, am still on a Mediterranean diet, still consume more than 100 ounces of liquid daily, and still consume at least 8 bags worth of green tea daily, steeped with a few drops of lemon juice and stirred, which is known to enhance the benefits of the tea.

    I don’t know whether this regimen would work for many of us, but I do suspect that green tea would be generally successful in mitigating a sense of hunger, and that has got to be an advantage in trying to lose weight. I believe that the green tea and other healthy practices I was following prior to bringing my weight under control had set the stage for the final successful push with the decreased cereal and branched chain amino acids/morning fasting/exercise combo. There is a considerable body of research on green tea and weight. For instance, a search of http://www.pubmed.gov for “green tea AND weight”, filtered for humans and papers with abstracts, results today in 901 hits. Adding “AND visceral” to the search string yields 16 hits.

    Exercise is widely supported in evidence for weight loss of course.

    Using branched chain amino acid probably would work for many of us and is a well-known fitness tactic, but its effectiveness, and perhaps safety, might depend in part on an individual’s genetics.

    As for impact of healthy weight on disease, I’ll just say that my healthy weight and likely cure of a challenging case are consistent with the evidence of a benefit from weight loss, though I believe that radiation supported by imaging and ADT did the heavy lifting.

  6. Dear Natron:

    I promise faithfully to let you know if and when I need them.

    :O)

  7. Change in Eating Habits

    Hi Bill,

    One thing I noticed after a few months of switching to a Mediterranean diet with no red meat (and pork, lamb) and more plant-based food, little bread, and almost no dairy products was that my sense of taste changed. I found those plant foods and other foods were tastier.

    Now that I think I have been cured, I’m glad to be eating cheese again — really missed that. I might have done fine while continuing to eat cheese but I was going all out. I still go for the low or no milk fat varieties. While I like most soy products, soy cheese just didn’t do it for me.

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