Diet and prostate cancer
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- Why should I improve my diet?
- How can I make changes to my diet?
- What is a healthy diet?
- Which foods may affect my risk of prostate cancer?
- Fruit and vegetables
- A rainbow of colours
- Cruciferous vegetables
- Antioxidants
- Selenium
- Vitamin E
- Lycopene
- Pomegranate juice
- Green tea
- Fat
- Calcium
- Zinc
- Soy
- Pulses and whole grain foods
- Storing and cooking food
- Tips for buying and storing food:
- What can I do to reduce my risk of prostate cancer?
The diet and nutrition fact sheet put together by The Prostate Cancer Charity is a superb summary. A great deal of epidemiologic and laboratory data now supports the favourable impact of dietary modification and micronutrients on prostate cancer prevention. The advice in this fact sheet accurately reflects the lessons of these scientific findings. I'd encourage any man interested in prostate cancer prevention to use them as a guide to healthier eating and a longer life."
Dr Laurence Klotz, M.D., FRCSC
Professor, Department of Surgery, University of Toronto
Chief, Division of Urology
This page is for men who want to know more about how to improve their diet. It describes a healthy diet that may benefit men who want to help prevent prostate cancer or who have already been diagnosed. The page discusses the various food types and why they are important. It does not prescribe a fixed diet but instead suggests how to make sensible changes to ensure you are eating healthily. This sheet does not cover eating problems caused by prostate cancer or its treatment. For information on this, ask your doctor to refer you to a State Registered Dietitian or call our confidential Helpline.
Why should I improve my diet?
There are several factors that can increase your risk of getting prostate cancer. These include increasing age, an African Caribbean background, a family history of prostate cancer and diet. You cannot alter most of these risk factors; however one thing you can control is your diet. By improving your diet, you can take control over your own health and actively do something to improve it. This will also have other health benefits such as reducing your risk of heart disease and diabetes. Research is emerging which suggests that some foods not only help to prevent prostate cancer, but may also slow down the growth of prostate cancer in men who already have the disease.
The Western diet
Westerners have higher rates of prostate cancer than people living in Far Eastern countries such as China and Japan. However, prostate cancer rates have increased in men who have migrated from Japan to the USA. Researchers think that this may be due to the Western diet. This view is supported by the fact that cancer rates have been increasing in Eastern countries since more people have begun to eat more Western foods. Over the last 50 years, the British diet has included less fruit and vegetables and more saturated fats and meat products. This change may increase the risk of men developing prostate cancer over many years.
Prevention of prostate cancer
Several studies have shown that eating certain foods may reduce your risk of developing prostate cancer, reduce the likelihood of prostate cancer coming back after treatment, or help slow down progression of the disease. More research is needed to support these findings before we can say for sure whether certain foods can benefit men worried about, or diagnosed with, prostate cancer. We also do not know whether changing your diet later on in life can prevent prostate cancer. However by improving your diet your overall health will benefit and you will reduce your risk of heart disease.
How can I make changes to my diet?
Finding reliable information on healthy eating can be an overwhelming and confusing task. This page suggests ways of making changes to your diet, which may reduce your risk of prostate cancer and improve your overall health. You may find it easier to stick to your new diet if you introduce small changes gradually. You must feel happy with your new diet. Eating meals with family and friends is an important part of every day life and changes to your diet should not reduce the pleasure of these social events.
Try to cut down on unhealthy foods but do not totally exclude whole groups of food from your diet. In general, a diet that is good for your heart is also good for your prostate. Ask your doctor to refer you to a Registered Dietitian if you are making big changes to your diet or if you have any other medical conditions that could be affected by your diet.
A personal experience
“I was diagnosed with prostate cancer at age 52. Whilst I was studying different treatment options, my wife began exploring any possible dietary benefits. We changed our diet within a few weeks of my diagnosis.”
What is a healthy diet?
This page highlights changes you can make to your diet to reduce your risk of prostate cancer or to slow down its growth. However, these changes are also important for your overall health.
The picture below shows the five main food groups and the proportions that you should aim to include in your diet.
For a healthy diet:
- Base your meals on starchy foods like potatoes, rice and pasta
- Eat at least five portions of fruit and vegetables each day
- Include some protein, like fish, skinless chicken and pulses
- Eat a low-fat diet
- Cut down on sugar. The healthy daily limit is 70 grams or 17 teaspoons. This includes sugar hidden in soft drinks and processed foods
- Cut down on salt. Eat less than one and a quarter teaspoons each day and look out for hidden salt in processed foods. Try using herbs and spices to add flavour when cooking
- Drink six to eight glasses of water each day. Avoid sugary or fizzy drinks.
A personal experience
“I eat a wide range of extremely tasty meals, which include oily fish, vegetables, seeds, nuts, cereals, pulses and soya products. I feel fit and healthy, with plenty of energy for a very active lifestyle.”
A healthy weight
We do not yet fully understand how obesity affects the risk of prostate cancer but it may be linked to an increased risk of advanced disease1. Keeping to a healthy weight can reduce your risk of other health problems such as diabetes and heart disease.
Measure your Body Mass Index (BMI) using the chart below. Mark your weight in stone or kilograms and draw a line from top to bottom. Then mark your height in feet or metres and draw a line from left to right. The point where your two lines cross will fall in one of the shaded areas, showing whether or not you are at a healthy weight for your height.
Use this chart together with your waist measurement. If your waist measures more than 102 centimetres (37 inches) you have a higher risk of health problems2.
Following a low fat diet and getting regular exercise will help you to lose weight gradually and healthily. Eat regular meals and remember to include five portions of fruit and vegetables each day. There is help available if you need it. Ask your doctor to refer you to a dietitian or contact one of the organisations listed at the end of this page.
Which foods may affect my risk of prostate cancer?
Fruit and vegetables
Eating five portions of fruit and vegetables a day reduces your risk of heart disease and other medical problems, including cancer3. One portion is roughly the size of the palm of your hand or 80 grams in weight. Scientists have not yet identified all of the nutrients which are involved in protecting the body against disease so try to eat fresh fruit and vegetables rather than taking supplements or food extracts, which may not contain all of the beneficial nutrients.
A rainbow of colours
Different fruit and vegetables contain different vitamins and minerals. Eating a wide range of coloured fruit and vegetables is a good way of increasing your intake of these vitamins and minerals. Try to include all of the different colours in your weekly diet.
| Red | Tomatoes, raspberries, watermelon, kidney beans, strawberries, red onions, radishes, red peppers |
| Purple | Aubergines, grapes, aduki beans, blueberries, red cabbage, plums |
| Orange | Carrots, oranges, mangoes, apricots, sweet potatoes, pumpkin, orange peppers, butternut squash |
| Yellow | Pineapples, sweetcorn, peaches, chicory, bananas, yellow peppers |
| Green | Spinach, broccoli, avocados, peas, pears, kiwi fruit, lettuce, green peppers, courgettes, marrows, fresh herbs, watercress |
Cruciferous vegetables
These vegetables belong to the cabbage family. They contain a chemical (called sulforaphane) which helps the body repair any damage done by cancer-causing substances. Examples include broccoli, cauliflower, cabbage, Brussels sprouts, bok choy and kale. Eating at least five portions of these vegetables each week may reduce your risk of getting prostate cancer4.
If you have prostate cancer, cruciferous vegetables will not reduce your risk of the cancer spreading. However they are still important for your overall health and may reduce your risk of heart disease.4
Antioxidants
The body protects itself from outside invaders, like bacteria, by producing molecules called free radicals. If these free radicals get out of control, they can damage normal cells and tissues. They appear to be involved in various stages of the cancer process. Antioxidants mop up excess free radicals and therefore reduce the risk of cancer developing.
Sources of antioxidants that are thought to protect against prostate cancer include vitamins and minerals such as selenium and vitamin E, compounds such as lycopene and foods such as pomegranate juice and green tea.
Selenium
Selenium is found in: nuts such as Brazil nuts; seeds such as pumpkin, sunflower and sesame seeds; bread; cereals; fish and chicken. However, falling levels of selenium in British soils has lead to a decrease in the selenium content of the food we grow.
One study showed that men taking 200 micrograms of selenium each day were less likely to be diagnosed with prostate cancer than men who did not take selenium5. This link is now being studied in a large trial involving 32,000 men. The results of this trial, known as the SELECT study (Selenium and vitamin E Cancer Prevention Trial), are due in 2013.
Vitamin E
There is disagreement about the role of vitamin E in the prevention of prostate cancer. Some studies have shown a link between taking vitamin E supplements and a reduced risk of prostate cancer, whereas other studies have found no link. The SELECT study described above will give us more answers when it finishes in 2013. Good sources of vitamin E include
- Sunflower seeds
- Hazelnuts and peanuts
- Dark green leafy vegetables
- Vegetable oils
- Some breakfast cereals
It is better to get vitamin E from these natural sources rather than from supplements. If you choose to take supplements, taking more than 400 IU per day is not recommended as it may increase your risk of health problems6. If you have diabetes or heart disease you should avoid taking vitamin E supplements because they can increase the risk of heart failure7.
Lycopene
The best known source of lycopene is tomatoes but it is also found in watermelons, pink grapefruits, guava and papaya. You may need to avoid grapefruit if you are taking drugs called statins to lower your cholesterol or drugs to treat erectile dysfunction8. Ask your doctor or chemist for advice.
Lycopene supplements do not give the same protection against prostate cancer as lycopene-rich foods because the other nutrients in the food work together with the lycopene to protect the body9.
Processed and cooked tomatoes appear to be a better source of lycopene than fresh tomatoes. Men who eat two servings or more of tomato sauce each week may reduce their risk of being diagnosed with prostate cancer by one third10. We do not yet fully understand why tomato products such as tomato sauce are better than fresh tomatoes but it may be due to the cooking process releasing the lycopene and making it more easily available to the body.
Lycopene may also slow down the spread of prostate cancer in men who have already been diagnosed with prostate cancer by increasing the rate at which cancer cells die11.
Pomegranate juice
Drinking a glass of pomegranate juice every day may benefit men who have been diagnosed with prostate cancer. One study found that drinking pomegranate juice slowed down the rate of PSA (Prostate Specific Antigen) increase in men with a rising PSA level after radiotherapy or surgery12. There are only a small number of studies involving pomegranate juice so we need more research to find out whether it can benefit all men with prostate cancer.
Green tea
Green tea contains powerful antioxidants, called polyphenols. Drinking green tea may protect against the development and growth of prostate cancer. However you may need to drink around six cups a day for the beneficial ingredients to have a significant protective effect9. This may sound like a lot but, if you want to include green tea in your diet, you may find it easier to drink it in place of your usual hot drinks throughout the day.
Fat
When you eat fat your body breaks it down into smaller parts, uses what it needs and stores any remaining fat for future use. You need some fat for your body to function properly so you should aim for a low fat diet rather than a fat free diet.
We cannot say for certain whether reducing your overall fat intake can lower your risk of prostate cancer. However certain types of fat have been linked to prostate cancer development. For example, the fats found in red meat and dairy products may increase your risk of advanced prostate cancer4 13. On the other hand, fats in oily fish may lower your risk of prostate cancer and reduce the chances of cancer becoming advanced4 9. Fish oil supplements do not appear to have the same benefit so aim to eat fresh or frozen oily fish two or three times each week.
Cut down on fat by:
- Choosing tomato-based sauces instead of creamy ones
- Replacing fatty snacks like crisps and biscuits with fruit
- Avoiding red meat
- Removing any skin from chicken or turkey
- Using less fat in cooking. Grill, bake or steam food instead of frying
- Choosing low-fat or fat-free milk, cheese and yoghurt or replacing these with dairy-free alternatives like soya or rice milk.
Calcium
You should be able to get all of the calcium you need from your everyday diet. If you choose to take supplements, stay within the recommended daily limit of 700mg a day. Some studies have shown that men taking more than 2000mg of calcium a day are at greater risk of getting prostate cancer. However, other studies have shown no link between calcium and prostate cancer.
If you are on hormone therapy, it is important that you get enough calcium to prevent bone thinning (osteoporosis). Between 1000mg and 1500mg of calcium each day may help to keep your bones strong14. If you are concerned about this, speak to your doctor about suitable doses of supplements. The table below gives examples of foods that are good sources of calcium.
Milk |
|
Zinc
Zinc is good for the immune system and is found naturally in red meat, chicken, seafood, nuts and dairy products. The recommended safe limit for zinc supplements is 25mg a day. However taking high doses, or taking supplements for several years, may increase your risk of prostate cancer13.
Soy
The low rates of prostate cancer in Asian men may be partly due to their soy-rich diet. However, there is uncertainty about whether eating soy can reduce the risk of prostate cancer and only one large study has so far shown a protective effect16. If you decide to add soy to your diet, try to choose traditional forms such as tofu, miso and tempeh rather than processed products, such as burgers, which may be high in fat. Soy can now be bought in most supermarkets and health food shops.
Pulses and whole grain foods
A few studies have shown that eating more pulses such as beans, peas and lentils may help to prevent prostate cancer17. Whole grain foods such as brown bread, whole grain cereals and pasta may also reduce your risk of getting several cancers, including prostate cancer18.
Storing and cooking food
The way you store and cook your food is an important part of healthy eating. As soon as fruit and vegetables are picked, their vitamin and mineral content falls. However there are things you can do to make sure you are getting the most from your food.
Tips for buying and storing food:
- Buy fresh looking food.
- Look for locally grown food, and food that is in season. Less time will have passed since it was harvested.
- Avoid damaged fruit and vegetables as these will go mouldy more quickly.
- Store fruit and vegetables in a cool, dark place.
- Store raw and cooked meats separately.
- Throw mouldy food away. Do not just cut off the mould.
Try to steam, bake or lightly boil vegetables and cut down on fried and roasted foods. Barbecued meat and fish may contain cancer-causing substances but you can reduce the risk by cooking at a lower temperature and cutting off any burnt pieces.
What can I do to reduce my risk of prostate cancer?
The table below summarises the information in this page. It suggests some foods that you may wish to eat more of or add to your diet. A healthy diet, together with regular exercise, will benefit your overall health and reduce your risk of several health problems including cancer, heart disease and diabetes.
| What should I eat more of? | What does it do? | How do I include it in my diet? |
| Fruit and vegetables | Reduces your risk of cancer and other medical problems | Eat at least five portions each day Try to include a ‘rainbow of colours’ in your diet |
| Cruciferous vegetables | May reduce your risk of getting prostate cancer | Eat more cabbage-like vegetables such as broccoli, cauliflower, cabbage, Brussels sprouts, bok choy and kale |
| Selenium | May help prevent prostate cancer | Include Brazil nuts, pumpkin seeds, sunflower seeds, sesame seeds, bread, cereals, fish and chicken in your diet |
| Lycopene | May reduce your risk of prostate cancer and slow down its spread | Lycopene is found in tomatoes (particularly cooked and processed tomatoes), watermelon, pink grapefruit, guava and papaya |
| Pomegranate juice | May slow down prostate cancer growth in diagnosed men | Drink a glass every day |
| Green tea | May protect against development and growth of prostate cancer | Try drinking green tea in place of any hot drinks you have throughout the day |
| Oily fish | Fats in oily fish may help prevent prostate cancer developing and growing | Eat fresh or frozen oily fish two or three times each week Examples of oily fish include sardines, pilchards, mackerel, salmon, tuna and shrimp |
| Soy | May reduce the risk of prostate cancer | Choose traditional forms of soy such as tofu, miso and tempeh, available from supermarkets and health food shops |
| Pulses | May help to prevent prostate cancer | Include more beans, peas and lentils in your diet |
| Whole grains | May reduce your risk of several cancers, including prostate cancer | Whole grain foods include brown bread, whole grain cereals, whole grain pasta |
Sources used in the compilation of this page
1 Freedland SJ, Giovannucci E, Platz EA. Are findings from studies of obesity and prostate cancer really in conflict? Cancer Causes & Control. 2006; 17(1):5-9.
2 World Health Organisation. Chapter 5.2.6. Disease-specific recommendations. WHO; 2006 [cited 2006 Aug 30]. Available from: http://www.who.int/nutrition/topics/5_population_nutrient/en/index5.html.
3 Department of Health. 2000. The NHS Plan. London: Department of Health.
4 Gann PH, Giovannucci ED. Nutrition and prostate cancer. CA: Prostate Cancer Foundation; 2005.
5 Duffield-Lillico AJ et al. Se supplementation, baseline plasma Se status, and incidence of prostate cancer: an analysis of the complete treatment period of the Nutritional Prevention of Cancer study group. BJU International 2003; 91:608-612.
6 Miller ER 3rd, Pastor-Barriuso R, Dala D et al. Meta-analysis: high-dosage vitamin E supplementation may increase all-cause mortality. Annals of Internal Medicine 2005; 142:37-46.
7 Lonn E et al. Effects of long-term vitamin E supplementation on cardiovascular events and cancer: a randomized controlled trial. JAMA 2005; 293:1338-1347.
8 BNF. Appendix 1. Drug interactions: grapefruit juice. 2006; BNF 52.
9 Sonn GA, Aronson W, Litwin MS. Impact of diet on prostate cancer: a review. Prostate Cancer and Prostatic Diseases. 2005; 8(4):304-10.
10 Giovanucci E, Rimm EB, Liu Y, Stampfer MJ, Willett WC. A prospective study of tomato products, lycopene, and prostate cancer risk. Journal of the National Cancer Institute 2002; 94:391-398.
11 Kim HS et al. Effects of tomato sauce consumption on apoptotic cell death in prostate benign hyperplasia and carcinoma. Nutrition and Cancer 2003; 47:40-47.
12 Pantuck AJ et al. Phase II study of pomegranate juice for men with rising prostate-specific antigen following surgery or radiation for prostate cancer. Clinical Cancer Research 2006; 12(13):4018-26.
13 Leitzmann MF, Stampfer MJ, Michaud DS et al. Dietary intake of n-3 and n-6 fatty acids and the risk of prostate cancer. American J ournal of Clinical Nutrition 2004; 80:204-216.
14 Higano CS. Understanding treatments for bone loss and bone metastases in patients with prostate cancer: a practical review and guide for the clinician. The Urologic Clinics of North America 2004; 31:331-352.
15 Leitzmann MF, Stampfer MJ, Wu K et al. Zinc supplement use and risk of prostate cancer. Journal of the National Cancer Institute 2003; 95:1004-1007.
16 Hebert JR et al. Nutritional and socioeconomic factors in relation to prostate cancer mortality: a cross-national study. Journal of the National Cancer Institute 1998; 90:1637-1647.
17 Dagnelie PC, Schuurman AG, Goldbohm RA et al. Diet, anthropometric measures and prostate cancer risk: a review of prospective cohort and intervention studies. BJU International 2004. 93:1139-1150.
18 Jacobs DR, Marquart L, Slavin J et al. Whole-grain intake and cancer: an expanded review and meta-analysis. Nutrition and cancer. 1998;30: 85-96.
We would like to thank the following people for their help in reviewing the content of this page:
- Liz Butler, Senior Nutritional Therapist, Bristol Cancer Help Centre
- Frank Chinegwundoh, Consultant Urologist, Barts and the London NHS Trust and Newham University Hospital NHS Trust
- Saira Chowdhury, Acting Highly Specialist Oncology Dietitian, Guy’s and St. Thomas’ NHS Foundation Trust
- John McLoughlin, Consultant Urologist, West Suffolk Hospital, Bury St Edmunds and Addenbrooke's Hospital Cambridge
- Clare Shaw, Consultant Dietitian, Royal Marsden Hospital
- The Prostate Cancer Charity Support & Information Specialist Nurses
- The Prostate Cancer Charity Information Volunteers
Written by Georgia Diebel, Support & Information Specialist Nurse, The Prostate Cancer Charity.
Edited by Debbie Clayton, Information Manager, The Prostate Cancer Charity.
The Prostate Cancer Charity makes every effort to make sure that its services provide up-to-date, unbiased and accurate facts about prostate cancer. We hope that these will add to the medical advice you have had and will help you to make any decisions you may face. Please do continue to talk to your doctor if you are worried about any medical issues.
© The Prostate Cancer Charity September 2006 To be reviewed September 2008