You have two dishes in front of you. One is a thick juicy filet of beef, wrapped in bacon; the other a bowl of rigatoni tossed with a spicy tomato sauce. Which do you choose?

The steak is tempting, of course, but if you’re a red-blooded American male, the best choice is the bowl of rigatoni. Aside from the complex aromas, textures and flavors of the tomato sauce, this low-fat dish may also offer you significant protection from one of the greatest killers of men, prostate cancer.

You’re probably barely aware that you have a prostate, a small gland that produces some of the fluid that makes up semen. If you’re over age 50, however, you may soon discover that the health of your prostate may have a lot to do with how long and how happily you live.

Among American males, prostate cancer is the second most common cancer (after skin cancer) and the most deadly one for men who don’t smoke, claiming nearly 32,000 lives last year. Even men who have their cancers successfully removed are frequently haunted by after effects of treatment, including erectile dysfunction and urinary incontinence.

No one knows what causes prostate cancer or how it can be prevented. There is, however, a substantial body of circumstantial evidence suggesting that what you eat can make a difference to your risk of developing prostate cancer.

The American Cancer Society recommends a prostate-healthy diet that substantially limits consumption of red meat and saturated fats and that includes five or more servings of fruits and vegetables each day. While such a regimen may not match traditional American habits, it fits well with efforts to prevent heart disease, hypertension, stroke, diabetes and other cancers.

An American Tragedy?
Scientists have long known that prostate cancer is prevalent in the United States, particularly among African Americans, but far less common in Asian countries such as China, Japan and Korea.

Genetic susceptibility undoubtedly plays a role, but environment is apparently involved as well. When Japanese and Chinese men move to the United States and start following an American diet their risk of prostate cancer increases within a few generations to match that of American men. Rural Africans, eating a traditional diet, have less than one tenth the risk of African American males.

Autopsies performed on persons who die of other causes routinely find microscopic signs of prostate cancer in males in all parts of the world–in about 30 percent of men in their 50s and nearly all of those in their 80s and older. These latent cancer cells may be an inevitable part of aging, but in men in some parts of the world they rarely develop into invasive cancers that spread outside the prostate gland.

For an explanation, scientists have looked to diet. Red meat has long been a staple of Western diet, and the average American male gets 36 percent of his calories from fat. By contrast, men living in Shanghai and Tokyo follow a fruit and vegetable-oriented diet relatively low in saturated fats.

The Health Professionals Follow-Up Study, which collected information about the dietary habits of 51,529 American men, found a strong correlation between consumption of animal fat, red meat and linolenic acid (a fatty acid found primarily in red meats) and the risk of prostate cancer. Another long-term study of 6,763 white male Seventh Day Adventists found that prostate cancer deaths were significantly associated with consumption of milk, cheese, eggs and meat. Other studies, however, have found weaker associations or none.

Meat eaters are generally less likely to get their fair share of fruits and vegetables. Several studies have found a reduced risk of prostate cancer in men who regularly eat substantial amounts of vegetables, particularly yellow orange vegetables such as corn and carrots and cruciferous vegetables such as broccoli, cabbage, cauliflower and brussels sprouts.

A study published in The Journal of Urology [December, 2001] found that a diet rich in fruits, vegetables and whole grains, combined with regular exercise, reduced the growth of tumor cells by 30 percent in 13 men, ages 42 to 73, diagnosed with prostate cancer. In another part of the study, men who had been following a high-fiber, low-fat, plant-based diet for an average of 14 years showed a 45 percent decrease in the growth of cancer cells.

Tomato Sauce Beneficial
A well publicized 1995 study found benefit for men regularly consuming lycopene, an antioxidant found in tomato sauce as well as apricots, watermelon and pink grapefruit. A more recent study [Journal of the National Cancer Institute, December 19, 2001] followed 31 men with cancer who consumed about three quarters of a cup a day of tomato sauce-based pasta for three weeks before surgery to remove their prostates. The subjects had a 21 percent decrease in oxidative DNA damage and an 18 percent reduction in serum PSA, a marker for cancer.

Other studies have suggested beneficial roles for vitamin E and selenium. Finnish smokers who took 50 milligrams per day of vitamin E for at least five years had a 32 percent reduced risk of prostate cancer. Male skin cancer patients who took 200 micrograms of selenium a day for four and one-half years had a 63 percent reduced risk compared to subjects who took a placebo.

Plants generally contain high levels of phytoestrogens. One theory is that these substances may correct a chronic hormonal imbalance that increases the risk of cancerous cell growth. Phytoestrogens are abundant in beans, lentils, peas, dried fruits, tofu and other forms of processed soy–foods that are staples of the diet in countries where the incidence of prostate cancer is low.

Dean Ornish, M.D., known for his efforts to reverse heart disease through lifestyle changes, is now conducting a study with 93 prostate cancer patients who have chosen “watchful waiting” over treatment. One group will continue their usual diet and lifestyle; the other will follow a very low-fat vegan diet, supplemented with soy, along with regular exercise and stress management. Early results have shown an average 6.5 percent decrease in PSA levels for men on the vegan diet.

Dr. Ornish hopes to find a way to slow, stop or even reverse the course of prostate cancer. So far, there is no evidence that can be done. Nor is there direct proof that healthy men can delay or prevent prostate cancer through dietary changes.

If you have prostate cancer and have chosen “watchful waiting,”however, it makes sense to try at least some of these lifestyle changes. If you don’t have prostate cancer but are worried about it, you might do well to choose the rigatoni with tomato sauce over the filet of beef.

REFERENCES:
Jeff Evans, “Tomato Sauce in Diet Cuts DNA Oxidation in Cancerous Prostates,” Family Practice News, March 15, 2002.
Lynn M. Fisher, “High-Fat Diet and Prostate Cancer: The Controversial Connection,” Urologic Nursing, June, 2000.
“Fruit and Vegetable Intakes and Prostate Cancer,” Journal of the American Dietetic Association, July, 2000.
Daphna W. Gregg, “Carnal Knowledge,” Harvard Health Letter, July, 1994.
The Johns Hopkins White Papers, Prostate Disorders, 2002.
“Lycopene, Antioxidant in Tomatoes, May Reduce Risk,” Cancer Weekly, January 15, 2002.
Reed Mangels, “Trial of Vegan Diet in Prostate Cancer,” Vegetarian Journal, September, 2001.
“New Study Reveals Link between Diet and Prostate Cancer,” Urologic Nursing, December, 1999.
David Noonan, Karen Springen, “The Prostate Plan: Fresh Findings Suggest That Changes in Diet and Lifestyle May slow Prostate Cancer. If the Results Hold Up, Surgery and Radiation Won’t Be the Main Choices,” Newsweek, April 22, 2002.
Jeff Novick, “Healthy Diet and Exercise Program Inhibits Growth of Prostate Cancer Cells,” Health Science, Winter, 2002.
“Prostate Cancer in Black South Africans,” Nutrition Research Newsletter, May, 1992.