There was a time when all men newly diagnosed with prostate cancer were fast-tracked into treatment; here Professor Robert Thomas talks of his work in encouraging Active Surveillance, and how the right diet and exercise programme can delay the need for orthodox treatment and how there can be much to gain and nothing to lose by biding time.
A Lifestyle Protection Plan for Your Prostate
by Professor Robert Thomas
Only a few years ago, a man newly diagnosed with prostate cancer in the UK would most likely expect (as well as fear) immediate treatment a fast track to radiotherapy, brachytherapy, hormone therapy or surgery. But Professor Robert Thomas, consultant oncologist at Bedford and Addenbrooke’s Cambridge University NHS Trusts, maintains that there can be much to gain and nothing to lose by biding time. For men with small, lower grade tumours confined to the gland, he positively recommends a more holistic, hold-fire approach, incorporating regular aerobic exercise and an antioxidant-rich diet. ’For the vast majority of men with Gleason grade 6, or early grade 7 cancer’ he reassures ’there is no need for immediate intervention.’
Professor Thomas puts these patients on an Active Surveillance programme, combining regular PSA checks to see if their cancer progresses. ’What we watch for is the doubling time how quickly the PSA rises in those measuring between six and 20. Our recent study showed that, through lifestyle changes, 40 per cent of patients stabilised and did not go on to have treatment. Of those whose cancer did progress, some advanced at only a slow rate that still required no intervention, whilst others did then need treatment. But even then, Professor Thomas stresses that there is no additional risk to delay: ’Treatment after active surveillance carries an identical chance of cure to that received on diagnosis. So a man might have another four or five more years without radical treatment and the accompanying risk of toxicity (rectal damage such as bleeding or urgency to open the bowels, impaired erectile and urinary function).’
The lowdown on lifestyle offered by Professor Thomas is highly significant not only for newly diagnosed men, but for any man wanting to prevent prostate cancer or its recurrence. ’Whatever category a guy falls into’ he says,"’the lifestyle guidelines are precisely the same. I see it work at every stage. The Kenfield trial published this year in the Journal of Clinical Oncology, shows that exercise for more than three hours a week reduces the risk of prostate cancer recurrence by 36 per cent. It is therefore disappointing that our joint Addenbrookes/Bedford study of 500 prostate cancer patients, five years after radiotherapy. showed that 65 per cent were inactive a factor that could", says Professor Thomas, "have contributed to them contracting prostate cancer in the first place. Our survey also shows that the 58 per cent of men who were overweight had worse toxicity and risk of relapse following treatment than those who maintained a healthy weight and active regime."
These are convincing enough statistics to galvanise any guy. But what level of exercise is beneficial? Certainly not a twice-weekly amble, nor gardening or a stab at housework. ’Men who do best are those who take up a particular exercise for the sake of it: brisk walking or jogging, cycling, dancing, Pilates - any gym class or supervised gym programme.’ Signing up for action is never left to chance or the vague notion that it’s something to get around to sometime: ’In clinic we ask patients what they’d most enjoy to get their heart and lungs going, and if they say dancing, then we send them home with a list of local salsa classes. We follow up with a phone call to see how they are getting on.’ So committed is Professor Thomas to the exercise-for-cancer cause that he is lobbying MPs (through the Wright Foundation) in the hope of persuading strategic health authorities to fund a formal exercise rehab programme. ’The idea is to expand the National Referral Scheme (through which diabetes and heart attack patients are given a free prescription for the gym) to include cancer survivors. Of whom there could be more if only all prostate patients would heed healthy eating advice. But persuading people to alter their eating habits remains a challenge, even when their lives depend upon it.
’Studies show that those whose diets were antioxidant rich have less aggressive cancers and therefore a better outcome. But most men in our studies do not have a good antioxidant intake’ says Professor Thomas. ’They may claim to eat green veg, but when asked specifically, it turns out that perhaps they only drink green tea once a week. It’s a rare man who sprinkles turmeric on his porridge like one fanatic.’
The perfect plateful for prostate patients contains food rich in Omega 3 foods (fish, walnut, seeds, organic meat and free range eggs) plus broccoli, green tea, pomegranate and turmeric, all of which have significant benefits in reducing cancer risk. Also positively indicated are tomatoes, peppers, herbs, spices, blackberries and apples. An Australian study finds that one good portion a day of broccoli or asparagus reduces the risk of cancer though, as Professor Thomas observes, it is hard to quantify quite what constitutes a portion.
As convinced as he is by the Rainbow Diet, so Professor Thomas is cautious about unsupervised supplementation with vitamins and minerals: ’If you want to find out what you need, then take a nutritional test. Measure and correct the specific deficiency. Otherwise focus on eating well. It would be very hard to overdose yourself with food, but certain supplements like Vitamin A can actually promote cancer cell growth if taken in excess. So I am against blind, over-the-counter supplementation except for Omega 3 in which our studies show that most men are deficient. We are currently evaluating POMI-T a freeze-dried supplement of broccoli, green tea, turmeric and pomegranate extract for men who don’t eat well enough. Certainly good levels of vitamin D reduce the risk of prostate cancer relapse. But going out in the sun though avoiding bits of the body that have previously burned raises your levels much faster than tablets.’
One extreme example of health reversal by diet is a Professor Thomas patient whose prostate cancer had spread beyond the gland to the lymph nodes. He had already received two courses of chemo. ’This chap started drinking broccoli soup every morning and his PSA dropped from 150 to 1.5. A dramatic case like this you do remember, and I can personally verify that nothing else at all was given to this particular guy: no radiotherapy, no hormone treatment; nothing.’
If the proof of the broccoli broth is in the plummeting PSA, then why don’t more medics spread the word? ’This is the biggest hurdle’ says Professor Thomas. ’If patients hear it from their doctors, they are, of course, much more likely to take notice. Unfortunately most units still lack the healthy lifestyle culture: local oncologists in Brighton are quite keen, whereas Harrogate wants definitive proof before asking the health authority to invest in a survivor lifestyle programme. The problem is that if lifestyle were a drug, and had to be approved by the MRHA, the evidence would not meet the standard, because studies are just not large enough. It’s very hard to do lifestyle research. You can’t just placebo one group of men by telling them to smoke cigarettes and put on three stone.’
For Professor Thomas however, the success of active surveillance is beyond doubt: ’This is not just talking over the garden fence. When you see men coming in with PSAs going up and then see their PSAs dropping because they have gone out, exercised and lost weight, that is very motivating and very believable. I have published statistically validated evidence in studies like the Arnish which looked at randomised people to lifestyle and showed clear benefits to cancer. I see the results on men’s faces.’
Chris Woollams, former Oxford University Biochemist and a founder of CANCERactive said, "I so agree with all this. Robert and I had a chat about what foods were important when he was creating POMI-T, and we find that we see great results in men who control their fat, change their diet, go in the sun and/or supplement with vitamin D and take long-chain omega 3 (fish oils) as a start. But the biggest benefits for us have been seen in men, even at the age of 60, who take up new activities - like kite-surfing or badminton, or walking football. In some cases, the prostate cancer has disappeared. One note of caution I would add is that there is an infection factor in some men. But then, as we always have told people, your cancer is as individual as you are".