Prostate Cancer: What You Need to Know Now

This year alone, 288,000 men in the United States will be diagnosed with prostate cancer, making it our second most common type of cancer.

Fortunately, due to the increasing number of treatment options, the five-year survival rate cancer is now higher than 97%.

Shahid Ahmed, MD, MBBS, a medical oncologist at The University of Vermont Medical Center who specializes in cancers of the urinary system and the reproductive organs in men, says that most men would develop prostate cancer if they lived long enough.

“Many men who have it don’t even realize it, and they don’t die from it. If you do autopsies on 85-year-olds, you’re going to see prostate cancer in about half. They pass away because of other things like heart attack or stroke or the natural process of aging. And most won’t die from prostate cancer while on treatments,” Dr. Ahmed explains.

A decade ago, there were only a few options for treatment. Now, research is leading to rapid advancements that are making it easier to find the cancer earlier and reduce the side effects of treatment.

“We can now detect even tiny amounts of cancer with this pet scan called PSMA, which stands for Prostate Specific Membrane Antigen,” says Dr. Ahmed. “The dye we inject binds to a molecule that’s found on top of prostate cancer cells and lights it up. Before, we could only pick up cancer once it was a certain size. This PSMA pet scan allows us to see it when it’s much smaller,” he explains.

That same idea is behind a new drug that targets those cancer cells.

“There’s at least six or seven different types of treatments right now where we can try one thing, then move on to the next if the cancer changes or comes back. A lot of these changes have only happened in the past five to seven years,” Dr. Ahmed says. “If we’re able to keep people alive longer, more treatments are going to come out. I’m very optimistic about what we’ll be able to provide to our patients.”

Combatting the Side Effects

Currently the most common form of treatment for advanced prostate cancer is to essentially shut down testosterone production in the body.

“Cancer cells feed on testosterone. So when the body stops making that hormone, 99% of those cancer cells die,” Dr. Ahmed says.

Treatments that eliminate testosterone can lead to side effects like fatigue, hot flashes, lower libido and reduced sexual performance, says Dr. Ahmed. Here, he shares some strategies for combatting the most common longer-term side effects:

Weight train to prevent muscle loss

“As you undergo these treatments for a long period of time, you’re going to lose a lot of muscle,” says Dr. Ahmed. “When you lose that muscle, you become weaker, and you’re kind of accelerating the aging process. Without testosterone in the body, it’s very hard for men to gain muscle.”

He strongly recommends weight-bearing exercises, daily if possible. Specifically, he suggests that patients sign up for the UVM Medical Center’s Steps to Wellness program, a free, medically-informed rehabilitation and group-exercise program that serves the unique needs of people living with cancer. The 12-week program is designed to help participants increase or maintain levels of strength and wellbeing.

If participating in this or other gym-based exercise programs isn’t possible, Dr. Ahmed encourages patients to get creative with their workouts.

“I’ve had patients who say they’ll use something like a gallon of milk, you know, something that’s slightly heavy, and use that almost like a dumbbell to do their weightlifting. And just going up and down stairs can help you keep your leg strength,” he recalls.

Exercise to avoid weight gain

Another common side effect of lower testosterone is a slower metabolism, which makes it easier to gain weight. So it’s important to do cardio exercises in addition to strength training.

“It’s important to try and keep your weight where it’s at,” Dr. Ahmed stresses. “Once you add weight, it’s hard to take it off. And cardio exercises are a great way to make sure you maintain that baseline.”

General guidelines suggest 150 minutes of moderate-intensity aerobic exercise each week, along with two strength-training sessions. Workouts will vary based on age and ability, but Dr. Ahmed notes that starting with even five minutes a day is better than doing nothing. Duration can be increased as your body adjusts.

Watch what you eat to help ward off heart attack and stroke

Weight gain and muscle loss can eventually lead to heart attacks and strokes, two of the most concerning long-term side effects of treatment, according to Dr. Ahmed.

“Strength training and cardio exercises will help, but diet is important, too,” he says. “Oftentimes, I’ll tell my patients to cut down their portions by 20 to 25%.

Eliminating animal protein entirely is not necessary, says Dr. Ahmed, but a diet that is predominantly vegetarian may slow the recurrence of prostate cancer. Beans, quinoa and vegetables like broccoli and spinach can help you maintain the protein needed to combat muscle loss, and the lycopene in vegetables like tomatoes and sweet potatoes has been associated with a decreased risk of cancer.

There is also a new medicine called Relugolix, says Dr. Ahmed, a pill that shuts down testosterone and has a nearly 50% reduction in heart attacks and strokes compared to some injectable treatments. If heart problems start to develop, Dr. Ahmed notes that it’s easier to stop the pills or adjust the medication.

Take vitamin D and calcium for bone health

Testosterone keeps bones strong, so when it goes away, bones become weaker over time, too. If you lose muscle mass, there’s less tension on the bones, which also makes them weaker.

To combat this progression, make sure you get enough vitamin D and calcium in your daily diet. Also, there are medications that can be taken to improve bone strength, but Dr. Ahmed says they should only be taken after consultation with a dentist, since they can have an impact on tooth health.

Mind your mind

Testosterone plays a role in mental health as well, and treatments can potentially reduce cognition over the long-term. It’s a rare occurrence and fortunately the effects can be reversed if the treatment is stopped and testosterone levels come back. Dr. Ahmed suggests talking to your physician about what’s best for you.