A new study provides extra reassurance for men with early prostate cancer managed with active surveillance. The research team from Coventry and Cambridge University demonstrated a strong relationship between the size of the underlying tumour, seen on MRI, with the the blood test – prostate specific antigen (PSA). This is an important finding as it reassures them that lifestyle changes that reduce or stabilise PSA are matched by underlying changes seen on MRI (Download full paper).
Prostate cancer is the most common cancer in the western world and its incidence is increasing across Asia as diet and lifestyle changes. Although 20% of men with aggressive disease can develop fatal disease, improvements in initial treatments are curing more men albeit with troublesome consequences such as incontinence and erectile dysfunction. More recently it has been discovered that men with non-aggressive disease have very slow growing tumours that rarely spread. These men are best managed with surveillance and only those showing evidence of progression require intervention. In this group, several well-conducted research studies have shown that lifestyle has a big influence on the rate of progression – in many cases stopping disease altogether (see below).
How are men monitored during Active Surveillance: The blood test Prostate Specific Antigen (PSA) remains very important as it generally reflects disease progression (although other factors can influence it). Rectal examination is now standard. The role for repeat prostate biopsy and MRI is less well established. Repeat biopsy does give more information on the amount of disease within the gland but is uncomfortable and can introduce infection. Modern diffusion-weighted MRI is able to look inside the prostate and can give an idea of whether disease is growing. Currently, few studies tell us which is best and how frequently they should be performed.
An important study was published in January 2016 which provided more information for men on active surveillance and how best to monitor them. It involved 204 high-resolution diffusion-weighted MRI from 102 men who had at least two annual scans one year apart and were part of a previous study in which they were taking the polyphenol-rich food supplement Pomi-T. The average PSA at the first MRI was 7.98 microg/dl and second was 6.04 microg/dl (a 24.3% improvement overall). Only 18% had MRI evidence of disease progression confirming a very slow progression in this group of men. There was a mean 44.5% rise in PSA in men with MRI progression (images E-F) and a mean 26% fall in PSA in men categorised as MRI-stable disease (G-H), no disease seen or regression (G-H) (p<0.0001). Most importantly, no man with progression seen on MRI had a falling PSA, all men with an MRI suggesting a shrinkage of disease had a falling PSA. All MRIs were reviewed by the hospital multidisciplinary team.
The impact of this study
The strong link between PSA dynamics and MRI tumour definitions has been demonstrated for the first time by this study providing reassurance for men on AS that changes in PSA, in response to self-help strategies such as Pomi-T and exercise, correlates with underlying disease seen on MRI tumour status. This work adds support and credibility for the original lifestyle study by Dean Ornish and the latest nutritional intervention study, both of which did not include MRI.
What is next?
The Chief Investigator Professor Robert Thomas, a consultant oncologist at Bedford and Addenbrooke’s Cambridge University Hospitals published this data in the Journal of Lifestyle Management academic institutions and patient advocacy groups alike (paper-mri-psa). His research team is now going on to investigate other benefits of polyphenol-rich foods for arthritis, exercise performance, hot flushes and nail health.
The main, lifestyle factors linked to reduce prostate cancer progression:
• Exercising 3 hours a week >>
• Increasing cruciferous and green vegetables >>
• Increasing herbs and spices >>
• Increasing colourful fruits. >>
• Reducing processed sugars and carbohydrate overload. >>
• Taking the polyphenol rich food supplement Pomi-T. >>
• Maintaining a normal cholesterol >>
• Maintaining a healthy weight. >>
• Avoiding carcinogenic foods. >>