What is the evidence around diet, physical activity and increased risk of prostate cancer?
A healthy diet will benefit your overall health and reduce your risk of medical problems such as heart disease and diabetes. There is also some evidence that certain foods may slow down the growth of prostate cancer or reduce the risk of it returning after treatment. The research at the moment is limited and we are unsure how different foods affect the growth of prostate cancer.
Exercise or physical activity is important for general health. It can help you to maintain a healthy weight by burning up extra energy which would otherwise be stored by the body as fat. It is unclear whether exercise can help to slow down the growth of prostate cancer, but it may help with some of the side effects of treatment. It can also help you cope with any feelings of anxiety or depression.
Being overweight (obese) may be linked to an increased risk of aggressive or advanced prostate cancer. However, we do not yet fully understand how weight affects prostate cancer growth. Being a healthy weight may improve the likelihood of surgery or radiotherapy being successful. If you have surgery, you are less likely to have problems like blood loss and urinary problems if you are a healthy weight. Keeping to a healthy weight can also reduce your risk of other health problems such as diabetes and heart disease.
Read our Tool Kit fact sheet Diet, exercise and prostate cancer for more detailed information about a healthy diet and exercise.
Why isn't there a screening programme?
Screening programmes aim to spot early signs of cancer in people who do not have any symptoms. There is no screening programme for prostate cancer because the PSA test is not reliable enough.
Screening using the PSA test could reduce the number of deaths from fast growing prostate cancer but it could also increase the number of men having unnecessary treatment for slow growing prostate cancer. Treatment can cause significant side effects so screening could lead to many men having worse side effects from treatment than they would have had from the cancer.
Early detection is still important for men at a higher risk of getting prostate cancer or who have advanced disease but no symptoms. If you are concerned about prostate cancer you can talk to your GP about your individual risk and talk through the advantages and disadvantages of the PSA test. If you then decide that you want a PSA test, you can ask your GP for one.
Although there isn't a screening programme for prostate cancer, all men are entitled to have a PSA test if they want it.
Prostate Cancer UK believes that the UK needs an improved programme that better provides balanced information about the PSA test and prostate cancer risk to men. we have launched our Testing Choices campaign to address this.
Why don’t we start testing men for prostate cancer from 40 years?
It is unlikely that a future prostate cancer screening programme would include men aged under 50 becuase 99% of prostate cancer cases, in the UK, are diagnosed in men aged 50 and over.
However, we know that some men are at higher risk of developing prostate cancer below the age of 50 - particularly those who have a family history of the disease and men from an African Caribbean background .
At the moment, any man can request a PSA test from his GP, who should give him balanced information about the pros and cons to help him make a decision about whether or not to have the test.
I have been diagnosed with prostate cancer. Should my son get a PSA test?
Having a close family member diagnosed with prostate cancer increase a man's chance of developing the disease. Men are two and a half times more likely to get prostate cancer if their father or brother has been diagnosed. The risk increases to about four times the average if their relative was under the age of 65 when they were diagnosed.
We would suggest your son discusses his risk of developing prostate cancer with his GP. It is important that men with a family history of prostate cancer receive the best available information and support to assist them in deciding whether or not to have a PSA test. Under the NHS Prostate Cancer Risk Management Programme any man over the age of 50, who asks for the PSA test, after careful consideration of the implications, should be given one. At present, there are no definitive guidelines for PSA testing in high risk families in the UK because of the uncertainties around the effectiveness of testing and treatment. However many men with a family history will choose to start having PSA monitoring in their mid-forties.
What level of over treatment is acceptable for the Charity to support a national screening programme?
Any new screening test would have to fulfil the World Health Organisation's ten criteria for screening. As part of this, the risks of over-treatment and the number of lives saved by a screening programme would be considered, as well as other benefits to the health system such as the impact of diagnosing prostate cancer at an earlier stage.
Do you think we will have a screening programme within the next five years?
Research is continuing into a better way to diagnose prostate cancer. Any new screening test would have to fulfil the World Health Organisation's ten criteria for screening and be thoroughly tested in large-scale studies. This means it is very unlikely that we will see a screening programme for prostate cancer within the next five years.
What are the characteristics of the perfect prostate cancer biomarker and when can we have it?
The "perfect biomarker" would probably be:
- easy and cheap to test
- easy to obtain samples with minimal impact on men eg. using a blood, semen or urine sample
- prostate cancer specific and not detect other prostate problems
- needs to be stable so that it can be sent by the clinician for testing without degrading
- needs to be reliable at indicating prostate cancer, with demonstrated success in multiple large scale, rigorous trials.
- combination of markers is likely to be ideal as some markers work well in certain men and not in others.
If the perfect biomarker was to be used to screen men for prostate cancer, it would need to fulfil the World Health Organisation's ten criteria for screening and be thoroughly tested in large-scale screening studies.
An ideal screening test would also have a high sensitivity (to correctly identify men with prostate cancer and not miss many cases i.e. limit "false-negatives") and a high specificity (to accurately rule out men who don't have prostate cancer ie limit "false-positives").
Do you need the consent of your GP to get on a trial?
You do not need your GP's consent to take part in a clinical trial. It is your hospital specialist who would refer you to a trial and will usually write to your GP to inform him or her about the referral and your decision to either take part in the trial or not. If you wish to take part in a trial, ask your specialist if there is one suitable for your situation.
Why don’t clinicians ask patients if they’d like to go on a trial?
Clinicians may not discuss clinical trials if there is not a suitable trial for an individual's situation. However, time is often very limited in clinics and some specialists have suggested that there is not always sufficient time to explore the option of being involved in a clinical trial. If you are interested in taking part in a trial ask your specialist if there are any that are suitable for you situation.
How do you inform people about clinical trials without them feeling pressured to take part?
No one should feel pressured to take part in a clinical trial, the decision to take part, or not, is completely voluntary. Clinical trials follow strict scientific and ethical rules to protect patients. The doctor or research nurse needs to give enough information to help their patient choose whether or not to participate. Patients may choose not to take part or ask for more time to think about it. Patients must feel that all their concerns and questions have been satisfied before their decision is made. It is important for patients to remember that if they have made a decision to take part in a trial, they can change their mind at any time, even after they have signed a consent form or they have been on the trial for some time.
It is also important for patients to know that if they say 'no' to a clinical trial their wishes will be respected and they will be offered the best available treatment for their prostate cancer. The decision to say 'no' or a change of mind will not affect care in any way.