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Prostate Cancer

The most common cancer in men. Often slow-growing; many cases never require treatment. Lifestyle factors (tomato-rich foods, lower animal fat and aerobic exercise) are associated with lower risk in observational studies; high-dose omega-⁠3 supplements are not established as safe5.

Cancer Evidence-Based

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โš ๏ธ Treatment safety: please read first. The nutrition and supplement approaches on this page are meant to work alongside cancer treatment, never to replace or delay it. Never stop, delay or change your treatment without your oncology team's guidance. Doing so can be dangerous. Several supplements interact with chemotherapy and other cancer treatments, so talk to your oncology team or pharmacist before starting anything on this page.
Definition

What Is Prostate Cancer?

Prostate cancer arises from cells of the prostate gland, a walnut-sized organ below the bladder that produces seminal fluid. Most prostate cancers are adenocarcinomas. The disease is exceptionally heterogeneous, ranging from indolent tumors that never threaten life to aggressive cancers that rapidly metastasize.

Risk is influenced by age (rare under 50, common over 65), genetics (BRCA2, HOXB13, Lynch syndrome), race (highest in African American men) and lifestyle. The disease's dependence on male hormones is why hormone treatment (androgen deprivation) is used.

The challenge is distinguishing "tigers" from "pussycats." Low-risk disease (Gleason โ‰ค6, PSA <10) often doesn't need immediate treatment; active surveillance with close monitoring spares men the side effects of overtreatment while preserving the option to treat if progression occurs.

๐Ÿ’ก Key Insight: Many men diagnosed with prostate cancer die with it, not from it2. In autopsy studies of men never diagnosed in life, prostate cancer was found in 2% of men in their twenties, rising to 69% by their nineties2. Risk stratification (Gleason score, PSA dynamics, MRI, genomic tests) is essential8; many men benefit from active surveillance rather than aggressive treatment.
The bladder above the prostate gland, with the urethra running down through the prostate and a tumor in one side of the gland

Risk Stratification

Low / Very Low Risk

PSA <10, Gleason 6 (Grade Group 1), T1c to T2a. Active surveillance preferred. Many never need treatment.

Intermediate Risk

PSA 10 to 20 or Gleason 7 (Grade Groups 2 to 3) or T2b to T2c. Treatment usually indicated, surgery or radiation. Active surveillance possible for select favorable intermediate-risk disease.

High Risk / Advanced

PSA >20, Gleason 8 to 10 or extracapsular extension. Aggressive treatment: surgery or radiation + ADT. Metastatic disease: ADT + chemo or newer agents.

By the Numbers

Prostate Cancer by the Numbers

~1 in 8
lifetime risk for US men, 13.2% on 2021 to 2023 data1
~334K
new US diagnoses projected for 2026 1
98%
five-year relative survival for all stages combined, but about 40% once the cancer has spread to distant organs (US, 2016 to 2022)1
2 to 69%
of men never diagnosed in life were found to have prostate cancer at autopsy, rising from their twenties to their nineties, across 25 autopsy studies2
17%
more prostate cancers in men taking vitamin E supplements than placebo, in the SELECT trial of over 35,000 men3
55 to 69
the ages at which US guidance makes PSA screening an individual decision, made with a clinician; it advises against screening from 70 13
Signs & Symptoms

Symptoms of Prostate Cancer

Most early prostate cancers are asymptomatic, found only by PSA screening or incidentally. Urinary symptoms are more commonly caused by benign prostatic hyperplasia (BPH); when prostate cancer causes them, it is usually advanced.

SymptomWhat happens
Urinary Symptoms (Often BPH, Not Cancer)
Difficulty UrinatingWeak or interrupted urine stream, straining to urinate, sense of incomplete emptying. Usually from BPH but warrants prostate evaluation.
Frequent Urination (Especially at Night)Nocturia 2+ times nightly. Urgency. Frequent small voids during day. Most often BPH but evaluate.
Blood in Urine or SemenHematuria or hematospermia. Always warrants evaluation. May indicate advanced prostate cancer, but more often other urologic causes.
Painful Urination or EjaculationMay indicate prostatitis (more common), urethral involvement or advanced cancer. Evaluation needed.
Advanced Disease
Bone Pain (Especially Spine, Pelvis, Ribs)Persistent deep aching pain. Bone is the most common metastatic site. Spine metastases can cause cord compression, a medical emergency.
Weakness or Numbness in LegsSpinal cord compression, EMERGENCY. New-onset back pain with neurologic symptoms requires immediate evaluation. Permanent paralysis possible if delayed.
Unexplained Weight Loss & FatigueConstitutional symptoms of advanced disease. Anemia common from bone marrow involvement.
Erectile Dysfunction (New Onset)May indicate advanced local disease. More commonly age-related or due to other causes. Combination with urinary symptoms warrants prostate evaluation.
Causes

Causes of Prostate Cancer

Most established risk factors for prostate cancer cannot be changed: age, ethnicity, family history and height. Excess body weight is the main one that can17.

CauseHow It Contributes to Prostate CancerWhat Helps
AgeRisk rises with age: about 3 in 4 cases are diagnosed at 65 or over, and most men in their 80s have some prostate cancer, often not life-limiting17An informed PSA decision with a clinician between 55 and 69 13; for low-risk cancer, active surveillance rather than immediate treatment10
EthnicityMen of African-Caribbean or African descent have a higher risk than white men, and Asian men a lower one17Weighing it in the PSA decision: US guidance asks men and clinicians to consider race and ethnicity, and family history13
Family history and inherited genesRisk is higher if a father, brother or uncle had prostate cancer, or a mother had breast cancer; about 5 to 9% of cases are linked to genes or family history17Genetic testing where the diagnosis section recommends it; in the UK, routine PSA testing is offered to men with a BRCA2 gene mutation14
Excess body weightMen living with overweight or obesity have a higher risk17A healthy weight through the diet section's plant-forward pattern and regular exercise
Dairy and calciumDairy products and calcium may increase risk, though the evidence is weaker than for the factors above17The diet section's limits: dairy at 1 to 2 servings a day and no high-dose calcium supplements
Vitamin E and selenium supplements (not recommended)In over 35,000 men, vitamin E supplements raised prostate cancer risk by about 17% against placebo, and selenium did not prevent it3Not taking vitamin E or selenium supplements, both not recommended (see the supplement section); food sources are not implicated
Diagnosis

How Prostate Cancer Is Diagnosed

TestWhat it shows
Screening & Detection
PSA (Prostate-Specific Antigen)Blood test. It is not specific to cancer: BPH and prostatitis also raise it. In the US, PSA screening at 55 to 69 is an individual decision made after discussing benefits and harms with a clinician, and is not advised from 70 13. In the UK there is no routine PSA screening except for men with a BRCA2 gene mutation, but anyone with a prostate can ask a doctor about the test after discussing its benefits and risks14. PSA velocity (rise over time) and density (PSA/prostate volume) are more informative than single values.
Digital Rectal Exam (DRE)Palpates posterior prostate for nodules, asymmetry, induration. Insensitive (misses many tumors) but specific when abnormal. Adjunct to PSA.
Multiparametric MRI3T MRI with PI-RADS scoring before biopsy. Reduces unnecessary biopsies and detects clinically significant cancers. Increasingly standard practice.
MRI-Targeted BiopsyImage-guided sampling of MRI-detected lesions plus systematic cores. More accurate than systematic biopsy alone. Reports the Gleason score and how much of each sample is involved.
Risk Stratification & Staging
Genomic TestsTissue-based genomic classifiers. Assess aggressiveness and recurrence risk. Particularly useful for borderline active surveillance decisions.
BRCA & Germline TestingRecommended for high-risk, metastatic, family history. BRCA2 carriers have more aggressive disease. PARP inhibitors available for BRCA-mutated metastatic disease.
Staging Imaging (Intermediate and High Risk)For intermediate- and high-risk disease: PSMA PET-CT is increasingly used for staging; in high-risk cancer it detected spread more accurately than CT and bone scan, and it is approved for initial staging when spread is suspected and for suspected recurrence22.
Other BiomarkersFree PSA and other blood and urine biomarker tests refine PSA's specificity and reduce unnecessary biopsies.
Treatment Comparison

Conventional and Holistic Treatment for Prostate Cancer

๐ŸŒฟ HOLISTIC
๐Ÿ’Š CONVENTIONAL
๐ŸŒฟ

Holistic / Functional Approach

Particularly relevant for active surveillance, prevention and survivorship.

Low-Risk Disease
Active surveillance plus lifestyle change; a small trial found PSA fell slightly with intensive lifestyle change11
Prevention
A Mediterranean-style pattern with tomato-rich foods and less animal fat is reasonable, but evidence of prevention is limited; high-dose omega-⁠3 supplements are not established as safe5
Survivorship
Manage ADT side effects (osteoporosis, metabolic syndrome, hot flashes)
Active Treatment
Adjunctive support for well-being and side effects alongside standard care

Full Holistic Approach Includes

  • Limit red and processed meat, though it is not an established prostate cancer risk factor17.
  • Lycopene from cooked tomatoes, 10+ servings/week of tomato sauce, paste, cooked tomatoes. Associated with lower risk of aggressive prostate cancer in cohort studies.
  • Cruciferous vegetables daily, broccoli, kale, cauliflower. In a small randomized trial, sulforaphane missed its main goal, though PSA rose more slowly on secondary measures15.
  • Green tea 2 to 3 cups/day, reasonable as a drink, but a randomized trial of green tea catechins did not lower prostate cancer rates4
  • Omega-⁠3 from fatty fish, anti-inflammatory; controversial if from supplements5 (one large study linked higher blood levels of omega-⁠3 with higher prostate cancer risk)
  • Pomegranate, not recommended as juice or extract: the juice slowed PSA rise in early uncontrolled studies, but a placebo-controlled trial of the extract found no significant effect16
  • Correcting low vitamin D, deficiency associated with worse prognosis.
  • Regular vigorous exercise, 3+ hours/week is associated with lower prostate cancer mortality in cohort studies
  • Limit dairy and calcium supplements, as weaker evidence suggests dairy and calcium may increase risk17. If you are on hormone therapy (ADT), your team may advise calcium and vitamin D to protect your bones; follow that advice.
  • Stress reduction, sleep, for well-being and coping
  • Limit alcohol to 2 drinks a day or fewer, and avoid binge drinking
  • For ADT patients: resistance training (preserves muscle), weight-bearing exercise (bones), Mediterranean diet (cardiometabolic protection)
โœ… Lifestyle trial insight: In a randomized trial of 93 men with early, low-grade prostate cancer who had chosen not to have conventional treatment, intensive lifestyle change (plant-based diet + exercise + stress management + group support) lowered PSA by 4% over one year while it rose 6% with usual care, and none of the lifestyle group went on to conventional treatment against six in the usual-care group11. Promising, but small and short; it supports lifestyle change alongside surveillance, not in place of it.
Supplement Protocol

Evidence-Based Supplements for Prostate Cancer

The evidence for every supplement here is limited, and two, vitamin E and selenium, are not recommended: they failed or caused harm in SELECT3. Always discuss with your urology/​oncology team.

SupplementWhat it is forTypical rangeTimingNotes & cautions
Vitamin D3Low levels are linked with worse outcomes in observational studies, but in a randomized trial of 25,871 adults, vitamin D did not lower cancer rates, and its effect on prostate cancer was not significant20.Not recommended for prostate cancer (the trial used 2,000 IU a day)Not applicableIf your clinician finds a deficiency, it is treated for its own sake. If you are on hormone therapy (ADT), your team may advise calcium and vitamin D to protect your bones; follow that advice.
LycopeneCarotenoid concentrating in prostate. A Cochrane review of three small randomized trials found too little evidence to support or refute lycopene for preventing prostate cancer21. Food sources (cooked tomato) likely better than isolated supplements.15 to 30 mg/day from supplement OR daily cooked tomatoesWith fat mealSynergy with cooking and olive oil.
Pomegranate ExtractEarly studies reported slower PSA rise, but the placebo-controlled trial found no significant effect16. Anti-androgen effects in lab. Multiple bioactive compounds.Not recommended for prostate cancer (a placebo-controlled trial found no significant effect)Not applicableThe whole fruit is fine as food.
Sulforaphane (or Broccoli Sprouts)Activates an antioxidant pathway in lab studies. In a randomized trial of 78 men with rising PSA after surgery, 60 mg a day missed its main goal15. Best from fresh broccoli sprouts.20 to 100 mg sulforaphane/day OR 2 to 4 oz (about 55 to 115 g) fresh broccoli sproutsEmpty stomachSprouts have about 100ร— the sulforaphane of mature broccoli. Activate with chewing or chopping.
Omega-⁠3 (EPA/DHA)Not shown to help prostate cancer. Mixed evidence (a large study linked higher blood levels with higher risk5), so moderate amounts from food are preferred.1,000 to 2,000 mg EPA+DHA/day, preferably from fatty fish; any supplement at this dose agreed on with your oncologistWith fat mealFood-based preferred: supplements are not established as safe in men with or at risk of prostate cancer5, so agree on any supplement with your oncologist or clinician. In heart trials, fish oil supplements raised the risk of atrial fibrillation, an irregular heartbeat, more so above 1 g a day28, so check this dose with your clinician first.
Green Tea Extract (EGCG)Effects in laboratory studies, but the randomized trial was null.4Not recommended for preventing prostate cancer (the trial used 400 mg EGCG a day)Not applicableSupplements giving 800 mg EGCG/day or more raised liver enzymes in trials, and rare liver injury has been reported even from green tea drinks12. Stop if liver enzymes rise.
SeleniumThe SELECT trial showed no benefit and possible harm from synthetic selenomethionine3.Not recommended for prostate cancer (a large trial found no benefit and possible harm)Not applicableDo not take selenium supplements: on current evidence they may cause harm. Food sources are not implicated.
Vitamin EAvoid as a supplement. In the SELECT trial of over 35,000 men, vitamin E supplements did not prevent prostate cancer, and longer follow-up showed they raised it by about 17% against placebo. Food sources are not implicated.3Not recommended for prostate cancer (a large trial found it raised the risk)Not applicableThis is the other half of the SELECT result: selenium showed no benefit, and vitamin E raised prostate cancer risk, so avoid both as supplements. Vitamin E supplements can also raise bleeding risk with blood thinners.
Modified Citrus PectinBinds galectin-⁠3 (involved in metastasis).6 Small studies show PSA modulation.5 g 3x/dayEmpty stomachLimited evidence but generally safe. No randomized trial has shown an effect on cancer outcomes6.
What to Expect

What to Expect Over Time

What happens depends on the risk group, and every option trades benefits against harms24.

Treatment and supportive care, together
First Weeks

Gleason score, PSA, MRI and stage set the risk group, as the diagnosis section describes8. For low-risk cancer, US guidance prefers active surveillance; higher-risk cancer is usually treated10. Tell your team about every supplement before taking it.

Months 1 to 3

On active surveillance, PSA is checked no more often than every 6 months, with MRI and planned biopsies10. After surgery or radiation therapy, effects on urinary, bowel and sexual function are usually greatest in the first months, with some recovery after19.

Months 3 to 12

On hormone therapy, resistance and aerobic training improved quality of life, fatigue and strength in randomized trials18.

Long Term

In a trial of men with PSA-detected localized cancer, about 3% died of it within 15 years whether assigned monitoring, surgery or radiation therapy; spread was more common with monitoring, and a quarter of that group were alive without any treatment at 15 years24.

When to Seek Care

New back or neck pain, leg weakness or numbness, or loss of bladder or bowel control can mean pressure on the spinal cord: get emergency care now, even on a weekend25. Being unable to pass urine is an emergency26. On chemotherapy, any fever of 100.5ยฐF (38ยฐC) or higher needs emergency care27.

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Next Steps

Choose Treatment Carefully

Many prostate cancers don't need aggressive treatment. Work with a urologist who supports active surveillance for appropriate cases; avoiding overtreatment matters as much as treating aggressive disease. Lifestyle changes may help in low-risk disease and survivorship, though the trials are small11.

Explore Breast Cancer โ†’ Explore Benign Prostatic Hyperplasia โ†’

References & Evidence Notes

Each numbered entry below is either a source you can follow or a note setting out what the evidence does and does not support. Both are numbered together so the markers in the text line up.

Last reviewed October 20, 2026. Supplement entries are cross-checked against the NIH National Center for Complementary and Integrative Health and the Linus Pauling Institute Micronutrient Information Center.9 Nothing on this page treats prostate cancer. Two things here matter more than any supplement. First, in low-risk prostate cancer the bigger risk is not undertreatment but overtreatment: many low-risk cancers never need treating, and active surveillance exists for exactly that reason. Do not let anything on this page push you toward or away from treatment; that is a conversation about your Gleason score, PSA dynamics, MRI and life expectancy, with a urologist. Second, some supplements are named here to tell you NOT to take them. Selenium and vitamin E were both tested in the SELECT trial and both failed, vitamin E with clear harm. Tell your team about every supplement you take. Diet and supplements are not an alternative to surgery, chemotherapy, radiation therapy or immunotherapy, and no dietary change should delay or replace treatment decided with your oncology team. Several supplements interact with cancer treatment.

  1. SEER (National Cancer Institute) prostate cancer statistics. seer.cancer.gov. Source for incidence, stage distribution and survival. Prostate cancer has one of the highest 5-⁠year survival rates of any solid tumor, which is part of why overtreatment rather than undertreatment is the central problem. ↩
  2. On indolent disease and active surveillance: autopsy series consistently find microscopic prostate cancer in a large proportion of older men who died of other causes, rising in a meta-regression of 25 autopsy studies from 2% in the twenties to 69% by the tenth decade in white men, PubMed 24735055, which is the basis for the statement that many men die with prostate cancer rather than from it. Active surveillance for low-risk disease (Gleason 6 / Grade Group 1, PSA below 10) is guideline-supported and avoids the erectile and urinary consequences of immediate treatment in men who would never have been harmed by the cancer. ↩
  3. On SELECT, and the reason two supplements on this page carry warnings rather than doses: Klein EA, et al. Vitamin E and the risk of prostate cancer: the Selenium and Vitamin E Cancer Prevention Trial. JAMA. 2011;306(14):1549-⁠1556. PubMed 21990298. In more than 35,000 men, vitamin E supplementation increased prostate cancer incidence by about 17% against placebo. Selenium showed no benefit, and a later analysis found that selenium supplements raised the risk of high-grade prostate cancer in men whose selenium status was already high, PubMed 24563519. Both arms were stopped. Food sources of either nutrient are not implicated; this is about supplementation. ↩ ↩
  4. On green tea catechins, read both trials: Bettuzzi S, et al. Cancer Res. 2006;66(2):1234-⁠1240: a one-year proof-of-principle study in men with high-grade prostatic intraepithelial neoplasia reported significantly fewer prostate cancers on green tea catechins. Then Kumar NB, et al. Randomized, placebo-controlled trial of green tea catechins for prostate cancer prevention. Cancer Prev Res. 2015;8(10):879-⁠887. aacrjournals.org: 97 men on Polyphenon E providing 400 mg EGCG daily, with cumulative one-year prostate cancer rate as the primary endpoint. No difference: 5 of 49 against 9 of 48, p = 0.25. The randomized trial with the prespecified endpoint is the stronger evidence. ↩
  5. On omega-⁠3 and prostate cancer, which is why this page hedges rather than recommends: Brasky TM, et al. J Natl Cancer Inst. 2013;105(15):1132-⁠1141, PubMed 23843441, found higher plasma phospholipid long-chain omega-⁠3 concentrations associated with increased prostate cancer risk. The finding is observational and contested, and it concerns high concentrations rather than eating fish. Fatty fish as food remains reasonable; high-dose supplementation in men with or at risk of prostate cancer is not established as safe. ↩
  6. On modified citrus pectin and galectin-⁠3: the human evidence is limited to small studies reporting changes in PSA kinetics, with no randomized trial showing an effect on cancer outcomes. Included on this page as a small signal, not a treatment. ↩
  7. On radical prostatectomy and radiation therapy outcomes, including the erectile and urinary side-effect rates quoted: these follow current AUA and EAU guidance. Side-effect rates vary by technique, surgeon volume and baseline function, and are a central part of the treatment decision rather than a footnote to it. ↩
  8. On risk stratification: Gleason score and Grade Group, PSA level and kinetics, clinical stage, multiparametric MRI and genomic classifiers together determine whether a cancer needs treating now, later or possibly never. No single number decides it. ↩
  9. National Center for Complementary and Integrative Health (NIH), nccih.nih.gov, and the Linus Pauling Institute Micronutrient Information Center, lpi.oregonstate.edu/mic. ↩
  10. On risk-based management: the 2022 AUA/ASTRO guideline on clinically localized prostate cancer, published in three parts in the Journal of Urology, recommends active surveillance as the preferred option for low-risk disease, monitored with PSA no more often than every 6 months, an examination every 1 to 2 years and surveillance biopsies every 1 to 4 years, with MRI used to refine risk but not to replace periodic surveillance biopsy. For high-risk localized disease treated with radiation, it recommends adding 18 to 36 months of androgen deprivation, with radical prostatectomy the other main option, as part of combined treatment where needed; AUA/ASTRO guideline part I, PubMed 35536144, and part II, PubMed 35536148. A 2026 amendment revised its guidance on imaging, shared decision-making, radiation treatment and disease management, PubMed 41988960, so ask your care team how the current version applies to you. ↩
  11. On the intensive lifestyle trial: in a 2005 randomized trial of 93 men with early, low-grade prostate cancer who had chosen not to have conventional treatment, PSA fell 4% over one year with comprehensive lifestyle change and rose 6% with usual care, and none of the lifestyle group went on to conventional treatment against six in the usual-care group. The authors called for further studies and longer follow-up, PubMed 16094059. ↩
  12. On green tea extract and the liver: a European Food Safety Authority review found evidence from clinical trials that 800 mg EGCG/day or more taken as a food supplement produced a statistically significant rise in serum transaminases, and noted rare cases of liver injury after green tea infusions, PubMed 32625874. ↩
  13. On PSA screening in the US: the US Preventive Services Task Force advises that for men aged 55 to 69 the decision to have PSA-based screening should be an individual one, made after discussing the potential benefits and harms with a clinician and weighing family history and race or ethnicity, and recommends against PSA-based screening from age 70. Screening offers a small potential benefit of reducing the chance of death from prostate cancer, while many men experience harms such as false-positive results, biopsies, overdiagnosis and overtreatment, USPSTF, prostate cancer screening. ↩
  14. On PSA testing in the UK: NHS guidance states that routine PSA testing is not offered except to people with a faulty BRCA2 gene, that anyone with a prostate can ask a doctor about the test after discussing its benefits and risks, and that a raised PSA does not necessarily mean cancer, NHS, PSA test. ↩
  15. On sulforaphane: in a randomized, placebo-controlled trial of 78 men with a rising PSA after prostatectomy, 60 mg of sulforaphane a day for 6 months did not reach its primary endpoint, although PSA rose more slowly on secondary measures, PubMed 25968598. ↩
  16. On pomegranate: early uncontrolled studies in men with a rising PSA after treatment reported a slower PSA rise, but a placebo-controlled phase III trial found that pomegranate extract did not significantly lengthen PSA doubling time, and phase II trials before surgery and in advanced disease were negative, PubMed 28440320. ↩
  17. On risk factors: the World Cancer Research Fund lists age, ethnicity (higher risk in men of African-Caribbean or African descent, lower in Asian men), family history, height and overweight or obesity as risk factors for prostate cancer, notes that about 3 in 4 cases are diagnosed at 65 or over and that most men in their 80s will have prostate cancer that is often not life-limiting, and rates the evidence that dairy products and calcium may increase risk as less strong. Red and processed meat are not among the factors it lists, World Cancer Research Fund, prostate cancer. ↩
  18. On exercise: a 2024 meta-analysis of 30 randomized trials in 2,216 men with prostate cancer found that combined resistance and aerobic training improved quality of life, reduced fatigue and urinary symptoms, and increased strength and fitness, and that resistance training increased lean mass, with no effect on PSA, PubMed 39766184. ↩
  19. On side effects: in the ProtecT trial of 1,643 men with localized prostate cancer, randomly assigned to monitoring, surgery or radiation therapy, prostatectomy had the greatest effect on sexual function and urinary continence, with some recovery; pad use for leakage rose from 1% before treatment to 46% at 6 months after surgery, and at 6 years 17% of men in the surgery group used pads, against 8% on monitoring and 4% after radiation therapy. Radiation therapy's effects on sexual and bowel function were greatest at 6 months and then partly recovered, PubMed 27626365. ↩
  20. On vitamin D and cancer: in the VITAL trial, 25,871 adults randomly assigned to 2,000 IU of vitamin D a day or placebo for a median of 5.3 years had no lower rate of invasive cancer, and the result for prostate cancer was not statistically significant, PubMed 30415629. ↩
  21. On lycopene supplements: a Cochrane review found only three small randomized trials, 154 men in total, two at high risk of bias, and concluded that the evidence is insufficient to support or refute lycopene for preventing prostate cancer, PubMed 22071840. ↩
  22. On PSMA PET-CT: National Cancer Institute treatment guidance states that PET-CT with specific tracers is becoming more common for staging prostate cancer; that PSMA tracers have been tested for staging intermediate- and high-risk disease and for suspected recurrence; that in high-risk prostate cancer a PSMA PET-CT was more sensitive (85% against 38%) and more specific (98% against 91%) than conventional imaging; and that two PSMA tracers are FDA-approved for initial staging when spread is suspected and for suspected recurrence after treatment, NCI PDQ, prostate cancer treatment. ↩
  23. On sugar and fast food: the World Cancer Research Fund advises limiting foods and drinks with added sugars and "fast foods" high in fat, starches or sugars, because eating them often can lead to weight gain, and states there is strong evidence that regularly drinking sugar-sweetened drinks leads to weight gain; it lists overweight and obesity as a risk factor for prostate cancer, World Cancer Research Fund, sugar and cancer, World Cancer Research Fund, prostate cancer. ↩
  24. On outcomes over 15 years: in the ProtecT trial of 1,643 men with PSA-detected localized prostate cancer, randomly assigned to active monitoring, surgery or radiation therapy, deaths from prostate cancer were low in all three groups (3.1%, 2.2% and 2.9%, not significantly different). Metastases were more common with monitoring (9.4% against 4.7% and 5.0%), and 24.4% of the monitoring group were alive without any prostate cancer treatment at the end of follow-up. The authors conclude that the choice involves weighing benefits against harms, PubMed 36912538. ↩
  25. On spinal cord compression: cancer that spreads to the spine can press on the spinal cord, which is more common in prostate, breast and lung cancer and myeloma. Warning signs include new back or neck pain, leg weakness, numbness or pins and needles, and loss of bladder or bowel control, and any of them needs medical advice immediately, even on a weekend or holiday, Macmillan, metastatic spinal cord compression. ↩
  26. On being unable to pass urine: NIDDK advises seeing a health care professional right away for being unable to urinate or severe pain in the lower abdomen, and warns that acute urinary retention can be life-threatening, NIDDK, urinary retention. ↩
  27. On fever during treatment: the National Cancer Institute states that infections during cancer treatment can be life-threatening and need urgent medical attention, that treatments such as chemotherapy raise the risk, and lists a fever of 100.5ยฐF (38ยฐC) or higher among the signs, NCI, infection and neutropenia. ↩
  28. Gencer B, Djousse L, Al-Ramady OT, Cook NR, Manson JE, Albert CM. Effect of long-term marine omega-⁠3 fatty acids supplementation on the risk of atrial fibrillation in randomized controlled trials of cardiovascular outcomes: a systematic review and meta-analysis. Circulation. 2021;144(25):1981-⁠1990. PubMed 34612056. Seven trials with 81,210 people followed for about 5 years: omega-⁠3 supplements were linked to a higher risk of atrial fibrillation (hazard ratio 1.25), more so in trials of more than 1 g a day (1.49), and the risk rose with each additional gram. ↩