Living with slow-growing prostate cancer

Photo by National Cancer Institute on Unsplash

By Howard LeWine, M.D.
Posted on June 12, 2024

Q: I have prostate cancer and just started active surveillance. I’m glad I don’t need to have surgery or start treatment immediately.

Meanwhile, while I am being monitored, what can I do to help stop the cancer from spreading?

A: Active surveillance is an option for men with low-grade cancer (cancer confined to the prostate gland and less likely to spread).

Most often this refers to men who have blood prostate-specific antigen (PSA) levels of less than 10 nanograms per milliliter (ng/ml) and a Gleason score of 6 or less.

High-grade and many intermediate-grade prostate cancers don’t qualify for active surveillance, and treatment for them usually begins immediately.

Men who choose active surveillance can avoid the side effects and possible complications related to surgery, radiation or hormonal treatment.

At the same time, it provides an opportunity for men to re-evaluate their lifestyle and make changes that may improve their cancer prognosis and ensure their life is the healthiest it can be.

Coping with the prognosis

Despite knowing that most men with low-grade prostate cancer do fine without specific therapy, some men find the adjustment difficult.

One way a man can mitigate the worry, stress or anxiety is to embrace a take-charge attitude about his health.

Men can take steps that not only may improve their prognosis, but also protect themselves from other health issues, like heart attacks and strokes. This can empower men and give them a better sense of control over their condition.

Here are some suggestions:

Increase exercise intensity. Observational research has found that men with prostate cancer who engaged most frequently in vigorous activity had a 30% lower risk of developing advanced cancer and a 25% lower risk of dying from the disease when compared with men who exercised the least.

Examples of vigorous activities include running, cycling, swimming and racquet sports.

Manage your weight. Weight gain is linked with more aggressive cancer. Even losing five to 10 extra pounds can help lower your risk.

A healthier weight also keeps blood pressure, blood sugar and cholesterol levels under control.

Eat a plant-based diet. Although it’s unclear whether specific dietary habits can slow prostate cancer growth, there is some evidence that suggests following a plant-based diet may make a difference. And healthy eating also lowers the risk of cardiovascular disease.

Check your cholesterol. Studies have found that men who need to take cholesterol-lowering statins may have a lower risk of advanced prostate cancer.

Statin use has also been associated with longer survival among men with prostate cancer. You wouldn’t take a statin for this reason, but if you need a statin to lower your cholesterol, this is a possible bonus.

Consider therapy. The anxiety about active surveillance may be associated with something else. A therapist can help a man explore where his anxiety lies and what may be driving it.

Howard LeWine, M.D., is an internist at Brigham and Women’s Hospital in Boston and assistant professor at Harvard Medical School. For additional consumer health information, visit health.harvard.edu.