Richard G. Petty, MD

An Aspirin a Day Keeps the Prostate Away?

Well I promise that that is going to be my only cheesy title his week. But I couldn’t resist after seeing some interesting new research published in this month’s issue of American Journal of Epidemiology.

As they age, many men develop an enlargement of the prostate gland, technically known as benign prostatic hyperplasia, can make urination difficult or trigger a need to urinate frequently. This can be particularly troublesome if men keep having to get up at night to pass urine.

The researchers decided to look at the potential impact of non-steroidal anti-inflammatory agents (NSAIDs), because they had previously been shown to reduce the risk of prostate cancer. The study was well designed and involved 2,447 men in a single county in Minnesota. Taking NSAIDs was found to significantly prevent or delay enlargement of the prostate.

We must be cautious: we don’t want to encourage men to take NSAIDs inappropriately: they can have many side effects, and more work is needed to confirm the findings, and then to find the optimum dose to cut risk.

This is useful information. I’m not keen on taking any medicine on a long-term basis; particularly not a class of medicines that can cause gastrointestinal upset and increase the risk of bleeding. But this research follows hard on the heels of one large negative study on the widely used herbal remedy Saw Palmetto.

This is a brief extract from something that I wrote for another program:
Saw Palmetto (Serenoa Repens) is also known as Sabal, American dwarf palm tree and Cabbage palm. As its name implies, it is a member of the palm family.

Uses and Indications:
It is primarily used in the management of prostate enlargement. Some early studies suggested that Saw Palmetto reduces the symptoms of benign prostatic hypertrophy through antagonism of both androgens and estrogens.
It only increases urine flow and does not decrease the size of the prostate. In a review of 18 randomized trials involving approximately 3,000 men, Saw Palmetto did provide overall benefit on prostatic symptoms. However, it is not certain how long any effect might last. In a one year prospective study, comparing Saw Palmetto with finasteride, (Proscar), the herb had no appreciable benefit, whilst the finasteride did. There was however no placebo arm in the study, and no measures of the patients’ subjective well-being.

If the herb is going to help it usually takes 4-6 weeks or longer for effects to be observed.

More recently, some women have been exposed to Saw Palmetto, since it sometimes an ingredient of those herbal concoctions that are supposed to increase bust size.

Cautions and Side Effects:
Saw Palmetto is a cause of gynecomastia in men. It may also have gastrointestinal side effects of nausea and diarrhea.
Saw Palmetto may cause insomnia, fatigue and headaches.
Due to its anti-androgenic and anti-estrogenic effects Saw Palmetto is contraindicated in:
Pregnancy (or in women at risk of becoming pregnant)
Hormonal dependent illnesses (e.g., prostate or breast cancers)

Drug interactions:

Oral contraceptives and any hormone replacement therapy such as conjugated estrogens.
Saw Palmetto contains tannins, and these may interfere with the absorption of iron.
If given with warfarin, there is an increased chance of bleeding.

Prostate Cancer, Shift Work and Vitamin D

One out of six American men will develop prostate cancer and more than a third of them will experience a recurrence after undergoing treatment, putting them at high risk to die of the disease.

A study from Japan in this month’s issue of the American Journal of Epidemiology, reports prospective research that examined the association between shift work and the risk of prostate cancer incidence among 14,052 working men. Compared with day workers, people who worked rotating shifts were significantly at risk for prostate cancer whereas fixed-night work was associated with a small and non-significant increase in risk. This report is the first to reveal a significant relation between rotating-shift work and prostate cancer. Previous research has found that shift work may be linked to an increased risk of breast and colon cancer.

It’s important not to jump off the deep end: we are long way from saying that sleep disturbance is linked to prostate cancer. But it is another piece of evidence suggesting a link between environmental factors and genes, since there are a number of genes that may increase a man’s risk for prostate cancer.

However, there have now been several reports that disturbances in normal body rhythms might be linked to some cancers and this report adds to that evidence. It has never been shown that the actual sleep disturbance itself is responsible for the slight increase in risk seen in these studies. It could also be that people with abnormal sleep patterns are more likely to be doing something else, for instance smoking or eating junk food that would interfere with sleep and increase people’s cancer risk.

But here’s something to think about: shift workers have been found to have reduced secretion of the sleep-inducing hormone melatonin. Melatonin has also been shown in some studies to have some potential anti-cancer effects. The studies are controversial and certainly not conclusive, despite what one or two melatonin manufacturers may say. But something that is true is that reduced secretion of melatonin has been linked to increased production of sex hormones, which play a role in regulating prostate tissues.

Under normal circumstances, secretion of the hormone is low during daytime, increases soon after the onset of darkness, peaks in the middle of the night, and gradually falls until morning. In shift workers the melatonin cycle becomes disrupted.

There has been some recent evidence that maintaining adequate levels of vitamin D may reduce a man’s risk of prostate cancer.

Another study, this time on pancreatic cancer and led by Northwestern University in Illinois has indicated that taking the US Recommended Daily Allowance (RDA) of vitamin D (400 IU/day) reduces the risk of pancreatic cancer by 43%. It is published in this month’s issue of Cancer Epidemiology Biomarkers & Prevention. This does not mean that we should start taking vitamin D supplements to reduce our cancer risk. But it ties in with research indicating that some exposure to sunlight might actually reduce the risk of some cancers. But all things in moderation: malignant melanoma and basal cell carcinoma of the skin have been increasing with increased exposure to sunlight.

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