What your patients need to know about diet and prostate cancer

No specific food can cause or cure cancer, but some may be associated with its development. Various dietary factors have been suggested to influence prostate cancer risk, but currently there is not sufficient evidence to support a direct causative association. In the future specific recommendations may be available to reduce prostate cancer risk, but for now people should adopt a healthy diet and maintain a healthy weight.

Practice points

  • There is no proven association between any specific diet and prostate cancer risk.
  • There is no evidence to support recommendations for any dietary supplements to reduce prostate cancer risk.
  • A healthy diet with a high intake of vegetables and fruits, a moderate intake of fat, and which avoids high energy foods and excessive meat and dairy products, is recommended. Although conclusive evidence on the effectiveness of this in reducing cancer risk is limited.1

Food and cancer

The food we eat can influence our risk of developing certain types of cancer – both directly and indirectly. In general high energy and high fat diets can lead to obesity and are thought to increase risk for some cancers. A healthy diet, high in fresh fruits, vegetables and wholegrain foods may reduce cancer risk.1

Evidence supports a link between some common cancers and specific food groups. For example, eating red and processed meats increases the risk of colorectal cancer.2 Based on this evidence, the World Cancer Research Fund advises to limit red meat intake (< 500 g per week) and avoid processed meats.3

However, more research is required to clearly understand the role of specific aspects of the diet to cancer risk, including prostate cancer.

Influence of lifestyle factors on prostate cancer

The only well-established risk factors for prostate cancer are non-modifiable – older age, race and family history.4 Some modifiable lifestyle factors may increase risk, but the extent to which they do so is yet to be determined.

One of the key indicators that risk of prostate cancer may be influenced by lifestyle factors, including diet, is the wide global variation in incidence (Figure 1). More than a 25-fold difference in age-adjusted incidence exists between countries, with Australia and New Zealand among the highest and South-Central Asia the lowest.5 Additional support for the influence of lifestyle factors comes from migration studies where men moving from low-risk to high-risk countries had increased rates of prostate cancer compared to those in their native countries.6,7

Some of the increased incidence may be explained by differences in prostate cancer screening practices, as this can lead to diagnosis of a significant proportion of otherwise latent prostate cancers.4

Read more information about testing for prostate cancer.

Figure 1. Estimated prostate cancer incidence worldwide in 20085

Lifestyle risk factors may contribute to prostate cancer risk

Several lifestyle factors are suggested to influence the risk of developing prostate cancer, including diet, obesity, smoking and physical activity. However, the evidence is not sufficient to estimate the benefit gained by modifying these factors. 

  • The relationship between obesity and the incidence of prostate cancer is complex, but there is consistent evidence that obesity is associated with worse outcomes and increased mortality, especially in aggressive disease.8
  • There is no consistent evidence that physical activity protects against prostate cancer, but several studies have reported that being active may reduce the risk of advanced disease and reduce mortality from prostate cancer.9,10
  • Smoking is known to increase risk of developing some cancers, but the link to prostate cancer risk is not consistent. In men with prostate cancer, smoking is associated with increased cancer mortality, with more recent smoking being more strongly associated.4

The contribution of diet to prostate cancer risk is less clear, but several foods have been investigated as being potentially protective or harmful. The dietary components that have received the greatest attention are: dietary fat, antioxidants (carotenoids) and dietary supplements including vitamin E, vitamin D, calcium and selenium.11

Dietary fat intake and prostate cancer risk

A diet with high fat intake

A high fat diet comprising mostly animal fat sources (such as dairy products and fatty meats) is suggested to increase the risk of developing prostate cancer and prostate cancer mortality.12,13 However, the overall findings are not consistent and many trials have not found evidence of a link.14-16

Polyunsaturated fatty acids

Several investigations have identified particular types of dietary fat that alter prostate cancer risk. Some studies suggest that a diet with a low omega-6 to omega-3 fatty acid ratio may reduce prostate cancer, but the evidence is not consistent.17,18 More recent evidence suggests that high blood concentrations of omega-3 polyunsaturated fatty acids is associated with increased prostate cancer risk.19

Prospective clinical trials have not reported a link between risk for prostate cancer and dietary fatty acid intake.20 However, data about plasma phospholipid levels may provide a greater insight into prostate cancer risk. The Melbourne Collaborative Cohort Study involving over 41,000 people suggested that people with high plasma phospholipid concentrations of saturated fatty acids were at increased risk of developing prostate cancer.20

Given the weakness of the association and reported inconsistencies, it has been suggested that it is unlikely that dietary fat is an important contributor to prostate cancer risk.20 However, given recent results 19 consider the potential risk of excessive plasma concentrations of omega-3 polyunsaturated fatty acids before recommending a diet high in omega-3 fatty acids.

Read more evidence about the recommended use of fish oil supplements containing omega-3 for secondary prevention of cardiovascular disease.

Are antioxidants beneficial?

In recent years, antioxidants have received much attention as potential anti-cancer compounds. Antioxidants reduce oxidative stress which may damage molecules including proteins and DNA, and has been implicated in carcinogenesis.4

Several dietary antioxidants, including isoflavones, selenium, vitamin E and lycopene have been investigated as nutritional factors with potential to protect against the development of prostate cancer.4 However there is little evidence from clinical trials to support this proposition.

Antioxidants are provided by a healthy diet that includes a variety of fruits and vegetables. A diet high in vegetables (soy, in particular) is thought to decrease the risk of prostate cancer or benign prostatic hyperplasia.21 Prostate problems are reportedly less frequent or less severe in areas in which a plant-based diet is predominant.12

Selenium and vitamin E

Vitamin E is a fat-soluble antioxidant found in many foods, such as nuts, seeds and vegetable oil. Selenium is a trace element that is naturally present in many foods, including seafood, meat and cereals.22 These two antioxidant supplements have attracted a great deal of attention as having a possible preventive role against prostate cancer.

However, evidence from a large clinical trial suggests that selenium or vitamin E, alone or in combination, do not prevent prostate cancer in relatively healthy men.23 The SELECT clinical trial that was planned for 7–12 years was stopped after 5.5 years due to lack of efficacy for risk reduction.23 The data did reveal a trend that suggests there may be an increased prostate cancer risk among men receiving 400 IU/day of vitamin E.23


Lycopene is a potent antioxidant found in tomatoes, tomato-based products, watermelon and strawberries that is proposed to reduce the risk of prostate cancer. Many trials have investigated the role of tomatoes in prostate cancer risk, but the association remains controversial. A meta-analysis showed that high levels of tomato in the diet may play a role in the prevention of prostate cancer.24 However, at present the data do not support the clinical use of lycopene in a preventive setting.25

Tea and coffee

Tea contains polyphenol compounds which are antioxidants proposed to play a role in cancer prevention. Consumption of tea, particularly green tea, is suggested to reduce prostate cancer risk.26,27 Most of the evidence comes from epidemiologic studies and few clinical trials have been conducted. Overall the results are inconsistent and it is not known if consumption of tea will reduce risk of prostate cancer.

Coffee contains many biological compounds that have potent antioxidant activities that are suggested may reduce risk of prostate cancer. A recent prospective clinical trial of almost 48,000 men demonstrated a small reduction in prostate cancer risk in men who consumed 6 or more cups per day.28 However, the results are not consistent and other trials have not shown an altered risk profile with coffee consumption.26

Soy isoflavones

Isoflavones are organic compounds that occur naturally in some foods, especially legumes such as soybeans. It is proposed that the high intake of soy-derived food products and the metabolism of the isoflavones they contain is one of the factors which accounts for the significant difference in the incidence of prostate cancer between Asian and European/North American populations.29 Epidemiological studies suggest that increasing soy intake decreases prostate cancer risk.30 But there is little evidence from clinical trials to suggest that dietary isoflavones can alter the risk of prostate cancer.31

Dietary supplements

Supplements should not be relied on to compensate for a poor diet. Antioxidant supplements do not appear to offer additional benefits in preventive prostate cancer over a well-balanced diet, possibly because of the choice of the substances tested or of an excessive dosage.32 The majority of studies investigating antioxidant supplements do not show a variation in general mortality or cancer incidence.32

Fish oil supplements are one of the most commonly used medicines. For example, a national census of medicines use in Australia estimated that 1 in 4 people over 50 years of age regularly take omega-3 fish oil supplements.33 Bearing in mind the data recently reported on potential increase in prostate cancer risk in men with high blood concentrations of omega-3 polyunsaturated fatty acids,19 additional research is required to determine how fish oil supplements may impact on prostate cancer risk.

Healthy advice for life

To date publications about the effect of diet on prostate cancer risk have been highly heterogeneous and variable in quality and design. More robust, high quality randomised controlled clinical trials are needed to improve the understanding of the complex relationship between diet and prostate cancer.

There are many ongoing clinical trials focusing on particular aspects of the diet that may allow future recommendations for risk prevention. But for now, advise men to eat a well-balanced diet including fruit and vegetables, maintain a healthy weight and undertake regular physical exercise.

Why be medicinewise? Ask your doctor the right questions

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Jul , 17  2013

During Family Doctor Week (15-21 July 2013), NPS MedicineWise is highlighting the importance of asking your doctor the right questions about your medicines and medical tests.

GP and clinical adviser at NPS MedicineWise, Dr Andrew Boyden, says that being an active partner in your own health care is the best way to get medicinewise and make the most of your visit to the doctor.

“Asking your doctor questions will help you get better results from your medicines, avoid side effects , understand the risks and benefits of medical tests, and enjoy better health – which is something we all want,” says Dr Boyden.

“Of course, if you don’t have a GP or a medical practice you visit regularly – a GP home where you and your medical history are well known – it may be more difficult to ask the right questions about your health, your medicines and medical tests.

“Being prepared and talking openly with your health professional is so important. Make sure you tell your doctor if you have any concerns, about your treatment options and their risks and benefits. It’s also important to discuss any side effects or problems you’re having with the medicines you are taking.”

To help people prepare for a visit to the doctor, NPS MedicineWise has produced an easy-to-use online tool that allows you to create personalised questions to ask your doctor.

Suggested questions cover the brand name and active ingredient of any prescribed medicines; how to take the medicine; expected benefits of taking the medicine; possible side effects; and whether there are any other treatment options available.

The online tool also includes specific questions about medical scans and X-rays as well as illnesses like respiratory tract infections including colds. It also allows people to include their own questions about specific health concerns and space to write down notes during their appointment.

Dr Boyden suggests printing the questions generated by the tool and taking them along when you visit your doctor.

“Preparing your medicinewise questions in advance and taking them along to your appointment will help you to remember what you wanted to ask and to get the information you need.

“It’s also important to remember some of the answers might also be available from other reliable medicine sources such as the consumer medicine information (CMI) leaflet for your medicine that your doctor or pharmacist can print off for you or you can download from the NPS MedicineWise website.

The question-building tool is available free on the NPS MedicineWise website.

For information on prescription, over-the-counter and complementary medicines (herbal, ‘natural’, vitamins and minerals) from a health professional, people can call NPS Medicines Line on 1300 MEDICINE (1300 633 424) for the cost of a local call (calls from mobiles may cost more). Hours of operation are Monday–Friday 9am–5pm AEST (excluding public holidays).

World Hepatitis Day: More must be done to stop this silent killer

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Jul , 15  2013 

 Viral hepatitis – a group of infectious diseases known as Hepatitis A, B, C, D, and E – affects hundreds of millions of people worldwide, causing acute and chronic disease and killing close to 1.4 million people every year. On World Hepatitis Day, 28 July 2013, WHO and partners focus on the fact that although the burden of disease caused by viral hepatitis is growing, it remains largely ignored or unknown to many policymakers, health workers and the public.

Haze Alert

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Jul , 2013

Why does haze matters for your health?

Haze is a sign of air pollution by fine particles (consisting of microscopic solid or liquid droplets). When these particles enter your lungs, they may pose severe health problems, for example:

• worsening of heart or lung disease

• heart attacks

• irregular heartbeat

• worsening of asthma

• symptoms, such as throat irritation, coughing or difficulty breathing

People with heart or lung diseases, children and older adults are more sensitive to the harmful effect of haze. Healthy individuals may not be spared and will experience temporary symptoms from exposure to haze.

How is the severity of haze situation measured?   

It is measured by PSI, which stands for ‘Pollutant Standards Index’. This index is developed by the United States Environmental Protection Agency (USEPA).

Singapore’s National Environmental Agency (NEA) monitors PSI constantly via network of monitoring stations and the Ministry of Health (MOH) issues specific health advisory for various range of 24-hour PSI.

23rd Singapore Pharmacy Congress 2013


23rd Singapore Pharmacy Congress 2013

17 Aug 2013 to 18 Aug 2013


Grand Copthorne Waterfront Hotel, Singapore



Organised by Pharmaceutical Society of Singapore (PSS)

The Pharmaceutical Society of Singapore is delighted to announce that the 23rd Singapore Pharmacy Congress will be held on 17 – 18 August 2013 at the Grand Copthorne Waterfront Hotel, Singapore. The theme to be adopted for this year’s event is “Transforming Pharmacy Practice, Towards New Horizons in Healthcare”.

The Congress will provide an update on the most recent developments and advances in the profession and practice of pharmacy and feature informative presentations by prominent local and international experts and speakers.


MPS Outstanding Pharmacist of the Year Award 2013

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Jul , 18 2013



Application is now open for members to be nominated as the MPS Outstanding Pharmacist of the Year Award 2013 in the following arenas:

  1. Excellence in Pharmacy Administration
  2. Excellence in Academia
  3. Excellence in Community Pharmacy
  4. Excellence in Hospital Pharmacy
  5. Excellence in Industrial Pharmacy
  6. Most Promising Young Pharmacist

All nominations must be in writing and to be submitted to the MPS Secretariat by 20th August 2013 by email. Supportive documents should be summarised and also email.

The winners will be announced at the forthcoming MPS Pharmacy Night on 20th Sep at the One World Hotel.

Furthur details of the award can be found at the MPS website.

– See more at: http://www.mps.org.my/newsmaster.cfm?&menuid=37&action=view&retrieveid=3779#sthash.TjapPBqT.dpuf

GENERIC MEDICINES : Doctors should accept their use


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Jul , 11 2013


I READ with interest the letter “Generic medicine crucial” and laud Dr Kim Hock, the president of Association of Specialists in Private Medical Practice of Malaysia for supporting the broader use of quality generic medicines. In Malaysia, our study had shown that by opting for generic medicines rather than branded ones, consumers can save up to 90 per cent of the cost for medication.

Currently, many blockbuster drugs used to treat chronic diseases are available as generics because their patents have ended. Many doctors that I have worked with have the mindset that generic medicines are only meant for poor countries, but in reality they do not know that generic medicines are used more than 80 per cent of the time in developed countries, such as the United States, Britain, Germany and France. One of the challenges that our generic medicine research group at Universiti Sains Malaysia has identified is to change the mindset of medical practitioners, especially in the private sector, towards the use of generic medicines. A study conducted among private practitioners in Perak found that the majority of the doctors surveyed, 58 per cent of the 105 physicians, doubted the efficacy and quality of generic medicines. These findings support the argument that perception towards generic medicines need to be corrected as Malaysia has stringent requirements for medicine registration, which is on a par with the requirements of many European countries. In Malaysia, the use of generic medicines is mandated in the National Medicine Policy and the Health Ministry is taking proactive steps in encouraging its wider use. The Health Ministry, through its Pharmaceutical Services Division, had taken a bold step by launching the Generic Medicines Awareness Programme roadshow nationwide to engage doctors in the public and private sectors. Assoc Prof Dr Mohamed Azmi Ahmad Hassali, deputy dean (student affairs and networking), School of Pharmaceutical Sciences, Universiti Sains Malaysia, Penang Read more: GENERIC MEDICINES : Doctors should accept their use –

Letters to the Editor – New Straits Times  – See more at: http://www.mps.org.my/newsmaster.cfm?&menuid=36&action=view&retrieveid=3773#sthash.N7kFrD6J.dpuf

PSA’s call to action on chronic disease

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Jul , 5 2013 

The Pharmaceutical Society of Australia has today released Australians stay healthier: PSA’s call to action on chronic disease, a document which highlights that chronic disease and our ageing population are placing increasing demands and pressures on Australia’s health system.

National President of PSA, Grant Kardachi, said the document is being released in the lead-up to the Federal election and urged all politicians, candidates and health stakeholders to read it.

“Chronic diseases account for 70% of all health expenditure in Australia and cause 50% of all deaths with more than 7 million Australians suffering from a chronic disease,” Mr Kardachi said.

“Consumers want more from governments for their health dollar and pharmacists have answers – and we’re ready for the challenge.

“Australia spends over $16 billion each year on medicines or around $700 for every man, woman and child in Australia – every year.

“We believe that pharmacists can do more to improve the health of the Australian community, particularly with regard to chronic disease. For example, all consumers deserve to access a medication management service when they need it and where they need it.”

Mr Kardachi said chronic diseases, or long-term conditions including diabetes, asthma, heart disease and mental illness, were placing increasing demands on the healthcare system, leading to significant healthcare costs associated with medicines, diagnostic services, aged care, medical services and in particular, hospital expenses.

“Community pharmacies are uniquely placed within Australian communities, and are increasingly being recognised as a hub for preventive health activities.”

“We need the health system to work smarter and make better use of pharmacists’ skills and knowledge.”

Mr Kardachi said Australians stay healthier: PSA’s call to action on chronic disease challenged outdated notions of pharmacists’ roles and presented viable and forward-looking solutions.

Australians stay healthier: PSA’s call to action on chronic disease can be viewed at psa.org.au  

MEDIA CONTACT:              Peter Waterman         0487 922 176

PSA joins calls for educational expenses cap to be scrapped

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Jul , 8  2013

The Pharmaceutical Society of Australia has united with a wide range of professional and industry peak bodies to urgently seek an end to Government plans to impose a $2000 cap on education expenses.

The $2000 cap was announced in the Federal Budget and covers all costs associated with education expenses including all travel, accommodation, conference and tuition fees.

National President of the PSA, Grant Kardachi, and CEO Liesel Wett joined   representatives from the pharmacy, medical, accounting, legal, engineering, veterinary, nursing and other professions to urge the Government to scrap the proposal.

“At a time when the Government is seeking to reduce health costs through a healthier population it is incongruous that it is proposing a move which will greatly curtail the ability of many health professional, including pharmacists, to maintain a level of expertise and knowledge that would help the Government see its goals met in the long term,” Mr Kardachi said.

“A survey of our more than 18,000 of our members found two thirds have annual education outlays of more than $2000 and 80 per cent said their employers did not reimburse them for educational expenses.

“Most disturbingly, 82 per cent of respondents said a $2000 cap would cause them to decrease their educational activities, a move which could have serious consequences for the health of all Australians.

“Educational activities help pharmacists to provide the best possible services and advice to consumers, and so improve the health outcomes of all members of the community. Any move which threatens the ability of pharmacists to undertake this education is a threat to the health of all Australians.”

Mr Kardachi said PSA was urging its members to talk to local politicians and candidates in the lead-up to the Federal election to urge the Government to scrap the cap.

“Members of Parliament and those aspiring to such high office need to know the potential impacts of bad Government policy,” Mr Kardachi said.

“The new Prime Minister Mr Rudd has a great opportunity to act now in the national interest and we urge him to grasp this challenge and stamp his authority by scrapping the cap.”

MEDIA CONTACT:              Peter Waterman         0487 922 176

New-look Self Care program takes off



Jul , 11  2013

Australian pharmacists are taking on a greater role in healthcare delivery, including a greater focus on health outcomes, and pharmacies themselves are becoming health destination hubs.

This is changing the way many pharmacies do business and PSA is meeting the need to provide increasing support for pharmacies in this new environment.

PSA’s Self Care program, reinvigorated following feedback from members, is one such resource which has been enthusiastically received with increasing   numbers of pharmacies becoming part of the new-look health education program.

The Self Care restructure followed extensive consultation with pharmacists and pharmacy staff using the system and now includes major improvements to the exciting offerings, as well as new features and innovations.

National President of PSA, Grant Kardachi, said the evolution of Self Care was in response to feedback from users of the program.

“We went out and spoke to those pharmacists using the program and we have responded to these consultations by improving the program because it is important that all of our members have access to these resources to take their pharmacy business to the next level,” Mr Kardachi said.

Some of the new features include PSA members having the option to buy the whole program or just individual elements and the provision of Self Care’s popular Fact Cards as online eFactCards.

“What this means is that pharmacies can now email information to customers,” Mr Kardachi said.

“As a Self Care member you can take your pharmacy’s service beyond the pharmacy doors.

“You can also brand the eFactCards with your own pharmacy details, effectively making them ‘your’ eFactCards.

“We have also developed ACTION kits which are topic-based resources to enable in-store health promotions and professional service implementation.

“These are all in one toolkit with promotional posters and other materials that can be branded to the individual pharmacy.”

Details of Self Care are available at the PSA website at psa.org.au/selfcare

 MEDIA CONTACT:               Peter Waterman         0487 922 176