Senior Urologist & Uro-Oncologist, Apollo Hospital Gurugram
Part 10 of 10 in Diagnosis and Management of Prostate Cancer
Nutrition and Multidisciplinary Care in Prostate Cancer
July 7, 2024
The session closed with a detailed, live question on nutrition and multidisciplinary care from a doctor in Ghana, one of the few questions asked directly rather than relayed through the moderator.
What the evidence actually supports on diet
Dr. Shrivastava was candid that, because so many factors are involved, no single dietary element has been pinned down as a direct cause of prostate cancer. Genetics and family history remain the dominant risk factor. That said, research points toward obesity as a genuine risk factor; the role of alcohol is controversial; there is some evidence linking red meat and certain non-vegetarian foods to prostate cancer; and there is some supportive evidence for vitamin D, vitamin E and lycopene (found in tomatoes), along with phytoestrogens like soy protein, though none of these are yet part of formal recommendations.
Practical dietary guidance
His practical advice: work with a dietician to build a balanced diet that manages weight and cuts down on easily digestible sugars, benefits that extend to heart and kidney health as well as cancer risk reduction, take vitamins from natural food sources where possible rather than relying on supplements, and treat tomatoes and soy-based foods as reasonable additions given the existing (if not definitive) evidence behind them.
Why a dietician belongs on the urology team
Asked how urologists and dieticians can better collaborate across facilities, his answer was structural: a dietician should always be part of the urology team, since nutrition intersects directly with kidney stones, uric acid levels, hypertension and weight management, and that team should also include a physical therapist to encourage patients toward regular exercise.
This article is based on a Jivo Masterclass session conducted by Dr. Nitin Shrivastava, Consultant, Urology and Uro-Oncology, Artemis Hospital, Gurgaon (his affiliation at the time of this session). The article has been summarised with the assistance of an AI tool from the original masterclass recording. Watch the full Masterclass recording
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This guide is based on a live Jivo Masterclass: Dr.Nitin Shrivastava taught doctors across Africa on July 7, 2024.
FROM THE LIVE Q&A
Moderator
CT scan is more accessible in our setup than MRI. Is there any place for CT to confirm prostate cancer?
Dr.Nitin Shrivastava
CT scan cannot be used to confirm prostate cancer diagnosis, only MRI can do that. But if MRI isn't available, CT scan is very useful for staging: once a cancer diagnosis is confirmed by biopsy, CT can tell you if it has spread outside the prostate.
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Frequently Asked Questions
What is the value of PSA to consider dangerous: free PSA, total PSA, PSA ratio?▼
PSA density above 0.15 is suspicious for cancer. A PSA rise of more than 0.75 per year is also suspicious. These are used alongside the age-adjusted PSA cutoffs (2.5 / 3.5 / 4.5 / 6.5 for the 40s / 50s / 60s / 70s age bands) when a single reading is borderline.
In case of BPH, what age range is surgery recommended instead of just urine diversion or catheterization?▼
It is not age but fitness for the procedure that matters. The doctor has operated on a 100-year-old patient, while some patients who are only 60 have too many other diseases and are too high-risk for surgery, and stay on a catheter instead. If a patient has a large prostate requiring long surgery and is high-risk, the choice to proceed with surgery understanding the risk ultimately becomes the patient's own.
After removal of prostate cancer, there is urine leakage. What is the remedy?▼
The most practical and best remedy is rehabilitation through Kegel exercises, pelvic floor muscle exercises. If these exercises don't help, an artificial urinary sphincter surgery is available, but that is the last resort.
What are the nutritional considerations for people with BPH and prostate cancer, and how can urologists and dieticians better collaborate across facilities?▼
The main risk factor for prostate cancer remains genetics and family history, but obesity is a genuine risk factor, alcohol's role is controversial, and there is some evidence linking red meat to prostate cancer, along with some supportive evidence for vitamin D, vitamin E, lycopene from tomatoes, and phytoestrogens like soy protein, though none of these are formal recommendations yet. A dietician should always be part of the urology team, since nutrition intersects directly with kidney stones, uric acid and hypertension, alongside a physical therapist to encourage exercise.
What is the value of PSA to say increased in a catheterized old patient, assuming 60 plus?▼
There is no cut-off value for a catheterized patient. Slight PSA increase is expected, sometimes to 8, 9 or 10, or occasionally near 20. If the PSA remains rising, an MRI should be done to find out what's going on inside the prostate.
What dietary factors are linked to prostate cancer risk?▼
Genetics/family history is dominant. Obesity is a genuine risk factor; red meat and certain non-vegetarian foods have some evidence linking them; vitamin D, vitamin E, lycopene (tomatoes) and phytoestrogens (soy) have some supportive evidence, though none are yet formal recommendations.
Should a dietician be part of a urology care team?▼
Yes. Nutrition intersects directly with kidney stones, uric acid, hypertension and weight management, so a dietician (and a physical therapist for exercise) should be a standing part of the team.
In This Series: Diagnosis and Management of Prostate Cancer
- 1.Diagnosis and Management of Prostate Cancer
- 2.Why Physical Examination Still Matters in Prostate Cancer
- 3.PSA Testing: Age-Adjusted Thresholds, Density and Velocity
- 4.Who Needs Earlier Prostate Cancer Screening
- 5.When to Biopsy: Balancing Missed Cancer Against Overtreatment
- 6.Biopsy Technique and Imaging: Transrectal vs Transperineal, CT vs MRI
- 7.Managing BPH: From Lifestyle to Alpha-Blockers to Surgery
- 8.TURP: How Often It Can Be Repeated, and the Real Tradeoff
- 9.After Prostate Surgery: Incontinence, Neobladder and Quality of Life
- 10.Nutrition and Multidisciplinary Care in Prostate Cancer