Partnering for prostate health: how one couple working as a team to prevent delay, and meet the challenge of prostate cancer strengthened their commitment and love.

You're leading a happy, healthy life. Why should you be concerned about prostate cancer? My husband, Allan, and I weren't either, until we received the devastating news from his doctor. Out of town at an antique music box convention, our future appeared uncertain as we clung to each other in shock. But our initial bewilderment and emotion faded as we counted our blessings. His cancer was diagnosed at an early stage. In our opinion, consistent healthy lifestyle choices had delayed this diagnosis more than 10 years.

Allan has been very conscientious about getting regular screenings for prostate cancer, following a healthy diet and exercise program, taking selected supplementation, and not smoking. When he was in the Army, doctors had told him that he was at increased risk for prostate problems because of the surgeries he required then.

Allan explained the health issues that he was concerned about before we got married and added, "I can't change heredity or past health problems, but I certainly have a choice about prevention steps to lower my odds for disease, avoid new problems, and improve the quality of my life. We have each other, and there's so much that makes life worth living." This optimistic attitude encourages me to continue following a healthy lifestyle also, as we work together to maintain and enhance our well-being.

Most men don't have such advance warning.

"I think a common misconception is that prostate cancer has a low threat potential and that more men will die with the disease than of it," says Dr. James M. Kozlowski, chief of urologic oncology at Northwestern University Medical School in Chicago.

"Although this is generically true, we know that prostate cancer is a leading cause of cancer death in men ... it's a common disease; it's a pervasive disease. When detected in relatively young men who have a significant amount of their life span ahead of them, their chances of dying from it decrease dramatically," he says.

The prostate is a walnut-sized male sex gland under the bladder whose secretions help form the seminal fluid. It surrounds the upper part of the urethra. The American Cancer Society estimates that 198,100 new cases of prostate cancer will be diagnosed and that 31,500 American men will die of this cancer in the year 2001. That's one diagnosis every three minutes and one prostate cancer death every 13 minutes. The incidence of prostate cancer is higher among Black men, and may be linked to higher levels of the male hormone testosterone.

Get Regular Testing

Debate continues among experts about the benefits of the PSA (prostate-specific antigen) screening test. Some physicians have raised objections, believing it leads to needless biopsies and treatment of a very slow-growing cancer. But since 1991, when PSA testing became prevalent, prostate cancer death rates have dropped by 16 percent (while there's been an increase in prostate cancers detected).

"Curative windows of opportunity that are lost are never retrieved," says Dr. Kozlowski. "You may live a normal life span with the disease, but it may be one adversely impacted by disease-related complications that could have been avoided if optimal treatment were provided earlier on." He agrees with the American Urological Association and the American Cancer Society's policy that both a PSA blood test and the digital rectal examination (DRE) should be offered annually to men beginning at age 50, and to younger men who are at higher risk.

Your internist can provide these tests, and may refer you to a urologist. If you have a family history or think you may be at high risk, it's probably best to see a urologist for testing. It's best not to ejaculate 48 hours before the test, as it can raise PSA levels. Since a rectal exam can also raise PSA levels, have your blood drawn for the PSA test first. It's also been suggested that it is best not to ride a bicycle beforehand.

Many urologists now do a "PSA profile." This consists of utilizing both the traditional PSA test and the percent-free PSA, which measures the percentage of free PSA in the blood. Then a ratio of free to total PSA in the blood is considered.

Inform your doctor of your medical history, including all supplements and medications you take. Dr. Kozlowski says it's wrong to assume anything over the counter is simple and safe, and if not helpful, at least neutral.

Some physicians are also concerned about the "fountain of youth" hormone supplements DHEA (dehydroepiandrosterone) and andro (androstenedione) and the possibility that they may increase risk for prostate cancer by raising testosterone levels. Dr. Kozlowski advises patients to discuss any over-the-counter dietary supplements or herbs they are utilizing or considering with their physician, rather than come to them later with many complications that could have been avoided had they been more open at the outset.

Men are not as conscientious as women about getting suggested routine health screenings. Eighty-five percent of women over 40 have had a mammogram (the recommended screening test for breast cancer), while only 30 percent of men over 50 have had a PSA test. Prostate cancer strikes as many men, and causes almost as many deaths annually, as breast cancer does women.

Dr. Kozlowski says wives should encourage their husbands to have routine screening for prostate cancer--especially if they haven't seen a physician in a long time.

"I think it's important to have other members of the family, perhaps at a younger age, nudged in the direction of surveillance, if there are a number of first- or second-degree relatives in that family who have been afflicted with the disease," he says.

Richard Sutera, 51, of Centerville, Ohio, was diagnosed with prostate cancer at the age of 46. There's no history of prostate cancer in his family, but he first sought testing at age 45 after experiencing lower back pain and noticing blood in his urine. Thinking he had a bladder infection, he saw his family physician (who did only a digital rectal exam the first time). He was treated with antibiotics for an enlarged prostate (benign prostatic hyperplasia--BPH or prostatitis), a noncancerous condition very common in men over 40.

After no improvement, further testing showed he had cancer. Because of his experience, he is a believer in early testing. "A high PSA doesn't necessarily mean cancer, but I think men should get their PSA at 40 (definitely no later than 45)," Sutera says.

Keep Your Own Records

Ask for test results from your urologist, including any percentage figure. Chart these numbers next to the date of testing (or get a copy of the actual test report). Ask your doctor questions and seek additional testing if you (or your spouse) notice increases in your PSA level over time, notice some other trend, or have a concern. No one cares about your health more than you and those who love you.

Allan kept a detailed chart of the date of his test, the number of the PSA, and when he last ejaculated prior to testing. He noticed a change in the PSA figures if he ejaculated prior to the test, and was told not to by his physician only after asking him. He keeps an updated list of all medication and supplements, and brings a copy to his doctor(s).

Allan also charted changes in urinary function in response to dietary supplements. He noticed an improvement in urinary function and a lower PSA level after supplementing his diet with lycopene. Although the United States Pharmacopeia concluded last April that there is "moderate evidence of effectiveness" for saw palmetto in men with BPH, it didn't seem to help Allan. A lack of effect could be because not all brands contain the same amount of active ingredients.

Can Prostate Cancer Be Prevented?

Since we don't know exactly what causes prostate cancer, we don't know what will prevent it. However, according to the American Cancer Society, existing scientific evidence suggests that about one third of the cancer deaths in the U.S. annually are caused by dietary factors. Cigarette smoking accounts for another third. Although genetics is a factor, heredity doesn't explain all cancer occurrences. So for most Americans who don't smoke, "dietary choices and physical activity become the most important modifiable determinants of cancer risk, at all stages of its development," says the American Cancer Society.

Lynn Danford, M.S., C.D.E., L.D., a nutritionist who works with a urologist at Weiss Memorial Hospital in Chicago, believes a low-fat, plant-based diet can help men who have already undergone treatment, aiding in their recovery and slowing the growth of any other cancer cells. She adds that happiness and social interaction also enhance health, such as eating out, dining with friends, and celebrating with food. She says, "As an aspect of complete wellness, no person should ever be expected to forgo the enjoyment that comes from eating."

"I Have Prostate Cancer! What Should I Do Next?"

1. Stay positive

Dr. Kozlowski says, "Once the diagnosis is made, it's important that wives be a calming influence for their husbands and help them realize it's not a death sentence. It doesn't require an immediate decision. In general there's plenty of time to learn more about the problem, seek a variety of opinions, and come to a decision based on what feels comfortable in terms of management strategy."

Allan maintained his sense of humor and was touched by many people who offered their prayers. I've encouraged Allan to pray more, with little success. But noticing the sincerity of all those praying for him, he said to me one night, "There might be something to that praying."

2. Do your homework--research treatment options.

We methodically went about researching treatment options, a consummate team effort. Quickly finding we weren't alone, we uncovered many misconceptions and myths about prostate cancer. Allan says, "Most of the prostate literature doesn't make it clear, and most of the men I talk to have no idea, that hormone therapy is actually castration--chemical or actual."

Here's some of what we found:

* Many factors determine treatment choice

No two men are the same; the best choice for your friend may not work for you. Some determining factors to consider before a treatment decision include age, other medical problems, and the stage and grading of the cancer.

The possibility of impotence and incontinence as a result of treatment weighs heavily on most men. Even New York Mayor Rudolph Giuliani (known as a decisive man) had a tough time making a treatment decision.

* Talk to others; attend support groups

Talking to others who have experienced prostate cancer (especially in a prostate support group setting) is an excellent way to get new information and firsthand accounts of various treatments. You can also learn what to avoid from others' mistakes.

3. Get other opinions.

Obtaining second opinions is a common practice and expected of a responsible patient. A recent study concludes that specialists overwhelmingly recommend the therapy that they themselves deliver (JAMA, June 28, 2000). Our experience bears this out. We saw both oncologists and urologists, and only one physician seemed to be objective about several treatment options appropriate for Allan.

Also, don't be pressured into an immediate decision. One physician strongly encouraged Allan to sign up for a clinical trial. After declining, we felt pressure to decide right then about his treatment choice. This was not the hospital or doctor of our final choice, though highly recommended. Joe from the support group was also disturbed by a similar experience.

Also, don't feel you must stay loyal to your current doctor, even if he/she is your friend. Although very happy with Allan's urologist, we still wanted the most qualified person (within our means) for our treatment choice.

We successfully found our way through the daunting labyrinth of issues and information, and after careful discussions came to a treatment decision together. For Allan, this was radical prostatectomy.

During Treatment

My support during treatment was very important to Allan, who was understandably anxious. I went with him to all preparatory appointments, where what to expect during and after his surgery and what I could do to help was explained.

During his operation I was informed at every stage what was happening and how it looked. After successful surgery I stayed with him at the hospital the first two nights.

After Treatment and Beyond

Patience and consistent effort make a huge difference in recovery. Allan notices significant improvement when he does the exercises recommended to speed recovery. All his functions since treatment have steadily improved. Follow doctor's orders and don't get discouraged; recovery takes time.

1. Keep a sense of humor.

After six weeks we were still able to travel to Mexico as we do every winter. Though it was more difficult than usual for him, the relaxing environment helped his continuing recovery. At one point when we parked an open Jeep we had a bag stolen containing Allan's extra incontinence articles (still needed at that point). We laughed to think how surprised the thieves must have been to find this "treasure."

2. Spouse support is important.

Humor also helps dispel anxiety and depression--a big factor for many men after treatment. Many men become concerned about intimacy issues and their ability to perform sexually. Also, loss of bladder control (usually temporary) can be humiliating.

Katherine J. says her experience shows that "a major illness can bring out the worst or the best in someone--facing potential mortality either increases one's fears and insecurities, or it expands their gratitude and appreciation of life."

Dr. G. Michael Durst, a psychologist who has counseled many men in both Chicago and South Africa, says, "After a major illness (especially one as personal as prostate cancer), many men tend to be more sensitive. The family of a man recovering from treatment (primarily the spouse), should be more understanding and patient; it's a stressful, trying time for everyone."

Dr. Durst recommends that "the spouse should not only listen to her husband's words, but also attempt to hear the emotions that underlie what he is saying. She can stimulate the conversation by perception-checking, such as asking such questions as `Are you really saying ...' or `Are you concerned that ...' or `Are you feeling ...?' Such questions help him to open up and talk more about feelings of inadequacy or concerns around insecurity."

3. Continue a healthy diet.

We believe a healthy lifestyle also helped with smoother surgery and faster-than-expected recovery. Joe from the support group changed his diet to include soy beverages, soy sausages and hot dogs, and lots of vegetables and fruit. He believes this has aided his recovery and is keeping his prostate cancer from returning.

4. Help others; share what you've learned.

Support other men by sharing your knowledge and experience. It may also help you gain more understanding of your own recovery, and diverse methods of coping and healing. We still find support groups helpful.

5. Keep updated.

"Our insights into the biology of prostate cancer and knowledge of what makes the tumor cell react aggressively has exploded," says Dr. Kozlowski. "New cutting-edge approaches are imminent. Utilizing our understanding of the human genome is now beginning to translate into potentially effective treatment. There's more incentive now, more research dollars, and it's a much better publicized disease than before. This is a good era for prostate cancer."

We have found that a healthy lifestyle, regular testing, thorough research, a sense of humor, and lots of love helped us successfully deal with Allan's prostate cancer. If you're a man age 40 or over or have a husband, brother, father, or friend over 40 or with history of prostate cancer in your family, take steps now to reduce your risk. Prostate cancer can truly test the intimacy and strength of a marriage. Working together for prevention--and treatment and recovery if necessary--can also bring a couple closer together.

RELATED ARTICLE: helpmates in the kitchen

by Judith K. Jarvis, M.S., R.D., and Susan M. Pall

Can the food you eat protect you from getting prostate cancer? Most experts think it can. Marriage partners working together can go a long way toward reducing risk with diet and lifestyle changes.

Bob Dole, Joe Torre, and Mayor Rudolph Giuliani made front-page news when they were diagnosed with prostate cancer. The publicity has created more awareness, but most men and women still know far too little about the disease and preventive strategies.

Experts estimate that 75 percent of deaths from prostate cancer--and 30 percent of deaths from all cancers--could be avoided by changes in diet. General recommendations to reduce the risk of all cancers include eating a diet low in fat with plenty of fruits and vegetables, being physically active, and not smoking. The National Cancer Institute says, "It is not known whether modifying one's diet by eating low-fat, plant-based foods will reduce prostate cancer risk," but it's a step that is likely to be beneficial.

Although most men don't develop prostate cancer until after 60 years of age, a latent cancer can take 20 or 30 years to develop. According to Dr. James M. Kozlowski, chief of urologic oncology at Northwestern University Medical School in Chicago, "diet and lifestyle changes may play a bigger role in preventing the progression of premalignant to malignant change, so they should be made early in a man's life (in his 20s and 30s)." He also believes good rationale exists for recommending a protective diet for men diagnosed with prostate cancer and undergoing treatment, since animal studies have shown that certain nutrients can slow cancer growth.

Men (with a little help from their wives) can get nutrients to enhance prostate health by stocking the refrigerator and pantry with a variety of fruits, vegetables, and other nutrient-rich foods.

Wives as Diet Advocates

When Susan Pail's husband, Allan, was diagnosed with prostate cancer last year, she became his ardent health advocate, not only for researching and making decisions about his treatment, but about his diet as well. She had gathered information about the components of a prostate cancer prevention diet years before; a doctor had told Allan when he was in the Army that because of previous surgeries he was likely to develop prostate problems before age 50. "I firmly believe," says Susan, "that our prevention-focused lifestyle of a healthy diet, supplementation (especially lycopene), and not smoking delayed Allan's prostate cancer by at least 10 years and aided his rapid recovery after surgery."

Both Allan and Susan take an active role in living a healthy lifestyle. "We both love to eat and have found eating healthy and delicious food can present a delightful culinary challenge," Susan says. One of their favorite snacks consists of soy nuts and honey mixed with almond butter and spread on a banana.

Allan also loves to create in the kitchen, and shops for fresh foods on a regular basis, reading labels for fat content. He and Susan plan their meals and sometimes shop together, emphasizing fresh, unprocessed foods and a variety of fresh fruits and vegetables.

"Our diet is varied and fun," says Susan. "We use calcium-fortified vanilla soy beverage, or for satisfying a sweet tooth, chocolate soy beverage (I add some malt powder) on whole-grain cereal. Allan snacks on pumpkin seeds, a rich source of zinc. (Zinc deficiency has been linked to enlargement of the prostate). We may have steamed kale dipped in tamari sauce with wasabi (Japanese horseradish). In nice weather we may picnic in the local park with an easy meal like seitan and veggie spinach wrap sandwiches, rice and black bean salad, and fresh fruit."

Allan says he loves the fact that Susan actively participates in his health. He says he wouldn't stay as motivated to exercise if she weren't encouraging him to swim, work out with a trainer, or take walks together.

"Wives are critical to helping their husbands eat to slow the growth or delay the onset of prostate cancer," says Lynn Danford, M.S., C.D.E., L.D. Danford is a nutritionist who collaborates with Gerald Chodak, M.D., a urologist at Weiss Memorial Hospital in Chicago, to provide lifestyle counseling to men diagnosed with prostate cancer or those considered at high risk because of elevated PSA (prostate-specific antigen) levels measured in a screening blood test.

Danford recommends that her clients eat at least six servings of fruits and vegetables daily. By including only two servings with each meal, it's easier than you might think. She recommends using monounsaturated fats, such as olive, canola, or flaxseed oil, for food preparation.

Sometimes wives become overly enthusiastic about the diet and want to go beyond what their husbands are willing to do. "But the worst thing a wife can do is nag or try to exert control," says Danford. "It's not worth giving up joyfulness, love, and peacefulness in the household to enforce any diet."

What About Supplements?

A headline "Tomatoes Cure Cancer" may grab attention and temporarily increase pizza parlor business. But it takes many years of painstaking research to understand fully which foods and nutrients may decrease the risk of a specific disease. Major health and nutrition organizations will not recommend dietary supplements to the public to reduce cancer risk until the totality of evidence from population-based observational studies, studies in laboratory animals, and human controlled clinical trials show consistent benefit.

"There are some prostate-friendly things people can do that are relatively simple," says Dr. Kozlowski. In addition to reducing intake of dietary fat, he says supplementation with vitamin E, vitamin C, and selenium--and eating a lycopene- and soy-enriched diet--may be useful. "The problem is, a lot of people go overboard with it," he warns. "They assume that anything over the counter is simple and safe, and if not helpful, at least neutral--and that's wrong."

Marketers of dietary supplements are allowed to make "structure/function claims" for their products--describing how a nutrient or other component works in the body--but they are not allowed to claim the product cures disease. Those claims are reserved for drugs, which are strictly regulated by the Food and Drug Administration (FDA). The Government Accounting Office reported to Congress in July 2000 that improvements are needed in overseeing the safety of dietary supplements (including herbs). However, the FDA's plan to bolster the program to improve safety, composition, and labeling of dietary supplements may take 10 years.

"You can't eat a poor diet, take supplements, and think it will prevent cancer," says Danford. Incorporating protective foods into your diet is the best and safest way to enhance health. If you think your diet is nutritionally inadequate, consult a registered or licensed dietitian who can evaluate your present diet, give you credible information on appropriate amounts of protective nutrients, and recommend supplements as needed.

You can start eating now to reduce your risk of prostate cancer. It can be delicious, satisfying--and easier than you think. When wives work as allies to help their husbands eat more healthfully, they are true helpmates in the kitchen. Both will reap multiple health benefits--and will feel great!

RELATED ARTICLE: tips nutritionist Lynn Danford gives her clients on eating for prostate health:

Keep a balanced perspective.

No diet has been proved to cure or prevent cancer. Enjoy meals with your spouse and dining with friends. "If your diet is so restrictive that it causes unhappiness, stress, or divisiveness in the family, it is not likely to promote anyone's health," reminds Danford.

Keep it simple.

Life is stressful enough, especially if you have cancer, without making meals complicated. Rather than try to cook elaborate meals, increase fruit and vegetable servings by putting a big bowl of washed, uncut strawberries on the table or snacking on precut carrots and yogurt dip.

Choose foods you like.

It's not about eating foods you hate because you think they're good for you. Try to eat a variety of vegetables, fruits, whole-grain breads and cereals, but pick your favorites. Enjoy a treat now and then.

Plan meals and shop for food together.

Planning what you will eat ahead of time helps control impulse purchases of less nutritious foods and reinforces a sense of working together.

RELATED ARTICLE: preventing prostate cancer for our sons and grandsons

Can Selenium and Vitamin E Lower the Risk?

The National Cancer Institute is seeking the answer by conducting the largest clinical trial on men in U.S.

by Scott E. Woods, M.D., M.P.H., M. Ed.

The National Cancer Institute (NCI) is currently designing a clinical trial to answer the question Does selenium and/or vitamin E prevent the development of prostate cancer? Last summer the NCI initiated a 12-year study conducted at 200 centers nationwide. The 32,400 men participating in the study received 200 micrograms of selenium, 400 micrograms of vitamin E, both agents, or a placebo. Every six months during the 12-year study the men will be assessed for new cases of prostate cancer. Currently there is no universal recommendation for men regarding selenium or vitamin E for the prevention of prostate cancer.

Selenium

Selenium is an essential trace mineral that functions as an antioxidant, neutralizing free radicals. Free radicals accelerate the aging process and can cause cellular DNA changes that could increase the risk of cancer. The daily recommended intake of selenium is 55 micrograms/day. The most important sources of selenium in American diets are meats, fish, and grains. Some foods such as Brazil nuts have relatively high selenium concentrations.

In lab models, selenium exhibits antitumor growth activity. The best clinical evidence for a potential benefit of selenium was the Nutritional Prevention of Cancer Clinical Trial. This study involved 1,312 participants who received either selenium or a placebo for 4.5 years. The individuals who took selenium experienced a 46 percent reduction in lung cancer rates, a 63 percent reduction in prostate cancer rates, and a 58 percent reduction in colon cancer rates during the period of the study.

Vitamin E

Vitamin E is a fat-soluble vitamin that functions as an antioxidant, scavenging flee radicals. Vitamin E is found in wheat germ, corn, nuts, seeds, olives, spinach, asparagus, green leafy vegetables, and vegetable oils (corn, sunflower, soybean, and cottonseed). There are eight variants of vitamin E; alpha-tocopherol is the most active and abundant.

In lab models, vitamin E exhibits how antitumor growth affects and inhibits prostate cancer in rats. The best clinical evidence for vitamin E preventing prostate cancer comes from the Alpha-tocopherol, Beta-Carotene (ATBC) Study. The ATBC followed 29,133 men who smoked. The men either received vitamin E, beta-carotene, both agents, or a placebo. After 6.1 years the men taking vitamin E had a 32 percent reduction in the incidence of prostate cancer and a 41 percent reduction in prostate cancer mortality.

Men With Risk Factors

The NCI has recruited men for the selenium and vitamin E cancer-prevention trial who have known risk factors for prostate cancer. Prostate cancer's five known risk factors are: increasing age; African-American ancestry; a high-fat diet; physical inactivity; and family history. A man's chance of developing prostate cancer increases rapidly after age 50. Eighty percent of all prostate cancers are diagnosed in men over age 65. Second, race is also an important risk for prostate cancer. The risk of developing prostate cancer is twice as high for African-Americans as it is for Caucasian men. Asians and Eastern Europeans are least likely to develop prostate cancer. Additionally, there is evidence that a healthy lifestyle lowers the risk of prostate cancer. Regular physical activity, a low-fat diet, and maintaining an appropriate weight are all associated with a lower risk. And finally, having a brother or father with prostate cancer doubles a man's risk of developing this disease.

The Cause of Prostate Cancer

Although the cause of prostate cancer is unknown, some significant advancement has occurred in this area. In particular, specific genes have been isolated that appear to be responsible for an inherited tendency to develop prostate cancer. These genes include HPC1/hereditary prostate cancer gene 1), HPC2, HPCX (found on the X chromosome), and CAPB/cancer of the prostate and brain). Research in this area is still preliminary, and testing for these genes is currently not available. It is currently thought that these genes are responsible for approximately 10 percent of all prostate cancers.

The Benefit

In 12 years we will know if selenium and/or vitamin E prevents the development of prostate cancer. If selenium and/or vitamin E could prevent 25 percent of prostate cancers, the annual benefit would be 45,000 fewer new cases and 8,000 fewer deaths resulting from this disease.

Nutrients Showing Promise for Reducing the Risk
of Prostate Cancer

Although the evidence is sometimes contradictory and far from
complete, this chart summarizes the strength of evidence to
date, intake recommendations, and the best food sources.

Vitamin E

Evidence for protection:
Strong

Male smokers who took 50
IU/day of vitamin E for six
years had a 32 percent
lower risk of prostate cancer
and 41 percent fewer deaths
from prostate cancer than
those receiving placebo
(Heinonen, JNCI, 1998).

Recommended intake:
15 mg./day for men and
women

Tolerable upper limit:
1,000 mg./day. Higher doses
increase the risk of stroke or
bleeding problems.

Food sources:
Vegetable oils, salad dressing,
nuts, seeds, wheat germ

Selenium

Evidence for protection:
Strong

Individuals at high risk of
skin cancer who took 200
mcg. selenium/day developed
one third fewer
prostate tumors than those
not supplemented (Clark,
JAMA, 1996).

Recommended intake:
55 mcg./day for men and
women

Tolerable upper limit:
400 mcg./day

Food sources:
Whole grains

Lycopene

Evidence for protection:
Promising

Men who consumed 10
servings of tomato products
/week had a 35 percent
lower risk of prostate cancer
than those who consumed
less (Giovanucci, JNCI,
1995).

Recommended intake:
None

Food sources:
Cooked or raw tomatoes
(provide 85 percent of U.S.
intake),  1/2 c. spaghetti sauce
(20 mg.), 3/4 c. tomato juice
(17.7 mg.), 1 large raw
tomato (5.5 mg.), 2 tbsp.
catsup (5.1 mg.), grapefruit,
watermelon, dried apricots

Vitamin D

Evidence for protection:
Encouraging

Two forms of vitamin D [25
(OH) D and 1 25 [(OH).sub.2] D]
inhibited the growth of
human prostate cancer cells
in a dose-dependent manner
(Barreto, CEBP, 2000).

Recommended intake:
200 IU (adults 19-50 years)
400 IU (adults 50-70 years)
600 IU (adults 70+ years)

Sources:
Sunlight, Vitamin D-fortified
milk (100 IU per 8 oz.), egg
yolks

Soy Foods

Evidence for protection:
Encouraging but limited

Genestein, an isoflavone
found in soybeans, was
found to decrease the
growth of human prostate
cancer cells in culture
(Geller, Prostate, 1998).

Recommended intake:
None

Food sources:
Soy beverage, tofu, roasted
soy nuts, tempeh

Scott Woods, M.D., M.P.H., M.Ed., is director
of research at the Bethesda Family Practice
Program in Cincinnati, Ohio.

Susan M. Pall is a freelance writer, antique aficionado,
and prevention-minded health advocate living
in River Forest, Illinois. Her husband, Allan, is
successfully recovering from radical prostatectomy.
Judith K. Jarvis, MS., RD., is a registered dietitian
and freelance writer living in Chicago, Illinois.