Pilot study to explore effects of low-fat, flaxseed-supplemented diet on proliferation of benign prostatic epithelium and prostate-specific antigen

Therapeutic Implications of Dietary Polyphenols-Loaded Nanoemulsions in Cancer Therapy

Cancer is one of the major causes of death worldwide, even the second foremost cause related to non-communicable diseases. Cancer cells typically possess several cellular and biological processes including, persistence, propagation, differentiation, cellular death, and expression of cellular-type specific functions. The molecular picture of carcinogenesis and progression is unwinding, and it appears to be a tangled combination of processes occurring within and between cancer cells and their surrounding tissue matrix. Polyphenols are plant secondary metabolites abundant in fruits, vegetables, cereals, and other natural plant sources. Natural polyphenols have implicated potential anticancer activity by various mechanisms involved in their antitumor action, including modulation of signaling pathways majorly related to cellular proliferation, differentiation, relocation, angiogenesis, metastatic processes, and cell death. The applications of polyphenols have been limited due to the hydrophobic nature and lower oral bioavailability that could be possibly overcome through encapsulating them into nanocarrier-mediated delivery systems, leading to improved anticancer activity. Nanoemulsions (NEs) possess diverse feasible properties, including greater surface area, modifiable surficial charge, higher half-life, site-specific targeting, and formulation imaging capability necessary to create a practical therapeutic impact, and have drawn increased attention in cancer therapy research. This review has summarized and discussed the basic concepts, classification, delivery approaches, and anticancer mechanism of various polyphenols and polyphenols-encapsulated nanoemulsions with improved cancer therapy.

Antioxidant and Anti-Obesity Effects of Juglans mandshurica in 3T3-L1 Cells and High-Fat Diet Obese Rats

Juglans mandshurica Maxim. walnut (JMW) is well-known for the treatment of dermatosis, cancer, gastritis, diarrhea, and leukorrhea in Korea. However, the molecular mechanism underlying its anti-obesity activity remains unknown. In the current study, we aimed to determine whether JMW can influence adipogenesis in 3T3-L1 preadipocytes and high-fat diet rats and determine the antioxidant activity. The 20% ethanol extract of JMW (JMWE) had a total polyphenol content of 133.33 ± 2.60 mg GAE/g. Considering the antioxidant capacity, the ABTS and DPPH values of 200 μg/ml of JMWE were 95.69 ± 0.94 and 79.38 ± 1.55%, respectively. To assess the anti-obesity activity of JMWE, we analyzed the cell viability, fat accumulation, and adipogenesis-related factors, including CCAAT-enhancer-binding protein alpha (C/EBPα), sterol regulatory element-binding protein-1c (SREBP1c), peroxisome proliferator-activated receptor-gamma (PPARγ), fatty acid synthase (FAS), and acetyl-CoA carboxylase (ACC). We found that total lipid accumulation and triglyceride levels were reduced, and the fat accumulation rate decreased in a dose-dependent manner. Furthermore, JMWE suppressed adipogenesis-related factors C/EBPα, PPARγ, and SREBP1c, as well as FAS and ACC, both related to lipogenesis. Moreover, animal experiments revealed that JMWE could be employed to prevent and treat obesity-related diseases. Hence, JMWE could be developed as a healthy functional food and further explored as an anti-obesity drug.

Role of Phytotherapy in the Management of BPH: A Summary of the Literature

Benign prostatic hyperplasia (BPH) describes the non-malignant enlargement of the prostate. It is both common and growing in incidence. Treatment is multimodal, involving conservative, medical, and surgical interventions. This review aims to examine the evidence base for phytotherapies, specifically analyzing their role in treating lower urinary tract symptoms (LUTS) attributable to BPH. A literature search was completed, specifically looking for randomized control trials (RCTs) and systematic reviews involving phytotherapy treating BPH. Specific emphasis was placed on exploring substance origin, the proposed mechanism of action, evidence of efficacy, and the side-effect profile. Several phytotherapeutic agents were evaluated. These included serenoa repens, cucurbita pepo, and pygeum Africanum, among others. For most of the reviewed substances, only modest effectiveness was reported. Generally, though, all treatments were tolerated well with minimal side effects. None of the treatments discussed in this paper form part of the recommended treatment algorithm in either European or American guidelines. We, therefore, conclude that phytotherapies, in the treatment of LUTS attributable to BPH, do provide a convenient option for patients, with minimal side effects. At present, however, the evidence for the usage of phytotherapy in BPH is inconclusive, with some agents having more backing than others. This remains an expansive field of urology whereby there is still more research to be done.

Seeds

A wide variety of plant species provide edible seeds. Seeds are the dominant source of human calories and protein. The most important and popular seed food sources are cereals, followed by legumes and nuts. Their nutritional content of fiber, protein, and monounsaturated/polyunsaturated fats make them extremely nutritious. They are important additions to our daily food consumption. When consumed as part of a healthy diet, seeds can help reduce blood sugar, cholesterol, and blood pressure.

Natural antioxidants of plant origin

Interest in the content of natural antioxidants in plant-based foods can be from the human health perspective, in terms of how these compounds might help promote one's health and wellness, or from the storage point-of-view, as the endogenous antioxidant constituents aid to extend a foodstuff's shelf-life. This chapter reports essential information about the mechanism of antioxidant action and methods employed for determination of their activity, classes of phenolic compounds (phenolic acids, flavonoids, lignans, stilbenes, tannins), sources of plant antioxidants (oil seeds, cereals, legumes, plants of the Lamiaceae family, tea and coffee, tree nuts, fruits, and berries), extraction strategies of phenolic compounds from plant material, and the influence of processing and storage on the content of natural antioxidants in foods and their antioxidant activity. Thermal processing, if not releasing bound phenolics from the structural matrices of the food, tends to decrease the antioxidant potential or, in the best case scenario, has no significant negative impact. Gentler sterilization processes such as high-pressure processing tend to better retain the antioxidant potential of a foodstuff than thermal treatments such as steaming, boiling, or frying. The impact of processing can be assessed by determining the antioxidant potential of foodstuffs either at the point of formulation or after different periods of storage under specified conditions.

Secoisolariciresinol Diglucoside of Flaxseed and Its Metabolites: Biosynthesis and Potential for Nutraceuticals

Secoisolariciresinol diglucoside (SDG), found mainly in flaxseed, is one of the essential lignans. SDG, as well as the beneficial fatty acid composition and high fiber content, has made flaxseed an important source of functional food or nutraceutical ingredients. Various studies have shown that SDG offers several health benefits, including protective effects against cardiovascular diseases, diabetes, cancer, and mental stress. These health benefits have been attributed to the antioxidant properties of SDG. Additionally, SDG metabolites, namely mammalian lignans, enterodiol and enterolactone, have shown promising effects against cancer. Therefore, understanding the biosynthetic pathway of SDG and its molecular mechanisms is a key to enable the production of new flaxseed cultivars rich in nutraceutical content. The present review highlights studies on the different health benefits of SDG, as well as lignan biosynthesis in flaxseed and genes involved in the biosynthetic pathway. Since SDG, the predominant lignan in flaxseed, is a glycosylated lignan, we also focus on studies investigating the genes involved in secoisolariciresinol glycosylation. These genes can be used to produce new cultivars with a novel level of glycosylation or lignan composition to maximize the yields of lignans with a therapeutic or protective potential.

Flaxseed Consumption Inhibits Chemically Induced Lung Tumorigenesis and Modulates Expression of Phase II Enzymes and Inflammatory Cytokines in A/J Mice

Flaxseed consumption is associated with reduced oxidative stress and inflammation in lung injury models and has shown anticancer effects for breast and prostate tissues. However, the chemopreventive potential of flaxseed remains unexplored for lung cancer. In this study, we investigated the effect of flaxseed on tobacco smoke carcinogen (NNK)-induced lung tumorigenesis in an A/J mouse model. Mice exposed to NNK were fed a control diet or a 10% flaxseed-supplemented diet for 26 weeks. Flaxseed-fed mice showed reduced lung tumor incidence (78%) and multiplicity, with an average of 2.7 ± 2.3 surface lung tumor nodules and 1.0 ± 0.9 H&E cross-section nodules per lung compared with the control group, which had 100% tumor incidence and an average of 10.2 ± 5.7 surface lung tumor nodules and 3.9 ± 2.6 H&E cross-section nodules per lung. Furthermore, flaxseed-fed mice had a lower incidence of adenocarcinomas compared with control-fed mice. Western blotting performed on normal lung tissues showed flaxseed suppressed phosphorylation (activation) of p-AKT, p-ERK, and p-JNK kinases. RNA-Seq data obtained from normal lung and lung tumors of control and flaxseed-fed mice suggested that flaxseed intake resulted in differential expression of genes involved in inflammation-mediated cytokine signaling (IL1, 6, 8, 9, and 12α), xenobiotic metabolism (several CYPs, GSTs, and UGTs), and signaling pathways (AKT and MAPK) involved in tumor cell proliferation. Together, our results indicate that dietary flaxseed supplementation may be an effective chemoprevention strategy for chemically induced lung carcinogenesis by altering signaling pathways, inflammation, and oxidative stress. Cancer Prev Res; 11(1); 27-37. ©2017 AACR.

Enterolactone Induces G1-phase Cell Cycle Arrest in Nonsmall Cell Lung Cancer Cells by Downregulating Cyclins and Cyclin-dependent Kinases

Flaxseed is a rich source of the plant lignan secoisolariciresinol diglucoside (SDG), which is metabolized into mammalian lignans enterodiol (ED) and enterolactone (EL) in the digestive tract. The anticancer properties of these lignans have been demonstrated for various cancer types, but have not been studied for lung cancer. In this study, we investigated the anticancer effects of EL for several nonsmall cell lung cancer (NSCLC) cell lines of various genetic backgrounds. EL inhibited the growth of A549, H441, and H520 lung cancer cells in concentration- and time-dependent manners. The antiproliferative effects of EL for lung cancer cells were not due to enhanced cell death, but rather due to G1-phase cell cycle arrest. Molecular studies revealed that EL decreased mRNA or protein expression levels of the G1-phase promoters cyclin D1, cyclin E, cyclin-dependent kinases (CDK)-2, -4, and -6, and p-cdc25A; decreased phosphorylated retinoblastoma (p-pRb) protein levels; and simultaneously increased levels of p21WAF1/CIP1, a negative regulator of the G1 phase. The results suggest that EL inhibits the growth of NSCLC cell lines by downregulating G1-phase cyclins and CDKs, and upregulating p21WAF1/CIP1, which leads to G1-phase cell cycle arrest. Therefore, EL may hold promise as an adjuvant treatment for lung cancer therapy.

The treatment effects of flaxseed-derived secoisolariciresinol diglycoside and its metabolite enterolactone on benign prostatic hyperplasia involve the G protein-coupled estrogen receptor 1

Secoisolariciresinol diglucoside (SDG), a lignan extracted from flaxseed, has been shown to suppress benign prostatic hyperplasia (BPH). However, little is known about the mechanistic basis for its anti-BPH activity. The present study showed that enterolactone (ENL), the mammalian metabolite of SDG, shared the similar binding site of G1 on a new type of membranous estrogen receptor, G-protein-coupled estrogen eceptor 1 (GPER), by docking simulations method. ENL and G1 (the specific agonist of GPER) inhibited the proliferation of human prostate stromal cell line WPMY-1 as shown by MTT assay and arrested cell cycle at the G0/G1 phase, which was displayed by propidium iodide staining following flow cytometer examination. Silencing GPER by short interfering RNA attenuated the inhibitory effect of ENL on WPMY-1 cells. The therapeutic potential of SDG in the treatment of BPH was confirmed in a testosterone propionate-induced BPH rat model. SDG significantly reduced the enlargement of the rat prostate and the number of papillary projections of prostatic alveolus and thickness of the pseudostratified epithelial and stromal cells when comparing with the model group. Mechanistic studies showed that SDG and ENL increased the expression of GPER both in vitro and in vivo. Furthermore, ENL-induced cell cycle arrest may be mediated by the activation of GPER/ERK pathway and subsequent upregulation of p53 and p21 and downregulation of cyclin D1. This work, in tandem with previous studies, will enhance our knowledge regarding the mechanism(s) of dietary phytochemicals on BPH prevention and ultimately expand the scope of adopting alternative approaches in BPH treatment.

Investigating the prostate specific antigen, body mass index and age relationship: is an age-BMI-adjusted PSA model clinically useful?

PURPOSE

Previous studies indicate a possible inverse relationship between prostate-specific antigen (PSA) and body mass index (BMI), and a positive relationship between PSA and age. We investigated the associations between age, BMI, PSA, and screen-detected prostate cancer to determine whether an age-BMI-adjusted PSA model would be clinically useful for detecting prostate cancer.

METHODS

Cross-sectional analysis nested within the UK ProtecT trial of treatments for localized cancer. Of 18,238 men aged 50-69 years, 9,457 men without screen-detected prostate cancer (controls) and 1,836 men with prostate cancer (cases) met inclusion criteria: no history of prostate cancer or diabetes; PSA < 10 ng/ml; BMI between 15 and 50 kg/m2. Multivariable linear regression models were used to investigate the relationship between log-PSA, age, and BMI in all men, controlling for prostate cancer status.

RESULTS

In the 11,293 included men, the median PSA was 1.2 ng/ml (IQR: 0.7-2.6); mean age 61.7 years (SD 4.9); and mean BMI 26.8 kg/m2 (SD 3.7). There were a 5.1% decrease in PSA per 5 kg/m2 increase in BMI (95% CI 3.4-6.8) and a 13.6% increase in PSA per 5-year increase in age (95% CI 12.0-15.1). Interaction tests showed no evidence for different associations between age, BMI, and PSA in men above and below 3.0 ng/ml (all p for interaction >0.2). The age-BMI-adjusted PSA model performed as well as an age-adjusted model based on National Institute for Health and Care Excellence (NICE) guidelines at detecting prostate cancer.

CONCLUSIONS

Age and BMI were associated with small changes in PSA. An age-BMI-adjusted PSA model is no more clinically useful for detecting prostate cancer than current NICE guidelines. Future studies looking at the effect of different variables on PSA, independent of their effect on prostate cancer, may improve the discrimination of PSA for prostate cancer.

Flaxseed reduces epithelial proliferation but does not affect basal cells in induced benign prostatic hyperplasia in rats

PURPOSE

This study aimed to quantitatively and qualitatively evaluate the effects of a flaxseed-based diet on the histoarchitecture of the prostate of normal Wistar rats and of rats with induced BPH.

METHODS

The study included four experimental groups of ten animals each: casein control group (CCG), who were fed a casein-based diet; flaxseed control group (FCG), who were fed a flaxseed-based diet; hyperplasia-induced casein group (HICG), who were fed a casein-based diet; and hyperplasia-induced flaxseed group (HIFG), who were fed a flaxseed-based diet. Hyperplasia was induced by the subcutaneous implantation of silicone pellets containing testosterone propionate. After 20 weeks, the rats were euthanized and their prostate fixed in buffered formalin. Tissue sections were stained with HE, picrosirius red and immunostained for nuclear antigen p63. Histomorphometric analysis evaluated the epithelial thickness, epithelial area, individual luminal area, and total area of prostatic alveoli.

RESULTS

The mean epithelial thickness obtained for HIFG and HICG was 16.52 ± 1.65 and 20.58 ± 2.86 µm, respectively. The mean epithelial thickness in HICG was greater than that in the other groups tested. HIFG had a smaller epithelial thickness and lower percentage of papillary projections in the prostatic alveoli. No significant difference was observed between CCG and FCG. The total area and mean alveolar area showed no significant differences between the groups. The number of cells immunostained for p63 was not significantly different between the groups evaluated.

CONCLUSION

These results suggest that flaxseed has a protective effect on the prostate epithelium in BPH-induced animals.

Flaxseed suppressed prostatic epithelial proliferation in a rat model of benign prostatic hyperplasia

Benign prostatic hyperplasia (BPH), a disease occurring frequently among elderly males, is a slow progressive enlargement of the fibromuscular and epithelial structures of the prostate gland. Dietary factors may influence the prostate and exert an influence on prostatic growth and disease. The current study was undertaken to investigate the protective effect of dietary flaxseed supplementation against testosterone-induced prostatic hyperplasia in male rats. Forty male Wistar rats were divided into 5 groups: (1) untreated control; (2) treatment with testosterone propionate (TP) to induce prostate enlargement; (3) TP-treated group fed a diet containing 5% milled flaxseed; (4) TP-treated group fed a diet containing 10% milled flaxseed; and (5) TP-treated group fed a diet containing 20 ppm finasteride. Treatment with TP significantly increased the absolute and relative weights of different prostatic lobes, serum testosterone (T), and testosterone/estradiol ratio, as well as prostatic vascular endothelial growth factor (VEGF) expression, RNA synthesis per cell, and epithelial cell proliferation, detected as Ki67 labeling. Histopathological examination did not reveal marked differences in acinar morphology in ventral prostate, whereas morphometric analysis showed significantly increased epithelial cell height. Co-administration of flaxseed or finasteride with TP significantly reduced prostatic VEFG, epithelial cell proliferation, and RNA/DNA ratio, along with a significant increase in serum T and testosterone/estradiol ratio compared with TP-only-treated rats. Our results indicate that flaxseed, similar to the 5α-reductase inhibitor finasteride, blocked TP-induced prostate enlargement in a rat model of BPH, likely through suppression of prostatic VEFG and cellular proliferation.

Anthocyanin induces apoptosis of DU-145 cells in vitro and inhibits xenograft growth of prostate cancer

PURPOSE

To investigate the effects of anthocyanins extracted from black soybean, which have antioxidant activity, on apoptosis in vitro (in hormone refractory prostate cancer cells) and on tumor growth in vivo (in athymic nude mouse xenograft model).

MATERIALS AND METHODS

The growth and viability of DU-145 cells treated with anthocyanins were assessed using the 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide (MTT) assay and apoptosis was assessed by DNA laddering. Immunoblotting was conducted to evaluate differences in the expressions of p53, Bax, Bcl, androgen receptor (AR), and prostate specific antigen (PSA). To study the inhibitory effects of anthocyanins on tumor growth in vivo, DU-145 tumor xenografts were established in athymic nude mice. The anthocyanin group was treated with daily oral anthocyanin (8 mg/kg) for 14 weeks. After 2 weeks of treatment, DU-145 cells (2×10⁶) were inoculated subcutaneously into the right flank to establish tumor xenografts. Tumor dimensions were measured twice a week using calipers and volumes were calculated.

RESULTS

Anthocyanin treatment of DU-145 cells resulted in 1) significant increase in apoptosis in a dose-dependent manner, 2) significant decrease in p53 and Bcl-2 expressions (with increased Bax expression), and 3) significant decrease in PSA and AR expressions. In the xenograft model, anthocyanin treatment significantly inhibit tumor growth.

CONCLUSION

This study suggests that anthocyanins from black soybean inhibit the progression of prostate cancer in vitro and in a xenograft model.

A pilot study comparing the effect of flaxseed, aromatase inhibitor, and the combination on breast tumor biomarkers

Use of complementary approaches is common among breast cancer survivors. Potential interactions between aromatase inhibitors (AI) and high phytoestrogen foods, such as flaxseed (FS), are not often described. We conducted a pilot 2 × 2 factorial, randomized intervention study between tumor biopsy and resection, in 24 postmenopausal women with estrogen receptor positive (ER+) breast cancer, to assess the effects of FS and anastrozole, and possible interactions between them, on serum steroid hormone and tumor-related characteristics associated with long-term survival (Roswell Park Cancer Institute, 2007-2010). The effect of each treatment vs. placebo on outcomes was determined by linear regression adjusting for pretreatment measure, stage, and grade. Although not statistically significant, mean ERβ expression was approximately 40% lower from pre- to postintervention in the FS + AI group only. We observed a statistically significant negative association (β ± SE -0.3 ± 0.1; P = 0.03) for androstenedione in the FS + AI group vs. placebo and for DHEA with AI treatment (β ± SE -1.6 ± 0.6; P = 0.009). Enterolactone excretion was much lower in the FS + AI group compared to the FS group. Our results do not support strong effects of FS on AI activity for selected breast tumor characteristics or serum steroid hormone levels but suggest AI therapy might reduce the production of circulating mammalian lignans from FS.

Preventive effects of lignan extract from flax hulls on experimentally induced benign prostate hyperplasia

Consumption of diet rich in lignans may decrease the risk of some chronic hormonal conditions such as benign prostatic hyperplasia (BPH). This study investigated whether a lignan-rich extract from flaxseed hulls, LinumLife EXTRA (LLE), could prevent BPH using the testosterone propionate (TP)-induced BPH rat model. Male Wistar-Unilever rats were randomly divided into four groups of 12 rats each: a negative control group fed with control diet and receiving daily subcutaneous injections of corn oil without TP, and three groups fed with control diet (positive control), diet containing 0.5% LLE (LLE 0.5) or 1.0% LLE (LLE 1.0) and receiving daily subcutaneous injections of TP in corn oil. Treatments with diets started 2 weeks before the induction of BPH and were carried out for 5 consecutive weeks. The influence of TP and LLE on body weight (BW), food and water consumptions, and enterolactone (ENL) levels in serum and urine of rats was examined at the end of the 5-week treatment period. TP significantly diminished the mean body weight gain (MBWG) of positive control rats and their food and water consumptions while LLE reduced significantly this MBWG reduction in a dose-dependent manner. The lignan-rich extract significantly inhibited TP-induced prostate size ratio (prostate weight/rat BW) increase in comparison with positive controls (P<.001). This effect was dose dependent. Higher serum and urine levels of ENL correlated well with the dose of extract provided to rats. It was concluded that the lignan-rich flaxseed hull extract prevented the TP-induced BPH indicating it might be beneficial in the prevention of BPH.

A novel measure of dietary change in a prostate cancer dietary program incorporating mindfulness training

Diet may represent a modifiable prostate cancer risk factor, but a vegetable-based prostate-healthy diet is a major change for most men. We used a ratio of animal to vegetable proteins (A:V) to evaluate whether a comprehensive dietary change was self-sustaining following completion of 11 weekly dietary and cooking classes that integrated mindfulness training. Thirty-six men with recurring prostate cancer were randomized to the intervention or wait-list control. Assessments were at baseline, 3 months, and 6 months. Of 17 men randomized to the intervention, 14 completed the requirements. Nineteen were randomized to control and 17 completed requirements. Compared with controls, a significant postintervention (3 months) decrease in A:V in the intervention group (P=0.01) was self-maintained 3 months postintervention (P=0.049). At each assessment, A:V was correlated with lycopene, fiber, saturated fat, and dietary cholesterol, four dietary components linked to clinically relevant outcomes in prostate cancer. Change in A:V was also significantly correlated with changes in fiber, saturated fat, and dietary cholesterol intake. Participants reported regular mindfulness training practice, and there was a significant correlation between mindfulness training practice and changes in both initiation and maintenance of the change in A:V. These pilot results provide encouraging evidence for the feasibility of a dietary program that includes mindfulness training in supporting dietary change for men with recurrent prostate cancer and invite further study to explore the possible role of mindfulness training as a means of supporting both initiation of dietary changes and maintenance of those changes over time.

Evaluation of a social cognitive theory-based email intervention designed to influence the physical activity of survivors of breast cancer

OBJECTIVE

The aim of this study is to evaluate a 12-week social cognitive theory (SCT)-based email intervention designed to influence the physical activity of survivors of breast cancer.

METHODS

Seventy-four volunteers (intervention group, n = 36; control group, n = 38) were recruited by mass email and written letter solicitation. Participants completed a series of online questionnaires measuring demographic characteristics, physical activity readiness, level of physical activity and selected SCT variables at baseline, 6 and 12 weeks. The intervention group received email messages based on SCT designed specifically for breast cancer survivors and targeting physical activity. For the first 6 weeks of the intervention, participants assigned to the intervention group received messages weekly, from weeks 7 to 12, participants received messages every other week and had access to an e-counselor. The control group did not receive email messages, nor did they have access to an e-counselor.

RESULTS

Significant differences in levels of self-reported vigorous physical activity were found between groups at 6 and 12 weeks. Significant differences were also found for self-reported moderate physical activity at 12 weeks.

CONCLUSION

Email-based interventions based on SCT can significantly influence levels of self-reported physical activity of breast cancer survivors.

A diet, physical activity, and stress reduction intervention in men with rising prostate-specific antigen after treatment for prostate cancer

BACKGROUND

Nearly 35% of men treated for prostate cancer (PrCA) will experience biochemically defined recurrence, noted by a rise in PSA, within 10 years of definitive therapy. Diet, physical activity, and stress reduction may affect tumor promotion and disease progression.

METHODS

A randomized trial of an intensive diet, physical activity, and meditation intervention was conducted in men with rising post-treatment PSA after definitive treatment for PrCA. Intention-to-treat methods were used to compare usual care to the intervention in 47 men with complete data. Signal detection methods were used to identify dietary factors associated with PSA change.

RESULTS

The intervention and control groups did not differ statistically on any demographic or disease-related factor. Although the intervention group experienced decreases of 39% in intakes of saturated fatty acid (SFA as percent of total calories) (p<0.0001) and 12% in total energy intake (218 kcal/day, p<0.05)], no difference in PSA change was observed by intervention status. Signal detection methods indicated that in men increasing their consumption of fruit, 56% experienced no rise in PSA (vs. 29% in men who did not increase their fruit intake). Among men who increased fruit and fiber intakes, PSA increased in 83% of participants who also increased saturated fatty acid intake (vs. 44% in participants who decreased or maintained saturated fatty acid intake).

CONCLUSION

Results are discussed in the context of conventional treatment strategies that were more aggressive when this study was being conducted in the mid-2000s. Positive health changes in a number of lifestyle parameters were observed with the intervention, and both increased fruit and reduced saturated fat intakes were associated with maintaining PSA levels in men with biochemically recurrent disease.

The optimal male health diet and dietary supplement program

The primary cause of mortality in most developed countries is cardiovascular disease, which is the primary cause of death in the largest clinical studies of male health conditions. There are simplistic correlations between heart health and male-specific diseases. Clinicians need to motivate and provide a simplistic and realistic set of lifestyle, dietary supplement, and prescription drug recommendations to men to affect all-cause morbidity and mortality. This article provides recommendations to assist the clinician and patient to make practical changes that may be accomplished in a short period of time, and should provide tangible overall benefit for men's health.

Assessment of information to substantiate a health claim on the prevention of prostate cancer by lignans

Lignans and their in vivo metabolites, especially enterolactone (ENL), have attracted substantial interest as potential chemopreventive agents for prostate cancer. Preclinical and clinical interventions performed with lignan-rich flaxseed that use surrogate biomarkers as endpoints suggest that lignans may attenuate prostate carcinogenesis in individuals with increased risk or with diagnosed cancer. No unequivocal prostate cancer risk reduction has been found for lignans in epidemiological studies, suggesting that lignan concentrations found in populations consuming a regular non-supplemented diet are not chemopreventive in prostate cancer. Presumably, the main obstacles in assessing the efficacy of food lignans is limited knowledge of the serum and tissue lignan concentrations required for the putative prevention. Further clinical studies performed with the purified compounds are required to substantiate a health claim.

Fatty acids and lignans in unground whole flaxseed and sesame seed are bioavailable but have minimal antioxidant and lipid-lowering effects in postmenopausal women

Fatty acids and lignans in ground flaxseed and sesame seed are absorbed, metabolized, and exert some health benefits in vivo. However, it is unclear if they are absorbed, metabolized, and exert health benefits when consumed as unground whole seed; therefore, it was investigated in this study. In a randomized crossover study, 16 postmenopausal women supplemented their diets with food bars containing either 25 g unground flaxseed, sesame seed, or their combination (12.5 g each) (flaxseed+sesame seed bar, FSB) for 4 wk each, separated by 4 wk washout periods. Total serum n-3 fatty acids increased with flaxseed (p<0.05) and FSB (p=0.064) while serum n-6 fatty acids increased with sesame seed (p<0.05). Urinary lignans increased similarly with all treatments (p<0.05). Plasma lipids and several antioxidant markers were unaffected by all treatments, except serum gamma-tocopherol (GT), which increased with both sesame seed (p<0.0001) and FSB (p<0.01). In conclusion, fatty acids and lignans from unground seed in food bars are absorbed and metabolized; however, except for serum GT, the 25 g unground seed is inadequate to induce changes in plasma lipids and several biomarkers of oxidative stress.

Are all n-3 polyunsaturated fatty acids created equal?

N-3 Polyunsaturated fatty acids have been shown to have potential beneficial effects for chronic diseases including cancer, insulin resistance and cardiovascular disease. Eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA) in particular have been studied extensively, whereas substantive evidence for a biological role for the precursor, alpha-linolenic acid (ALA), is lacking. It is not enough to assume that ALA exerts effects through conversion to EPA and DHA, as the process is highly inefficient in humans. Thus, clarification of ALA's involvement in health and disease is essential, as it is the principle n-3 polyunsaturated fatty acid consumed in the North American diet and intakes of EPA and DHA are typically very low. There is evidence suggesting that ALA, EPA and DHA have specific and potentially independent effects on chronic disease. Therefore, this review will assess our current understanding of the differential effects of ALA, EPA and DHA on cancer, insulin resistance, and cardiovascular disease. Potential mechanisms of action will also be reviewed. Overall, a better understanding of the individual role for ALA, EPA and DHA is needed in order to make appropriate dietary recommendations regarding n-3 polyunsaturated fatty acid consumption.

Effects of dietary flaxseed on intestinal tumorigenesis in Apc(Min) mouse

Dietary flaxseed has been shown to prevent azoxymethane (AOM)-induced colorectal cancers in male Fisher rats. The present study was designed to investigate the chemopreventive effects of dietary flaxseed on the development of intestinal tumors in Apc(Min) mice. Apc(Min) mice were divided into five different groups, fed with control (AIN-93M meal), corn meal, flaxseed meal, corn oil, and flaxseed oil supplemented diets. Results showed that dietary flaxseed significantly decreased (P < 0.05) tumor multiplicity and size in the small intestine and colon as compared to control, corn-treated groups. Intestine, colon, and serum samples of corn-treated groups showed higher levels of omega -6 fatty acids, whereas the flaxseed treated groups exhibited higher levels of omega -3 fatty acids. Lignans were detected in the serum, intestine, and colon samples for flaxseed meal group. COX-1 and COX-2 expression in the colon samples from the flaxseed meal group were significantly lower (P < 0.05) as compared to the corn meal group. Dietary flaxseed may be chemopreventive for intestinal tumor development in Apc(Min) mice possibly by increasing omega -3 fatty acid levels, lignans, and decreasing COX-1 and COX-2 levels.

A systematic review of the effect of diet in prostate cancer prevention and treatment

Dietary therapy has been proposed as a cost effective and noninvasive means of reducing the risk of prostate cancer (PC) and its progression. There is a large volume of published studies describing the role of diet in the prevention and treatment of PC. This article systematically reviews the data for dietary-based therapy in the prevention of PC, as well as in the management of patients with PC, aiming to provide clarity surrounding the role of diet in preventing and treating PC. Although conclusive evidence is limited, the current data are indicative that a diet low in fat, high in vegetables and fruits, and avoiding high energy intake, excessive meat, excessive dairy products and calcium intake, is possibly effective in preventing PC. However, caution must be taken to ensure that members of the public do not take excessive amounts of dietary supplements because there may be adverse affects associated with their over consumption. The dietary recommendations for patients diagnosed with PC are similar to those aiming to reduce their risk of PC.

Flaxseed supplementation (not dietary fat restriction) reduces prostate cancer proliferation rates in men presurgery

BACKGROUND

Prostate cancer affects one of six men during their lifetime. Dietary factors are postulated to influence the development and progression of prostate cancer. Low-fat diets and flaxseed supplementation may offer potentially protective strategies.

METHODS

We undertook a multisite, randomized controlled trial to test the effects of low-fat and/or flaxseed-supplemented diets on the biology of the prostate and other biomarkers. Prostate cancer patients (n = 161) scheduled at least 21 days before prostatectomy were randomly assigned to one of the following arms: (a) control (usual diet), (b) flaxseed-supplemented diet (30 g/d), (c) low-fat diet (<20% total energy), or (d) flaxseed-supplemented, low-fat diet. Blood was drawn at baseline and before surgery and analyzed for prostate-specific antigen, sex hormone-binding globulin, testosterone, insulin-like growth factor-I and binding protein-3, C-reactive protein, and total and low-density lipoprotein cholesterol. Tumors were assessed for proliferation (Ki-67, the primary endpoint) and apoptosis.

RESULTS

Men were on protocol an average of 30 days. Proliferation rates were significantly lower (P < 0.002) among men assigned to the flaxseed arms. Median Ki-67-positive cells/total nuclei ratios (x100) were 1.66 (flaxseed-supplemented diet) and 1.50 (flaxseed-supplemented, low-fat diet) versus 3.23 (control) and 2.56 (low-fat diet). No differences were observed between arms with regard to side effects, apoptosis, and most serologic endpoints; however, men on low-fat diets experienced significant decreases in serum cholesterol (P = 0.048).

CONCLUSIONS

Findings suggest that flaxseed is safe and associated with biological alterations that may be protective for prostate cancer. Data also further support low-fat diets to manage serum cholesterol.

Overcoming challenges in designing and implementing a phase II randomized controlled trial using a presurgical model to test a dietary intervention in prostate cancer

BACKGROUND

The time between the diagnosis of cancer and a planned definitive surgical procedure offers a strong and direct approach for assessing the impact of interventions (including lifestyle interventions) on the biology of the target tissue and the tumor. Despite the many strengths of presurgical models, there are practical issues and challenges that arise when using this approach.

PURPOSE/METHODS

We recently completed an NIH-funded phase II trial that utilized a presurgical model in testing the comparative effects of flaxseed supplementation and/or dietary fat restriction on the biology and biomarkers associated with prostatic carcinoma. Herein, we report the rationale for our original design, discuss modifications in strategy, and relay experiences in implementing this trial related to the following topics: (1) subject accrual; (2) subject retention; (3) intervention delivery; and (4) retrieval and completion rates regarding the collection of paraffin-embedded and fresh frozen prostate tissue, blood, urine, ejaculate, anthropometric measures and survey data.

RESULTS

This trial achieved its accrual target, i.e., a racially-representative (70% white, 30% minority) sample of 161 participants, low rates of attrition (7%); and collection rates that exceeded 90% for almost all biospecimens and survey data. While the experience gained from pilot studies was invaluable in designing this trial, the complexity introduced by the collection of several biospecimens, inclusion of a team of pathologists (to provide validated readings), and shifts in practice patterns related to prostatectomy, made it necessary to revise our protocol; lessons from our experiences are offered within this article.

CONCLUSIONS

While our experience specifically relates to the implementation of a presurgical model-based trial in prostate cancer aimed at testing flaxseed-supplemented and fat-restricted diets, many of the lessons learned have broad application to trials that utilize a presurgical model or dietary modification within various cancer populations.

Multi-targeted therapy of cancer by omega-3 fatty acids

Omega-3 (n-3) and omega-6 (n-6) polyunsaturated fatty acids (PUFAs) are essential fatty acids necessary for human health. Currently, the Western diet contains a disproportionally high amount of n-6 PUFAs and low amount of n-3 PUFAs, and the resulting high n-6/n-3 ratio is thought to contribute to cardiovascular disease, inflammation, and cancer. Studies in human populations have linked high consumption of fish or fish oil to reduced risk of colon, prostate, and breast cancer, although other studies failed to find a significant association. Nonetheless, the available epidemiological evidence, combined with the demonstrated effects of n-3 PUFAs on cancer in animal and cell culture models, has motivated the development of clinical interventions using n-3 PUFAs in the prevention and treatment of cancer, as well as for nutritional support of cancer patients to reduce weight loss and modulate the immune system. In this review, we discuss the rationale for using long-chain n-3 PUFAs in cancer prevention and treatment and the challenges that such approaches pose in the design of clinical trials.

Educating patients about lifestyle modifications for prostate health

Benign prostatic hyperplasia (BPH) and other prostatic diseases share many observational and mechanistic features with cardiovascular disease. Both BPH and cardiovascular disease increase significantly with age and affect a disproportionate number of men from racial/ethnic minority populations. Pharmacotherapy and surgical options are the treatments most often discussed in the medical literature for the 2 conditions, and these treatments have demonstrated remarkable effectiveness, regardless of the severity of the condition. Obesity, lack of physical activity, dyslipidemia, diabetes mellitus, higher blood pressure, a heart-unhealthy diet, and other factors that increase the risk for cardiovascular disease also appear to be associated with increased risk for BPH. However, the potential for lifestyle changes to prevent or reduce the severity of BPH, especially as an adjunct to conventional treatments, has not received significant attention, even in recent specialty treatment guidelines. Because lifestyle changes may affect the risk for developing BPH or its progression, clinicians are in need of guidelines they can use to educate patients about the potential links between increased risk of cardiovascular disease and increased risk or greater severity of BPH. Patients need to know that a heart-healthy lifestyle is also a prostate-healthy lifestyle. This article provides educational and lifestyle recommendations that may favorably affect BPH and improve overall health in men.

Dietary flaxseed lignan extract lowers plasma cholesterol and glucose concentrations in hypercholesterolaemic subjects

Lignans, derived from flaxseed, are phyto-oestrogens being increasingly studied for their health benefits. An 8-week, randomised, double-blind, placebo-controlled study was conducted in fifty-five hypercholesterolaemic subjects, using treatments of 0 (placebo), 300 or 600 mg/d of dietary secoisolariciresinol diglucoside (SDG) from flaxseed extract to determine the effect on plasma lipids and fasting glucose levels. Significant treatment effects were achieved (P < 0.05 to < 0.001) for the decrease of total cholesterol (TC), LDL-cholesterol (LDL-C) and glucose concentrations, as well as their percentage decrease from baseline. At weeks 6 and 8 in the 600 mg SDG group, the decreases of TC and LDL-C concentrations were in the range from 22.0 to 24.38 % respectively (all P < 0.005 compared with placebo). For the 300 mg SDG group, only significant differences from baseline were observed for decreases of TC and LDL-C. A substantial effect on lowering concentrations of fasting plasma glucose was also noted in the 600 mg SDG group at weeks 6 and 8, especially in the subjects with baseline glucose concentrations > or = 5.83 mmol/l (lowered 25.56 and 24.96 %; P = 0.015 and P = 0.012 compared with placebo, respectively). Plasma concentrations of secoisolariciresinol (SECO), enterodiol (ED) and enterolactone were all significantly raised in the groups supplemented with flaxseed lignan. The observed cholesterol-lowering values were correlated with the concentrations of plasma SECO and ED (r 0.128-0.302; P < 0.05 to < 0.001). In conclusion, dietary flaxseed lignan extract decreased plasma cholesterol and glucose concentrations in a dose-dependent manner.

Diet and survival after prostate cancer diagnosis

Prostate cancer is the most commonly diagnosed non-skin cancer in men in the United States. Among environmental factors, diet may play a particularly important role in its incidence, progression, and clinical outcome. This article reviews the findings of eight observational studies and 17 intervention or laboratory trials on the effect of plant-based diets and plant nutrients on both the progression and clinical outcome of prostate cancer as well as additional studies examining mechanisms that may explain dietary effects. While additional long-term therapeutic clinical trials are needed to further elucidate the role of diet, these early investigations suggest that a recommendation for individual patients to shift their diets toward plant foods may serve as an important component of the tertiary treatment of prostate cancer.

Novel techniques for the treatment of localized prostate cancer: Evidence of efficacy?

Radical retropubic prostatectomy and radiation therapy remain the mainstay of treatment for localized prostate cancer. However, with the advent of the Internet, more patients are arriving in physicians' offices questioning novel techniques for their treatment that they otherwise would not have discovered. This paper discusses several of these techniques, including focal cryotherapy, high-intensity focused ultrasound, robotic-assisted laparoscopic prostatectomy, diets, supplements, and hormonal therapy. We also render our opinion on their efficacy for treatment based on the available published studies.

Metabolic diversity of the intestinal microbiota: implications for health and disease

The bacteria colonizing the human intestinal tract exhibit a high phylogenetic diversity that reflects their immense metabolic potential. By virtue of their catalytic activity, the human gut micro-organisms have an impact on gastrointestinal function and host health. All dietary components that escape digestion in the small intestine are potential substrates of the bacteria in the colon. The bacterial conversion of carbohydrates, proteins and nonnutritive compounds such as polyphenolic substances leads to the formation of a large number of compounds that may have beneficial or adverse effects on human health.

Chemopreventive Effects of Dietary Flaxseed on Colon Tumor Development

Fatty acid composition of dietary fat plays a vital role in colon tumor development in animal models. Fats containing omega-6 fatty acids (e.g., corn oil) enhanced and omega-3 fatty acids (e.g., flaxseed oil) reduced chemically induced colon tumor development in rats. Lignans have also been shown to prevent colon tumor development in experimental animals. The objective of this investigation is to study the effects of dietary flaxseed meal, a source of both omega-3 fatty acid and lignans, on colon tumor development and compare them with the effects of dietary corn meal. Male Fischer rats, two groups of 24 each, were assigned to the AIN-93M diet supplemented with either 15% corn meal or 15% flaxseed meal, respectively. Carcinogenesis was initiated with subcutaneous injections of azoxymethane (15 mg/kg) once a week for 3 consecutive wk. After 35 wk of initiation, rats were anesthetized with ether. Blood was collected by cardiac puncture, and rats were sacrificed. The gastrointestinal tract was isolated. The site, size, and number of tumors were recorded. The fatty acid analysis of the collected serum and colon samples was performed. Expression of cyclooxygenase (COX)-1 and COX-2 was performed by Western blot method. Lignan levels in serum and colon samples were assayed. Colon tumor incidence, multiplicity, and size were found to be 82.6% and 29.4%; 1.3 and 0.3; and 44.4 and 5.3 mm(2) in corn and flaxseed meal groups, respectively. Colon and serum samples of the corn meal group showed higher levels of omega-6 fatty acid levels whereas the flaxseed meal group exhibited higher levels of omega-3 fatty acids. COX-1 and COX-2 expression in the flaxseed group was significantly lower (P < 0.05) as compared to the corn group. Dietary flaxseed meal containing high levels of omega-3 fatty acids and lignans is effective in preventing colon tumor development when compared with dietary corn meal possibly by increasing omega-3 fatty acid levels and decreasing COX-1 and COX-2 levels.

Dietary phytoestrogen, serum enterolactone and risk of prostate cancer: the cancer prostate Sweden study (Sweden)

OBJECTIVE

Based on evidence that phytoestrogens may protect against prostate cancer, we evaluated the associations between serum enterolactone concentration or dietary phytoestrogen intake and risk of prostate cancer.

METHODS

In our Swedish population-based case-control study, questionnaire-data were available for 1,499 prostate cancer cases and 1,130 controls, with serum enterolactone levels in a sub-group of 209 cases and 214 controls. Unconditional logistic regression was performed to estimate multivariate odds ratios (ORs) and 95% confidence intervals (CIs) for associations with risk of prostate cancer.

RESULTS

High intake of food items rich in phytoestrogens was associated with a decreased risk of prostate cancer. The OR comparing the highest to the lowest quartile of intake was 0.74 (95% CI: 0.57-0.95; p-value for trend: 0.01). In contrast, we found no association between dietary intake of total or individual lignans or isoflavonoids and risk of prostate cancer. Intermediate serum levels of enterolactone were associated with a decreased risk of prostate cancer. The ORs comparing increasing quartiles of serum enterolactone concentration to the lowest quartile were, respectively, 0.28 (95% CI: 0.15-0.55), 0.63 (95% CI: 0.35-1.14) and 0.74 (95% CI: 0.41-1.32).

CONCLUSIONS

Our results support the hypothesis that certain foods high in phytoestrogens are associated with a lower risk of prostate cancer.

Dietary lignans: potential role in cancer prevention

Recent in vitro, animal, and epidemiological studies suggest that dietary lignans may be chemopreventive, potentially through anti-estrogenic, anti-angiogenic, pro- apoptotic, and anti-oxidant mechanisms. In this article, we review lignan food sources and metabolism, proposed anti-carcinogenic mechanisms, and the evidence for a role of lignans in breast, colon, and prostate cancer prevention from animal and epidemiologic literature. Although a number of in vitro and animal studies support a role for lignan-rich foods and purified lignans in the modulation of cancer events of the breast, prostate, and colon, epidemiological studies, sparse and often retrospective in nature, offer inconsistent findings. The most support for a role of lignans in cancer is observed for premenopausal breast cancer. Additional epidemiological studies that use a prospective design and well-developed food databases and questionnaires are needed to adequately evaluate the role of lignans in cancer prevention.

Heart healthy equals prostate healthy equals statins: the next cancer chemoprevention trial. Part I

PURPOSE OF REVIEW

Several important observations should be kept in mind by cancer researchers: cardiovascular disease (CVD) is the number one cause of death; CVD is the number one cause of death in the largest cancer chemoprevention trials; CVD is the number one or two cause of death in prostate cancer patients; and some of the mechanisms that increase the risk of CVD may also increase the risk or progression of prostate cancer.

RECENT FINDINGS

Screening studies suggest a high prevalence of dyslipidemia in men with and without prostate cancer. Numerous recent lifestyle interventions that reduce cholesterol have also been found to have a potential impact on reducing the risk of prostate cancer. Recent studies of statins and other heart healthy agents have found a secondary potential for exhibiting a reduced risk or progression of prostate cancer.

SUMMARY

Laboratory and clinical data over the past several decades continue to support the use of a heart healthy agent in the nest cancer chemoprevention trial. The potential for an agent to simultaneously reduce the risk of the primary and secondary cause of death suggests that statins and other heart healthy agents are the ideal next interventions to be utilized in the next major cancer chemoprevention trial. If successful, this agent would most likely represent a dramatic impact on the history of cancer chemoprevention, and if not successful the potential secondary impact would again be a landmark finding in cancer chemoprevention; so the time is more than ripe for such a unique trial.

Milk thistle and prostate cancer: differential effects of pure flavonolignans from Silybum marianum on antiproliferative end points in human prostate carcinoma cells

Extracts from the seeds of milk thistle, Silybum marianum, are known commonly as silibinin and silymarin and possess anticancer actions on human prostate carcinoma in vitro and in vivo. Seven distinct flavonolignan compounds and a flavonoid have been isolated from commercial silymarin extracts. Most notably, two pairs of diastereomers, silybin A and silybin B and isosilybin A and isosilybin B, are among these compounds. In contrast, silibinin is composed only of a 1:1 mixture of silybin A and silybin B. With these isomers now isolated in quantities sufficient for biological studies, each pure compound was assessed for antiproliferative activities against LNCaP, DU145, and PC3 human prostate carcinoma cell lines. Isosilybin B was the most consistently potent suppressor of cell growth relative to either the other pure constituents or the commercial extracts. Isosilybin A and isosilybin B were also the most effective suppressors of prostate-specific antigen secretion by androgen-dependent LNCaP cells. Silymarin and silibinin were shown for the first time to suppress the activity of the DNA topoisomerase IIalpha gene promoter in DU145 cells and, among the pure compounds, isosilybin B was again the most effective. These findings are significant in that isosilybin B composes no more than 5% of silymarin and is absent from silibinin. Whereas several other more abundant flavonolignans do ultimately influence the same end points at higher exposure concentrations, these findings are suggestive that extracts enriched for isosilybin B, or isosilybin B alone, might possess improved potency in prostate cancer prevention and treatment.

Improving overall men's health and potentially reducing the risk of certain cancers via serum markers and risk assessment for coronary heart disease

Introducing men to standard and other risk markers for cardiovascular disease (CVD) can be difficult, but especially in urologic oncology where men are being evaluated for non-cardiovascular conditions. The current explanations for discussing cardiac risk factors and assessment in potential urologic oncology patients include: (1) The primary cause of death of men in the U.S. and in most regions around the world is CVD; (2) the number 1 cause of death from the largest cancer prevention trials (high or average risk) is CVD; (3) the number 1 or 2 cause of death in men with prostate cancer is CVD; (4) a relationship between some factors that increase the risk of coronary heart disease (CHD) and similar factors that increase the risk of prostate cancer should not be ignored; (5) reducing the risk of CVD via cholesterol reduction may reduce the risk of certain urologic cancers such as prostate cancer and renal cell carcinoma; and (6) one of the potentially best methods to monitor the success of lifestyle changes for the patient in urologic oncology is to monitor cardiovascular markers, as is the case in some studies of men at higher risk or diagnosed with prostate cancer. Patients and clinicians need to know their cardiovascular risk markers as well as they know the results of their cancer screening tests because there is a potentially profound overlap between the 2 conditions. A better knowledge of these basic markers and risk assessment methods may not only reduce cardiovascular risk in the worst case scenario, but in the best case scenario could reduce the risk or improve the prognosis of certain types of cancer.

Heart healthy equals prostate healthy equals statins: the next cancer chemoprevention trial. Part II

PURPOSE OF REVIEW

Specific ongoing observations from diverse medical studies do not serve to belittle the impact of prostate or other cancers, but the overall impact of cardiovascular disease (CVD) in individuals at high-risk or in individuals that have been diagnosed with common cancers needs to be addressed by future research. CVD has been the number one cause of death in men and women since the year 1990. Serum cholesterol levels are some of the most accurate long-term predictors of all-cause mortality. CVD has been the number one cause of death in the largest dietary supplement cancer chemoprevention trials.

RECENT FINDINGS

The potential for utilizing a cancer chemoprevention agent that may simultaneously reduce the risk of CVD and cancer is not only attractive, but several agents are available immediately that may demonstrate this unique impact. For example, recently statin drugs, low-dose aspirin and other non-steroidal anti-inflammatory drugs (NSAIDs), and even fish oil supplements may be utilized in the next major cancer chemoprevention trial.

SUMMARY

Heart healthy agents and interventions seem to also exhibit the ability to be prostate healthy. In addition, their low cost and potential to reduce all-cause mortality may also ensure good compliance. Statins and other heart healthy agents should be considered to be the next most ideal interventions to be utilized in the next major chemoprevention trial, especially now because several popular past dietary supplements and drugs have demonstrated the potential for notable side effects and an inability to impact the risk of CVD.