Cancer and inflammation are long-term allies. Inflammation is a normal process used by the body to fight off microbes. But it quickly turns against us in many ways. Prostate cancer uses inflammation to its benefits, increasing the risk of malignancy.
In this article, we’re covering the topic of inflammation in prostate cancer. After this consideration, we’re recommending a type of diet to reduce the risk of prostate cancer.
It is known as the anti-inflammatory diet. Have you heard of it?
Let us dive into the topic and discuss the benefits of an anti inflammatory diet for cancer.
There are different types of inflammation. For educational purposes, we can narrow it down to two types: acute and chronic. Acute inflammation appears suddenly and is usually required to heal wounds. Chronic inflammation is sustained for months or years, and our metabolism generally triggers it.
In acute inflammation, you usually feel pain. The tissue becomes reddened and hot. You have probably experienced this type of inflammation after enduring a lesion. It is also the type of inflammation that results from fractures, trauma, and other life events we all have.
Despite hurting so much sometimes, acute inflammation usually works for us. It increases the blood flow to the trouble area in an attempt to heal faster. It also increases the migration capacity of white blood cells to trigger an immune response against microbes. However, sometimes acute inflammation hurts too much, and we need non-steroidal anti-inflammatories to counter this side effect.
If we understand acute inflammation, it will be easier to understand chronic inflammation. In this case, it will be low-grade inflammation. It is a type of inflammation that is not severe and won’t cause any immediate pain. If you had low-grade inflammation for a while, nothing would happen. But this one is sustained for weeks, months, or years. Thus, the effects of this type of inflammation are not usually associated with pain. Instead, it wears down internal organs and increases the risk of disease.
For example, chronic inflammation facilitates the migration of white blood cells all over the body. When sustained for a long time, it triggers inflammation by including macrophages into the blood vessels’ fat plaques. These macrophages eat oxidized LDL particles and turn them into foam cells. Without them, the progression of atherosclerosis would not be possible. Thus, instead of being a good thing, chronic inflammation contributes badly to our health.
But how does chronic inflammation end up in cancer? Cancer cells grow disproportionately to the surrounding tissues. To keep growing, these aberrant cells need more nutrients and more blood flow. They also need new blood vessels to feed the growing tumor. Otherwise, it would not continue growing, and distant cells would die away from starvation.
Chronic inflammation contributes in many ways. In the short term, it increases the blood flow and feeds cancer cells with more nutrients. In the long term, inflammatory substances trigger blood vessel formation. Thus, it allows tumors to keep growing and facilitates the process of metastasis-no wonder why many books and authors say that cancer feeds off inflammation (1).
Inflammation and prostate cancer
The prostate can undergo acute and chronic inflammation as two distinct processes noted above. Different lines of evidence show that the prostate undergoes inflammation in different ways. The worst type of inflammation in the prostate is prostatitis, which can also be acute or chronic.
We have four main types of prostatitis:
- Acute bacterial prostatitis: Symptomatic inflammation triggered by bacterial invasion of the prostate.
- Chronic bacterial prostatitis: Prolonged inflammation, sometimes mildly symptomatic, triggered by bacterial invasion of the prostate.
- Chronic prostatitis with chronic pelvic pain syndrome: A type of chronic prostatitis whose primary symptom is chronic pelvic pain. This pain is continuous and sometimes severe, affecting the patient’s quality of life.
- Asymptomatic prostatitis: Patients with ongoing inflammation who do not feel symptoms.
We would initially think that acute bacterial prostatitis is the most common type. But that’s not the case. Only 5-10% of cases fall into the acute bacterial category. On the other hand, asymptomatic prostatitis is much more common than we think (2).
Asymptomatic prostatitis and prostate cancer
A clinical trial that evaluated the effects of dutasteride on prostate cancer used prostate biopsies in various patients.
According to their results, a striking 80% of prostate biopsy results had mild, moderate, or severe inflammation. This has been reproduced in other studies featuring patients with low PSA levels and normal results in a digital rectal examination.
The results are also very high, letting us know how common inflammation can be in the prostate. There are unexplained bouts of inflammation in the prostate continuously. We can even find inflammation-associated lesions in apparently healthy individuals (3).
We don’t know precisely why the prostate is inflamed in a healthy individual, but we do have some clues. The leading causes are related to prostate infections and dietary habits. Let us review each one:
Bacterial species in the prostate induce inflammation. The most common agents are E. coli and Enterococcus species. It can also become inflamed by sexually transmitted organisms, especially Chlamydia trachomatis.
An asymptomatic inflammation of the prostate can even raise a man’s PSA level. According to a study on patients with high PSA levels, patients with leucocytes in their prostatic secretions reduced their PSA levels with antibiotics and anti-inflammatories. This only highlights the contribution of asymptomatic prostatic infections in prostate health (4).
Certain nutritional components can have an essential role in modulating inflammation. By doing so, they also increase or reduce prostate cancer risk. For example, there is a dietary mutagen known as heterocyclic amine or HCA. We have many HCA generated in meat cooked in high temperatures.
According to studies, these particles can trigger chronic inflammation and facilitate prostate cancer, breast cancer, colorectal cancer, etc. It also increases the risk of aggressive prostate cancer in patients who develop this condition. It causes an increase in mutation frequency and cancerous lesions mostly located on the prostate’s ventral lobe.
Along with cancer cells, the investigators also found macrophages and mast cells. They are activated under inflammatory conditions triggered by HCAs. More inflammatory infiltrates were found throughout the prostate, even in areas where no tumor or cancer cells were found (5, 6, 7).
But is the link between prostate cancer and inflammation active in the prostate? Some studies suggest that it certainly is. Patients with a history of prostatitis in a multiracial study had a higher risk of prostate cancer. Even having sexually transmitted diseases can be a risk factor for prostate cancer in some racial groups (8).
But what if your inflammation is subclinical, not symptomatic? Even in that case, inflammation triggered by E. coli can increase the risk of prostate cancer and BPH. What happens is that inflammation triggers metabolic stress in the tissue. In turn, the natural response of the body is to induce proliferation of epithelial tissue. After a while, this turns into dysplasia and DNA damage caused by free radicals (9, 10).
Dietary-induced inflammation has also been proven as a trigger of prostate cancer. Some study lines show that people who consume more polyunsaturated fats increase their risk of cancer. The risk of high-grade prostate cancer is higher as compared to the general population. Linoleic acid, the most common polyunsaturated fat in our diet, is the building block to create proinflammatory substances. It is used to synthesize prostaglandin E2 and leukotriene B4. Thus, the association has been confirmed between diet, inflammation, and prostate cancer (11).
How does inflammation turn into prostate cancer?
One of the most important links between inflammation and prostate cancer is cytokines. They are inflammatory substances that create signals between cells and modulate inflammation. One of them is known as Macrophage Inhibitory Cytokine or MIC-1. This substance is up-regulated in prostate cancer and predicts cancer prognosis.
Another is interleukin 6, commonly known as IL-6. This inflammatory cytokine has many roles in prostate cancer. In prostate cancer patients, it is found all over the tumor. In patients with metastasis, IL-6 is increased in the blood. In patients with poor prognosis, IL-6 levels are still higher. And recent studies suggest that this inflammatory substance helps to activate androgen receptors in the prostate tissue. In other words, IL-6 contributes to the initiation and progression of cancer into the most aggressive types (12).
As a result of prolonged inflammation, there are lesions in the prostate tissue that, in time, turn into cancer. They are known as PIA or proliferative inflammatory atrophy. These areas contain atrophic cells. These cells underwent damage and are trying to regenerate. In trying to regenerate, they sometimes turn into adenocarcinomas of the prostate. This is especially the case when prostate damage has affected the cell’s DNA (13).
In a nutshell, the transition between inflammation and prostate cancer goes like this:
- You have inflammatory risk factors such as infections and dietary factors
- Inflammation causes damage to the prostate tissue and triggers cytokines
- The inflammatory tissue undergoes atrophy in lesions known as PIA
- Cytokines contribute to activating androgen receptors and rapid growth
- PIA tissue tries to regenerate. If there was genetic damage, cancer starts to grow
- Inflammatory cytokines continue facilitating tumor growth and metastasis
How could we stop this from happening?
One way could be readily treating any urologic infection. It is very important to give special attention to sexually transmitted diseases. Solve any prostatitis issue as soon as possible and do not neglect urinary symptoms.
However, there’s another measure we can take. Dietary factors stand as an important cause of inflammation in the prostate. So, let us review why the anti-inflammatory foods is now considered an ally to prevent prostate cancer. How could you adapt this diet to you? What is it about?
Anti-inflammatory diet for prostate cancer
The anti-inflammatory diet is a very flexible eating pattern. The main goal is to eat more antioxidant and anti-inflammatory foods. It is also essential to avoid all types of inflammatory foods, such as polyunsaturated fats. Antioxidants also play a significant role in the anti-inflammatory diet.
What they do in an anti-inflammatory diet is neutralizing free radicals. Otherwise, they would be causing DNA damage. This may turn PIA lesions into prostate cancer, as reviewed above in step 5 of the progression.
With anti-inflammatory substances, the anti-inflammatory diet prevents the creation of aggressive inflammatory cytokines. For example, Omega-3 fatty acids can be taken instead of linoleic acid to create cytokines. But cytokines made with Omega-3 use inflammation more wisely. They are not as aggressive as those created with linoleic acid. Thus, inflammatory damage is less likely to appear. This would neutralize step 2 of the progression.
Yes, with the anti-inflammatory diet, we’re halting cancer progression in at least two ways. That’s why phytonutrients in fruits and vegetables have been associated with a reduction in prostate cancer. That’s why tomato products reduce prostate cancer risk in many studies.
How can you start an anti-inflammatory diet today? It is merely knowing what to eat and what to avoid. Make changes slowly and get used to the inflammatory diet as a new lifestyle. That’s the best way to get the benefits of the inflammatory diet in your particular case.
You will notice that this is not a strict diet plan. If you want one, you could consider the Mediterranean Diet, which has a similar approach.
What to eat
- Whole grains and legumes such as lentils and beans
- Fruits and vegetables
- Fish instead of red meat
- Nuts and seeds
- Low-fat dairy
- Olive oil
What to avoid
- Ultra-processed foods, including hot dogs, microwaveable food, dehydrated soup, baked goods, processed meat, highly processed cereals, and others.
- Added sugars and sweeteners
- Too much salt
- Products made with refined flour
- High-fat foods, including butter, cream, and many salad dressings
There is a close association between inflammation and cancer. We can see that in colon cancer, invasive breast cancer, prostate cancer, and other types. The link is also apparent in heart disease, atherosclerosis, and other conditions.
The immune system uses inflammation to work against pathogens. But when it is sustained for a long time, low-grade inflammation can wear us down. Inflammatory markers in the blood can predict the aggressiveness of cancer and the onset of chronic disease. High inflammatory potential can also increase prostate cancer risk.
Anti-inflammatory diets use anti-inflammatory foods (fatty fish, whole foods, fruits, and vegetables) while reducing inflammatory foods’ consumption (saturated fat, processed food, sugar).
Omega 3 fatty acids, for example, have an anti-inflammatory effect by creating less harmful cytokines. And the anti-inflammatory properties of this diet is completed with antioxidants. Together they stop the progression of cancer through the inflammatory way. Thus, this diet is an excellent asset for prostate cancer prevention.
The best aspect of the anti-inflammatory diet is that it is not a strict eating regime. Instead, you get a list of foods to eat and another list of foods to avoid. The diet gives importance to choosing healthy fats, whole foods, and natural foods. Combining this type of diet with physical activity and a prostate healthy foods will reduce prostate cancer risk and other conditions.
Still, it would help if you remembered that reducing the risk is not the same as bringing it down to zero. You should still trust your doctor and get yourself tested if you are at risk. So, do not neglect your urinary symptoms and talk to your doctor if you have a doubt about prostate cancer screening.