Aggressive Prostate Cancer; How to Tell if You’re at Risk

It’s become clear that only a small portion of prostate cancers will ever become aggressive.  The ultimate question is, will YOUR prostate cancer become aggressive?

The same situation applies almost exactly for breast cancer.

I have always felt that the key to cancer research is to determine which cancers will progress.  We have done a poor job of spending our money in this direction, instead choosing to spend billions of research dollars on drugs that do little to extend cancer survival at an extreme cost.  These “costs” are made up of dollars for treatment as well as side effects.

And so many of the treatments given are for cancers that were never going to progress anyway.  How real is a “cure” when the condition was going to either resolve on its own or never progress?  And what about treatments like cancer surgery, which may actually promote cancer spread due to the massive stress on the body?

My position has remained strong on this matter.  It is clear that widespread cancer screenings like PSA and mammography are far more likely to identify cancers that will never progress.  However, if someone does undergo testing and finds they have breast or prostate cancer, this person should be educated as much as possibly about lifestyles that will increase survival.  At the same time would should be spending a greater portion of cancer research dollars on determining factors that will identify those cancers that are going to progress.

Luckily, the factors that increase survival are closely related to the factors that indicate a cancer will progress.  I have covered many of the protective factors for prostate cancer in a previous article that can be read by clicking here.

This particular article begins to address the other side of the equation:  what factors are associated with prostate cancer progression?

Hormones play an important role in the development of sex-specific cancers like breast, uterine and prostate, with estrogen and testosterone being on the top of the list.  In the study researchers looked at several aspects of hormones in aggressive prostate cancer (stage III or IV and/or Gleason ≥7) including:

  • Estrone
  • Estradiol
  • Thirteen breakdown products of estrogen (in the 2-, 4-, or 16-hydroxylation pathways)
  • Testosterone
  • Sex hormone-binding globulin

When it comes to the breakdown products of estrogen in the male body, the wrong metabolites can be quite toxic to the cells of the prostate.  Specifically, the “16” and “4” pathways are considered bad, while the “2” pathway is considered friendly.  The same goes for breast cancer.

With this in mind, here are the results from the study:

  • The risk of aggressive prostate cancer was 73% lower in those with the highest estradiol:testosterone ratio
  • On the other side of the coin, the risk was 244% higher with higher 2:16α-hydroxyestrone ratios.

To put this in English, having a higher ratio of estradiol to testosterone was incredibly protective against the development of aggressive prostate cancer.  Given that this is a ratio, there are two sides to the equation.  The first would be low testosterone, which should come as no surprise.  Testosterone will directly stimulate the cells of the prostate to reproduce, so higher levels are not good.  That is why testosterone therapy can be such a bad idea.

The other side of the equation is the estrogen one.  The effects of estrogens on prostate cancer are not quite as well-known and it may be, based on the results of this study, that estrogen has some type of strong protective effect against prostate cancer.

Ironically, mainstream medicine has focused on the prostate side of this equation almost exclusively, without much success (I recently reviewed this evidence in a prior blog article that can be found by clicking here).  Maybe they’ve had the right theory but the wrong approach.

The results of the 2:16α-hydroxyestrone ratio have me a wee bit more confused.  As I already mentioned, the 2:16α-hydroxyestrone ratio has been shown to be protective against hormonal cancers, included breast, uterine and prostate cancer.  Further, intake of cruciferous vegetables like broccoli and cauliflower increase the ratio, so the ratio goes up with lifestyle choices well-known to be good for us.

But, the results of this study find that higher ratios led to increased risk of aggressive prostate cancer.

I can’t say that I have a readily available answer that makes sense for this finding.  I could postulate that anything that promotes a stronger estrogenic activity (like the 16 hyroxylation product would) is going to slow prostate cancer growth.

It could be possible that an elevated 2:16α-hydroxyestrone ratio might be protective against the development of prostate cancer, but that once prostate cancer has begun, this same elevated ratio now promotes the growth of the cancer.

For now, I am not about to recommend lower intakes of things like cruciferous veggies to keep the ratio low, but I will keep my eyes peeled for more info on this topic.

The take-home message applies to men who have been diagnosed with prostate cancer and are unsure of what to do.  Knowing that there is a factor that can easily be checked in the blood stream that will increase or decrease the risk of conversion to an aggressive cancer can be critical in making a treatment decision.

Given that the decision to progress or forgo treatment could be one of the most critical in a man’s life, any information to help make a decision is welcome.

For more than a decade, Dr. Bogash has stayed current with the medical literature as it relates to physiology, disease prevention and disease management. He uses his knowledge to educate patients, the community and cyberspace on the best way to avoid and / or manage chronic diseases using lifestyle and targeted supplementation.