Currently, most physicians who focus on prostate cancer (PC) as their main specialty will recommend routine prostate-specific antigen (PSA) testing starting at age 40. This is important to establish objective findings that indicate a healthy prostate. In a population in which there is a family history of PC, PSA testing should be commenced at age 35 with yearly testing for a few years to establish a trend or profile. Then, if the PSA remains below 1.0 ng/mL, consideration for testing every 2-3 years can be considered. Vigilance on the part of the empowered patient, partner, and physician will also involve digital rectal examination (DRE) at reasonable intervals and tracking of the PSA over time. If any persistent PSA increase is noted, determinations of PSA velocity, PSA doubling times, free PSA percentage, and additional testing that will be discussed in subsequent sections must be done. Moreover, a baseline colonoscopy and stool testing for microscopic blood (Hemoccult) would be a reasonable consideration in such men starting at age 40 rather than at age 50.
Measures to prevent PC must be a routine part of the counsel that general practitioners and internists give their patients. Selenium intake of at least 200 mcg a day should be a consideration in the prevention of PC. Low plasma selenium is associated with a four- to fivefold increased risk of PC. In addition, levels of plasma selenium also decrease with age, resulting in middle-aged to older men being at a higher risk for low selenium levels. Ideally, baseline levels of selenium should be obtained before beginning routine selenium supplementation. It would make sense to begin such a micronutrient and mineral assessment at age 25 and perhaps every 10 years thereafter.
Men who ate the greatest amount of boron were 54% less likely to develop PC compared to men who consumed the least amount of boron. This information was presented in the annual Experimental Biology Conference in Florida in 2001. The study was led by Cui et al. from the UCLA Medical Center and compared dietary patterns of 95 men with PC with those of 5720 males without cancer. The more boron-rich foods consumed, the greater the reduction in risk of being diagnosed with PC. Those men in the highest quartile of boron consumption had a 54% reduction in PC. Boron-rich foods include plums, grapes, prunes, avocados, and nuts such as almonds and peanuts. A serving of 100 grams of prunes (6 dried prunes) has 2-3 mg of boron and 6.1 grams of fiber.
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