Fish Oil and Prostate Cancer

When prostate cancer is less aggressive, slow moving, and/or caught early, the previous strategy was termed “watchful waiting.” That term was transitioned to “active surveillance” which involves more monitoring and can be more empowering for some patients.

“Active surveillance treatment is now available thanks to better analysis of biopsy specimens to determine tumor aggressiveness and via the deployment of sequential PSAs for monitoring,” explained integrative medical expert Ronald Hoffman, MD. “This approach can be a little nerve-wracking for patients who have been conditioned to believe that once cancer is detected it has to be rooted out; however, waiting has now become the preferred treatment for low-grade, localized prostate cancer.”

Prior to active surveillance, men with prostate cancer were offered surgery, radiation, and/or hormonal therapy.

“These treatments are associated with a high risk of side effects like urinary incontinence, erectile dysfunction, and general debilitation and hormone therapy increases the risk of metabolic syndrome which is a pathway to premature cardiovascular death,” said Dr. Hoffman who is the host of the popular podcast Intelligent Medicine.

For these reasons, active surveillance can be a preferred treatment choice; however, even though research is clear that active surveillance is effective for many men with prostate cancer, it can still be difficult for men to forgo conventional treatment for a surveillance strategy. Offering complementary interventions may be appealing to men who would like to be more proactive. Adding fish oil to the protocol and recommending a low omega-6 diet may help further improve outcomes for men using active surveillance.

CAPFISH-3 Trial

A new study published in the Journal of Clinical Oncology was a phase II prospective randomized trial featuring 100 men with grade group 1 or 2 prostate cancer under active surveillance. The primary outcome measure was a change in the Ki-67 index, which measures how quickly cancer cells divide. The Ki-67 index also indicates how likely the cancer is to grow and spread and how the cancer is responding to treatment.

The men were randomly assigned to a control group or a group that ate a high omega-3, low omega-6 diet and took fish oil capsules. This intervention altered the omega 3:6 ratio by reducing sources of omeg-6 fats and adding fish oil, which is a healthy source of omega-3s. There was a significant reduction in Ki-67 index numbers with the diet and fish oil group compared to the control group.

“There is biological plausibility to the notion that omega-3s might prevent cancer via their anti-inflammatory benefits and there is also some research showing omega-3s have pro-apoptotic effects which helps curb the immortality of cancer cells,” explained Dr. Hoffman. Research does indicate that high omega-3s in the diet are associated with lower risk of several cancers.

Dr. Hoffman believes this latest study is illustrative of a more integrative approach known as active holistic surveillance.

Active Holistic Surveillance

Active holistic surveillance was developed by Aaron Katz, MD, a urologist with NYU Langone Health. Active holistic surveillance adds diet and exercise advice along with some dietary supplements to the active surveillance protocol.

Part of the active surveillance protocol typically involves annual or biannual invasive prostate biopsies which can be uncomfortable, cause infection, and are expensive. Dr. Katz and his colleagues have shown that the active holistic surveillance approach can help prevent unnecessary biopsies in low- and low/intermediate-risk prostate cancer. They have also shown that the active holistic surveillance approach can help reduce the risk of advanced prostate cancer.

“Other components of active holistic surveillance include weight optimization, adequate sleep, microbiome interventions, and nutraceuticals like melatonin, curcumin, lycopene, green tea, and others,” said Dr. Hoffman. “The success of conservative management of low-grade prostate cancer is likely the result of a combination of factors within the active holistic surveillance protocol.”

Thanks to this latest study, a low omega-6, high omega-3 diet combined with fish oil supplements can be added to the active holistic surveillance protocol to help improve efficacy even further.