High cholesterol is not your heart’s best friend, right? Everyone knows that! But what you may not know is the impact of high cholesterol on your PSA levels as well as risk of prostate cancer (PCa).

As far back as 2014 we began posting blogs about the effects of statins—a class of drugs used to lower cholesterol—on PCa risk. The discovery that men who use statins to reduce cholesterol seem to have less chance of developing PCa, but particularly advanced PCa. After all, that’s not what the medications were designed to do, so it was something of a surprise.

In fact, statin use is associated with less probability of an abnormal PSA blood test.^[i]It is not known with certainty that statin use actually lowers PSA—an association that raised concern that statins can mask PCa. However, a more recent study out of Finland did not find a marked effect of statin use on PSA screening.^[ii]

However, the primary purpose of taking statin drugs is to preserve cardiovascular wellness by preventing excessive cholesterol. Neither the literature nor our own practice suggests taking such medication as a way to protect against cancer, particularly PCa. According to Alfaquih, et al. (2017), “…advocating that all men start taking statins as a chemopreventive measure against prostate cancer would currently be premature, as not all data agree on the potential benefits of statins…”^[iii]

A dietary alternative to drugs

So, if lowering cholesterol seems to keep PSA low and helps prevent PCa, is there another option besides popping a pill? The answer is yes!

A team of researchers from three expert Canadian medical centers took the question to heart, and delved into the published literature on the effect of cholesterol-reducing diets on PSA. They identified six randomized, controlled trials (the highest level of research) involving 291 men. Their 2022 published paper reports:

Men were aged ≥40 years, free of PCa, and had baseline PSA <10.0 ng/mL. Participants received one of four diets (high-fiber, low-glycemic index, low-glycemic load, or cholesterol-lowering) for 8-24 weeks. The primary outcome evaluated the association between change from baseline low density lipoprotein cholesterol (LDL-C) and PSA. How cholesterol reduction modified PCa risk was estimated using the Prostate Cancer Prevention Trial (PCPT) risk calculator (limited to age ≥55 years, baseline PSA ≥1.0 ng/mL).^[iv]

To the best of their knowledge, the authors point out that this is the first of its kind investigation into cholesterol-lowering diets and their implications for lowering PSA as well as PCa probability. All diets
reported in the six studies were designed by registered dieticians. They found that dietary interventions had comparable effects to statin use:

• For every 10% reduction in LDL cholesterol (the “bad” cholesterol) there was a concomitant 2% reduction in PSA
• The 7% calculated reduction in PCa risk, based on diet, was equal to the 7% reduction reported in published data for statin use.

Although there are some limitations to the study, and more research is needed, we believe the results discovered by the team support the theory that PSA can be controlled and PCa risk diminished by healthy eating.

What does a cholesterol-lowering diet look like?

If you’re wondering exactly how you should eat if you want to manage your cholesterol, the Mayo Clinic offers a list of foods that can set you on the right path. These include oatmeal/oat bran/high fiber foods as well as almonds, avocados, and other healthy ingredients. Don’t forget the omega-3 fatty acids.

While most signs seem to be pointing in the same direction, there is not universal agreement on the relationship between high cholesterol, abnormal PSA, and PCa risk. While statin drugs have had an immense impact on reducing death from cardiovascular disease and stroke, they can have side effects. Therefore, if you’re concerned about your cholesterol—and your risk factors for PCa—always consult with your own doctor before embarking on any changes whether dietary or other. Keep in mind that the idea of food as medicine is as old as ancient times, but always use common sense and the supervision of your primary care physician. If you have specific concerns or symptoms regarding your prostate health, contact our Center to learn more about our detection and diagnosis services for prostate cancer.

NOTE: This content is solely for purposes of information and does not substitute for diagnostic or medical advice. Talk to your doctor if you are experiencing pelvic pain, or have any other health concerns or questions of a personal medical nature.

References

[i] Shi Y, Fung KZ, Freedland SJ, Hoffman RM, Tang VL, Walter LC. Statin medications are associated with a lower probability of having an abnormal screening prostate-specific antigen result. Urology. 2014 Nov;84(5):1058-65.
[ii] Stenger, M. “Effect of Statin Use on Outcomes of PSA Screening.” The ASCO Post, Jan. 25, 2022. https://ascopost.com/issues/january-25-2022/effect-of-statin-use-on-outcomes-of-psa-screening-for-prostate cancer/
[iii] Alfaqih MA, Allott EH, Hamilton RJ, et al. The current evidence on statin use and prostate cancer prevention: Are we there yet? Nat Rev Urol. 2017;14:107–19. doi: 10.1038/nrurol.2016.199.
[iv] Jayalath VH, Lajkosz K, Fleshner NE et al. The effect of lowering cholesterol through diet on serum prostate specific antigen levels: A secondary analysis of clinical trials. Can Urol Assoc J. 2022 Aug;16(8):279-282.