Gabe Canales' experience with low-risk prostate cancer nearly matches mine -- with a couple of caveats, including a 27-year difference in the ages at which we were both diagnosed.
I was 62 years old with a rising prostate-specific antigen (PSA) level, close to the average age of diagnosis. Canales was just 35.
Canales, author of (2022) was diagnosed incidentally while investigating a problem with low testosterone. Instead, he found out he had what most consider "an old man's disease."
Like me, the Texan was diagnosed in 2010 with a single core of Gleason 6 (Grade Group 1) prostate cancer. And just like in my experience, his first doctor didn't emphasize that he had low-risk cancer and tried to persuade him to undergo a radical prostatectomy.
We both did research and got second opinions -- a half dozen in Canales' case -- and found that active surveillance, close monitoring of cancer, was an option to help us avoid the potential side effects of aggressive treatment, including erectile dysfunction and urinary incontinence.
But prostate experts viewed us differently based on our ages. He had maybe a 50- to 60-year life horizon to live with the cancer and be exposed to treatment and its side effects. My horizon was far shorter, maybe 20-30 years. In general, doctors were (and are) more supportive of older men going on surveillance.
This is in part because younger men tend to be diagnosed with cancers.
In the U.S., the average for prostate cancer is between 95% and 100% for men ages 40-80. For younger men, the 5-year survival rate is lower. For men ages 25-34, it's 80%. For men ages 20-29, it's 50%. For men ages 15-25, it's 30%.
Canales had a tough time coping with a disease one would more likely expect his grandfather or father to have. Canales recalled, "My world was just upside down. I was a mess. I really was."
He sorted out his situation after meeting with multiple experts, including at the University of Texas MD Anderson Cancer Center in Houston and Memorial Sloan Kettering Cancer Center in New York City.
One expert he spoke with, Aaron Katz, MD, a urologist at New York University, is an advocate of a holistic, dietary approach to active surveillance. "This isn't going to kill you," Katz told Canales, reassuring him he was going to be fine.
Katz guided him to go on a plant-based diet to slow progression of his cancer. In fact, Canales said Katz told him he had found that many of his patients had no detectable cancers after making lifestyle changes.
In contrast, my doctors told me there was no evidence that diet can impact prostate cancer, which is now controversial. Research is starting to support the idea that a plant-based diet may help slow the progression of and even prevent prostate cancer.
For example, in a presented at the American Society of Clinical Oncology Genitourinary Cancers Symposium in February, researchers from the University of California San Francisco reported that "plant-based dietary patterns are associated with lower risk of prostate cancer progression and recurrence, particularly among older men and those who reported a higher intensity walking pace." They concluded that prostate cancer survivors may be recommended diet and exercise counseling to improve clinical outcomes after prostate cancer diagnosis.
At the same meeting, Stacy Loeb, MD, a urologist at New York University Langone, that her study suggests: "Greater consumption of healthful plant-based foods is associated with modest improvements in [quality-of-life] domains among patients with prostate cancer."
I recently organized a webinar for featuring Loeb, who shared her findings. I was impressed. I went on a whole foods, plant-based diet recently with the goal of improving my health overall, with no expectation that it will impact my prostate. But I have lost 5 lbs in the first month -- so something is happening.
Canales told me that since meeting Katz, "I'm 100% whole foods plant-based. I don't eat processed vegan stuff. I eat a ton of beans, brown rice. You would think I'm a rabbit because I eat a ton of kale and arugula and chard and bok choy every day. I am the opposite of the guy I was in 2010 and earlier.
He added: "Having grown up in Texas, my favorite food was chicken fried steak with cream gravy. Just get a piece of steak, batter it, and deep-fry it. Lots of barbecue and red meat were my favorite protein source every day. And I just absolutely never ate a vegetable."
In 2010, he decided to spread the word by forming a charity called aimed at increasing awareness of prostate cancer in younger men. But prostate cancer awareness is a hard sell in young men because so few in their 20s and 30s are aware of what their prostates are, let alone their risk for prostate cancer.
After realizing this, Canales switched his mission to a broader one: making young men and their significant others aware of good health overall, emphasizing nutrition, exercise, smoking cessation, good sleep, and mental health promotion. As it was, he found young women seemed more interested in improving their male companion's health than did the men.
One of Canales' advisors, Lorenzo Cohen, PhD, professor and director of the MD Anderson Integrative Medicine Program, said prostate cancer is extremely rare in young adults and teens. Research indicates that of prostate cancer cases occur in men 55 and younger.
He added that most prostate cancers are slow growing and screening is not necessary before 50 years of age, with the exception of those of . "Screening is still controversial as it may cause more harm than good," he said.
Cohen, co-author of , said about Canales: "Gabe is a role model for how to transform your life and health. He did not just modify his diet but changed his whole life. This approach, going beyond just diet and exercise, is likely what is needed to prevent and help control such a complex disease like cancer that has many driving factors." He added, "Blue Cure is doing a great job at educating young men, as that is the time some of these lifestyle cancers get established. Establishing healthy lifestyle habits when you are young will increase the chance that you will prevent future non-communicable diseases like cancer."
This fall, Canales is launching Blue Cure Men's Health College Tour in Texas. It will roll out nationally in 2024. "This is about planting seeds with young men and encouraging action," he said.
Canales, a PR and marketing professional, stressed that the image of prostate cancer needs to be changed. "When you look at brochures and websites, they always feature a guy with silver hair, a guy who looks like my grandfather. We need to get this message out to save lives that prostate cancer can strike younger men. Prostate cancer is not just an old man's disease."
Howard Wolinsky has been writing "A Patient's Journey" for 鶹ý since 2016. He is a co-founder of the education and support groups, and the for Active Surveillance. He also is the editor of the Substack newsletter, . He just started an MPH program at the University of Illinois Chicago School of Public Health.