Inside Issue #2
How are food additives/preservatives & cancer related? - (01/09/26)
The burden of PCa in older adults: a 1990-2022 review - (01/08/26)
Molecular & genetic biomarkers for PCa - (01/08/26)
How important is the surgeon in robotic & laparoscopic prostate surgery? - (01/12/26)
Effect of gut microbiota in benign prostate hyperplasia - (01/13/26)
Deciphering the role of zinc in prostate health - (01/12/26)
Dark chocolate formulation for obesity management (!) - (01/14/26)
2026: The Most Important Papers 01/08 - 01/14
(1 minute read)
This large, long-term study followed over 100,000 adults for more than a decade and looked at how common food preservatives relate to cancer risk. The researchers found that higher intake of several widely used preservatives, including nitrites, nitrates, sulfites, sorbates and certain acetates, was associated with a higher risk of developing cancer overall, with the strongest links seen for breast and PCa ← the two hormone driven cancers.
Not every preservative showed a risk, and this study does not prove cause and effect, but the pattern was consistent enough that the authors themselves called for a re-evaluation of how freely these additives are used. The most reassuring takeaway? People who ate more freshly prepared, minimally processed foods had lower exposure to these preservatives, reinforcing something many of us already suspect but don’t always follow through on.
DON’T JUST FOCUS ON WHAT NOT TO EAT. THINK ABOUT HEALTHIER ALTERNATIVES.
Shift the balance, you don’t have to aim for zero. You don’t need to eliminate every packaged food, but making fresh, home-prepared meals the default significantly lowers preservative exposure.
Be especially mindful of processed meats. Hot dogs, bacon, deli meats and sausages are major sources of nitrites and nitrates. Roast a chicken and have chicken sandwiches for lunch all week. Seriously. It’s easier than you think. Let me know if your want a simple, delicious recipe.
Read labels when choosing packaged foods. If you see ingredients like sodium nitrite, potassium nitrate, sulfites or potassium sorbate near the top of the list, consider a different brand or a fresher alternative. I have found healthier sausage options in the grocery store. You just have to hunt a little.
Alcohol counts, too. Sulfites are common in wine and some beers, and designating alcohol-free days helps reduce cumulative exposure.
This is about long-term habits. Cancer risk builds over years, not from one snack or one meal. Small, consistent choices actually make a difference.
(1 minute read)
Often thought of as an “old man’s disease” additional risk factors can be deadly.
This large global study looked at PCa specifically in men aged 70 and older, using data from the Global Burden of Disease project across more than 200 countries from 1990 to 2021. What stood out to me most is this: even though PCa death rates have slowly declined in wealthier countries, the total number of older men living with, dying from PCa keeps rising worldwide.
In 2021 alone, more than 700,000 new cases and over 330,000 deaths occurred in men over 70, and that number is expected to nearly double by 2040. This study also highlights significant global inequities: high-income countries tend to diagnose more cases but have better outcomes, while lower-income regions see rising death rates due to later diagnosis and limited access to care. PCa in older men is no longer a small problem; it’s a growing global health challenge that requires improvements in screening, access to care and better treatment decisions based on findings in the very same papers you are reading in Prostate 180.
START THINKING ABOUT THESE THINGS IN YOUR 40’S
If you’re over 50 or if you’re caring for someone who is over 50, think about prostate health. Age is the biggest risk factor, and this study confirms that PCa overwhelmingly affects older men.
Have a conversation with your doctor about PSA testing. Screening decisions should be individualized, especially if you’re healthy. However, if you have a family history of PCa or breast cancer in your family, or you’re African American, test your PSA starting at 40!!!
Health status matters more than your birthdate. Chronological age alone shouldn’t decide treatment. Many men in their 70s and 80s do very well with appropriate care, while others may benefit more from monitoring than aggressive treatment.
Plan for the long term. With PCa cases expected to rise sharply as our population ages, lifestyle choices (ie. diet & exercise) and regular medical follow-up become even more important as we get older.
(1 minute read)
Active surveillance for PCa
This comprehensive review explains why active surveillance (closely monitoring low-risk prostate cancer instead of rushing into surgery or radiation) is now considered a safe and effective option for many men. Long-term data from large international studies show that PCa–specific survival on active surveillance exceeds 98% over 10–15 years, meaning most men do not die from their cancer while being monitored.
The challenge is figuring out who truly belongs on it and who needs closer watching. The authors show that traditional tools like PSA, biopsy results and MRI may miss important biological clues, leading to unnecessary anxiety or treatment. New blood tests, urine tests and tissue-based biomarkers may help fill this gap by better identifying slow-growing cancers and predicting progression earlier. While these tests are promising, the authors acknowledge they are not yet perfect and should not yet replace shared decision-making between patients and clinicians.
KEEP AN EYE OUT FOR NEW DIAGNOSTIC TESTS COMING SOON
If you’ve been told you have “low-risk” prostate cancer, active surveillance is usually safe. Large studies show that most men can put off treatment for many years (sometimes forever) without increasing their risk of dying from PCa.
New tests may add clarity, especially early on. Blood tests (like PHI or 4Kscore), urine tests (like ExoDx or SelectMDx) and genetic tests on biopsy tissue may help confirm whether surveillance is the right choice or whether closer monitoring is needed.
These tests are guides only. No biomarker is perfect, and results should always be interpreted alongside MRI findings, PSA trends and biopsy results.
Personalized monitoring is the future. Men with reassuring results may need fewer biopsies and scans, while higher-risk individuals may justify tighter follow-up. This is a much more minimally-invasive model than we have now.
(1 minute read)
This study compares two common surgical approaches for localized prostate cancer: robotic-assisted radical prostatectomy (RARP) and laparoscopic radical prostatectomy (LRP). This paper then adds an important variable that’s often overlooked: the experience of the surgeon.
Looking at 252 men treated between 2019 and 2023, the researchers found that robotic surgery consistently led to better short-term outcomes, including less blood loss, shorter hospital stays, fewer complications, faster recovery of urinary continence and better quality-of-life scores. Importantly, cancer control was similar between the two approaches, but robotic surgery resulted in significantly fewer positive surgical margins, meaning less cancer left behind.
What really stood out to me is that surgeon volume (how many cases they have completed) mattered as much as the technology itself. High-volume surgeons had dramatically better outcomes regardless of technique. The best results occurred when advanced robotic technology was paired with an experienced surgeon, reinforcing that who does the surgery is just as important as how it’s done.
KNOW THY SURGEON
If you’re choosing surgery, ask about experience and the equipment/technique. Surgeons who perform a high number of prostatectomies had far lower rates of cancer left behind and better recovery outcomes.
Robotic surgery offers real recovery advantages. Men undergoing robotic surgery lost less blood, spent fewer days in the hospital and regained bladder control faster than those having traditional laparoscopic surgery.
Cancer control was strong with both approaches. The risk of PSA recurrence was similar with either surgical technique.
Urinary continence. At one year, nearly 95% of robotic patients were continent, compared with about 80% in the laparoscopic group.
Technology alone isn’t enough. A robot in inexperienced hands does not guarantee better outcomes; surgeon training and experience are critical.
(1 minute read)
This study explores a fascinating and emerging idea: that the bacteria living in our gut may influence prostate size and symptoms in men with benign prostatic hyperplasia (BPH). Researchers compared men with large prostates to those with smaller prostates, analyzing stool samples to map differences in gut bacteria and metabolites (chemicals produced by the bacteria). While overall gut diversity wasn’t dramatically different, specific bacteria and metabolic pathways were.
Men with larger prostates tended to have different gut bacteria and chemical byproducts in their digestive system. Both of these are involved in hormone balance and fat metabolism.
Importantly, some gut bacteria were linked to PSA levels, prostate volume, urinary symptoms and quality of life, suggesting that the gut–prostate connection is real and measurable. This doesn’t mean gut bacteria cause BPH, but it strongly suggests they may influence how BPH develops and progresses.
KEEP YOUR GUT HEALTHY
Your gut may be talking to your prostate. Certain gut bacteria were linked to prostate size, PSA levels and urinary symptoms, hinting that your digestion, hormones and prostate health are more connected than we once thought.
Hormones appear to be part of the bridge. The gut bacteria associated with larger prostates reinforced the idea that BPH is not just “local prostate growth,” but part of a whole-body metabolic picture.
Diet likely plays a role. Because gut bacteria are strongly shaped by what we eat, this study supports the idea that long-term dietary patterns may influence prostate health indirectly through the microbiome.
Think prevention. Supporting a healthy gut through fiber-rich, plant-forward diets and metabolic health may one day become part of BPH prevention or management strategies.
(1 minute read)
This review takes a deep dive into why zinc matters so much for prostate health, and why it’s not as simple as “more zinc is better.” The prostate holds more zinc than any other organ in the male body, and that high zinc environment helps regulate energy production in prostate cells, hormone balance, immune defense and even antibacterial activity.
When zinc levels fall or zinc handling inside cells breaks down, the risk of common prostate problems like prostatitis, BPH and PCa appears to rise. At the same time, the authors are very clear that zinc plays a dual role: it may be protective in some settings but potentially harmful in others, depending on the dose, timing, disease state and how well zinc is absorbed and transported into prostate cells. That’s why zinc supplementation (taking zinc pills) remains controversial.
VITAMINS & SUPPLEMENTS ARE ALWAYS BETTER IF THEY COME FROM FOOD
Food > supplements. Zinc-rich foods like seafood (especially oysters), meat, dairy, nuts, legumes and fortified grains support steady zinc levels without overwhelming the system.
Your supplements matter. According to this review, zinc gluconate and amino-acid–bound forms like zinc glycinate are generally absorbed better than cheap inorganic forms like zinc oxide.
More is not always better. High-dose or long-term zinc supplementation may not be harmless in men with existing prostate disease. In these cases, get your zinc from food.
This is an evolving science. New zinc delivery systems and better ways to target zinc to prostate cells are under investigation, which tells us this story is still unfolding.
(1 minute read)
This review looks at dark chocolate and asks whether it can realistically play a role in weight and metabolic health rather than just being a guilty pleasure. The authors explain that dark chocolate, especially varieties with 70% cocoa or higher, is rich in bioactive compounds like flavonoids (including epicatechin and catechin), theobromine, small amounts of caffeine and beneficial fats from cocoa butter. These compounds appear to influence appetite hormones, insulin sensitivity, fat metabolism, inflammation, mood and even gut bacteria.
Importantly, the paper makes a clear distinction between true dark chocolate and highly processed chocolate products loaded with sugar and milk solids, which dilute or negate these effects. The takeaway isn’t that chocolate is a weight-loss drug, but that when properly formulated and eaten in moderation, dark chocolate may function as a supportive food within a healthy diet rather than something that automatically works against metabolic health.
DARK CHOCOLATE = >70% COCOA
Not all chocolate is created equal. The potential benefits come from high-cocoa dark chocolate (≥70%), not milk chocolate or white chocolate. Cocoa content matters more than brand names.
Dark chocolate may help curb cravings. By influencing hunger and satiety (stomach fullness) hormones and by digesting slowly, it may help reduce snacking and overeating.
It can support metabolic health. Compounds in cocoa may improve insulin sensitivity, fat metabolism and inflammation, but they work best alongside good nutrition and movement (even walking briskly 15 minutes three times a week can help).
Mood matters more than we think. Dark chocolate increases serotonin and endorphins, which may reduce stress-related or emotional eating which is something many people struggle with.
Portion size is IMPORTANT. Dark chocolate is still calorie-dense. Think a small square, not a whole bar.
OTHER NEWS
I added a couple extra papers this week because there was a lot of activity in the journals! The paper on dark chocolate was so interesting I just couldn’t resist sharing it with you.
If you like the general direction this newsletter is going, please let me know. If you don’t, I would LOVE your suggestions on how to improve it and make it more user friendly.
Please share with others who may benefit from the work we’re doing 🙂
And, THANK YOU!!