Active Surveillance

Many prostate cancers are small and slow growing, the so called non-aggressive tumours. Yes it is still a cancer, with all the fear that arrives with the diagnosis, but it is unlikely to impair your life or be the cause of your death unless it takes an unexpected turn for the worse.

In these cases, it is likely the man will be offered an alternative to ‘curative’ treatment such as surgery or radiation in the form of Active Surveillance (AS), known as Active Monitoring (AM) in the UK. This option involves regular monitoring of key indicators of cancer aggressiveness such as the Prostate Specific Antigen doubling rate (dPSA) and/or the Gleason score on subsequent biopsies, and/or ultrasound or MRI imaging of the prostate. These check-ups will provide an early indication of a change of the mood of the prostate cancer and may prompt a new strategy of moving on to treatment or the reassurance of continued surveillance.

Many men remain on AS for years until they either reach an age where it is deemed no longer necessary to keep watch, or they die from another cause.

Why follow the AS pathway? Simple – to avoid the life-changing side-effects that may accompany curative treatment. Side-effects such as incontinence, erectile dysfunction and depression. The cancer itself rarely causes any symptoms, however the treatments certainly do. Remaining on AS for as long as medically possible ensures an ongoing quality of life involving erections, no pads in your underwear and being able to socialise, work, play and rest with no fear.

The surveillance is important and must be adhered to if a man is to monitor his risk. But there is an other side to the program – the ACTIVE part. And this is where the man can take some control of his own destiny. The activities he chooses to do (or not do), the foods he consumes (or avoids) and the way he manages stress in his life can all influence the cancer in his prostate. None of these things is likely to cure it, but they may sabotage any progression.

For a lot more information, in fact this is all that the book is about, check out The Prostate Playbook to learn how to tweak your lifestyle and undermine your prostate cancer. Hopefully you can avoid surgery, radiation or other treatments forever.

Men’s Health Tip for Health Professionals


As a health professional there are two singularities when working with men that amuse and concern me. The first is their ability to understand all the good health messages (exercise, nutrition, sleep, etc) and the risks associated with non-compliance yet continue to engage in a fierce campaign of non-compliance. The second is their concept of what exactly comprises being healthy.

Taking the second one first, it seems to me that for a bloke, being healthy is simply the absence of death. As long as he can function in his life to some degree he sees himself as ‘in good health’. As demonstrated by the first response to the standard clinical interview question, ‘and how is your general health?’, to which he inevitably replies, ‘pretty good’. Only to reveal later (once rapport and confidence have been established) that he has type II diabetes, high blood pressure, sleep apnoea, two coronary bypasses, kidney disease and an unexplained tremor on movement. None of which have anything to do with health in his mind because he is still walking, breathing and working. The message for us is – don’t believe him! Dig deeper on health matters and try to get him to see how his current state is the end-game of his lifestyle decisions.

Back to the first issue on non-compliance. This is a second defense mechanism deployed by his male ego filter which may acknowledge at a cognitive level the links between lifestyle decisions and the prevalence of non-communicable diseases but seeks comfort in the fact that this only applies to other men. Every bloke believes he is outlying data – the exception, the maverick, the hero. Compliance is for those other men who are at risk, and as ‘I am not at risk I have no need to change my attitudes, thoughts and behaviours’. This is the blank canvas upon which we try to paint a treatment plan. Until the man acknowledges his risk he is not able to make vital changes. Note: acknowledges risk, not just understands it. Sometimes our job may include scaring the invincibility out of them to over-ride the ego filter defense. For example you could try this, ‘I had another client like you who did well for a while then it all went belly-up and his stroke left him totally disabled. If only he had done the exercises…….’. This line is best delivered while gazing into the distance over the client’s shoulder and gently shaking your head. Then pause, and make eye contact until he looks away.

Men’s Health Tip – Strong Posture

The only cost of improved posture is effort. The effort of working against gravity which continually drags you down into a lazy slouch. A slouch that can reduce your income, impair your health and change how people regard you.

Strong posture is a tall but relaxed stance or seated position where your sternum (top of your breast bone in your chest) is elevated but your shoulders are loose and relaxed.When teaching clients I asked them to imagine a string attached between belly button and top of sternum and to keep the string taut at all times – when standing, sitting, walking, driving, lifting, coughing, pushing a shopping trolley, wherever.

The benefits of a strong posture are well documented and it is the foundation upon which all your body language is delivered – your posture can reinforce or undermine your words, messages and signals without you even being aware. Just as others’ posture colours their communication. Imagine if James Bond slouched into a hotel lobby instead of arriving with a strong and relaxed posture which commands respect and attention.

Health-wise, a strong posture improves breathing function, oxygen supply to the brain and possibly clearer thinking. It aligns your joints and muscles into their most optimum position for action and protection. It improves transit and absorption in the gut, improving digestion. A strong posture engages the muscles that control pelvic floor, balance the head and stabilise the lower back (curiously, they are the same muscles!).

When working with men following prostate cancer treatment to restore their continence posture turns out to be a crucial element. As I learned from Stuart Baptist (Sydney Men’s Health Physio) using postural control strategies for those men who struggle with continence later in the day can help build a muscular pattern that enables better control.

Employers, negotiators, judges and mothers know the value of a strong posture, meaning you are likely to improve your job prospects and salary, win a debate, be found innocent and make your mum proud if you fight against gravity and don’t slouch.

Finally, if nothing else tips the scales (pun intended) you will look slimmer and taller with strong posture. Try it for a day and discover how many people remark that you have lost weight!

So if you want to be more healthy, successful, attractive and make your mum proud without spending any money – just straighten up.

More men’s health week tips each day this week.

Updated Dental Care – apologies to my children

Like most of us I was taught (and taught my kids) to brush their teeth after meals, at least twice per day. Apparently modern dental science has updated the optimal care and it is no longer necessary and possibly harmful to brush your teeth straight after eating.

Here are new guidelines:

Don’t brush your teeth straight after eating.  Chewing food stresses the enamel coating on teeth and it takes several hours of bathing in saliva for the coating to be restored. Brushing within this time-frame is a second episode of stress on the weakened tooth protection system. Wait at least a couple of hours following eating.

Use a circular action electric toothbrush. Most of us are too vigorous with a manual brush and can damage the gum line.

Apply the toothbrush to the gums not to the teeth. Brushing the gums stimulates blood flow and ensures you access the deeper crevices. The teeth will be flushed with the run-off (like a shower) and be cleaned without insult.

Once a day is enough for brushing. Seriously? Yes. The damage to teeth and gums is due to bacteria on the surface. The bacteria take several days to mature and begin to damage the tooth structure. Provided you brush well within the two to three day window you can remove immature bacteria before damage is done.

Your tooth care routine should take around four minutes. This includes a couple of minutes of picking and flossing followed by two minutes of gentle, circular brushing and rinsing. Dislodge the food scraps first then brush them away.

Mouthwashes (antiseptic or fresheners) are a well marketed but unnecessary part of the dental hygiene routine. Spend your money on a better toothbrush.

See your dentist at least once per year for a super clean and inspection. Then stick to the four minutes per day routine to maintain a quality mouth environment.

Special sensitive toothpaste does work to reduce sensitivity but is often very abrasive. Better to brush with regular toothpaste then when finished apply a small smear of the sensitive past to your gums using a finger. Then rinse.

There you go – an update based on current dental science. So, apologies to my children for being a ‘Tooth Nazi’ – turns out I was a bit over the top.

Craig Allingham
Men’s Health

A Fast Way to Manage Body Weight, Hunger and Energy

This plan has been around for hundreds if not thousands of years. In fact it is probably the way our evolutionary ancestors were obliged to eat and perhaps our DNA is molded toward it. More recently it has received some mainstream publicity on TV and in the press under different guises: it is Intermittent Fasting.

Our prehistoric forebears would hunt for protein in the form of animals. It might take days for the group to make a kill and upon returning it would be devoured promptly due to the lack of refrigerators. Meat had to be stripped from the carcass, prepared and eaten before it became bad. It might then take several more days (at least) to make another kill, so the diet between kills was collected from nature in the form of berries, roots, leaves, stems, flowers and so on. There were energy dense days (after a kill) interspersed with energy lean days (vegetarian).

Intermittent fasting is similar – days of full on eating and days of very light eating.  Like all eating plans it has its fans and its detractors, currently I am a big fan and let me tell you why before I tell you how.

Firstly, forget all the guff about fasting being a ‘detox’ for the body. The body does a very good job of detoxing every day, there are complex systems to prevent toxins getting in, for neutralizing them once they are identified and for eliminating them as quickly as possible. Ever had a dose of food poisoning? See how effective your body is at detox?

The benefits of Intermittent Fasting include:

  • Learning to manage hunger – most of us are unlikely to starve to death or even sustain any damage from not eating for a day. Learning to ride the hunger waves and become comfortable rather than immediately seek food (usually high in sugar and/or fat) is mastery of your body and mind.
  • You can eat what you want, but not on fasting days. After a day of denial, you have one or more days of no restrictions at all so this program is sustainable and low maintenance – no daily counting of kilojoules or calories, no portion control, no denial of what you enjoy.
  • It is a flexible program, you choose which days are fasting to fit your social or activity calendar. It doesn’t even have to be a full day without food, you can fast from 4pm to 4pm the next day, for example, meaning no day is totally without eating.

There are a range of fasting plans but the one I have found most compatible with my lifestyle (I love food) and my goals (losing the 5, maybe 7, OK 8 kilograms I have gained in the last 10 years) is the 5:2 Fasting Plan.

This involves five days of normal eating per week and two days of fasting or near fasting per week. I like the option of near fasting in the early weeks of starting the plan, but moving on to the full fasting is even more powerful. The partial fasting recommendations are – five days unrestricted and two days of limiting intake to 2500 kilojoules (around 600 calories) or less for a man and 2100 kJ (around 500 calories) for a woman.

Warning: complying with this limit puts you in the zone of ‘very low energy diet’ and should not be undertaken by pregnant women, diabetics or others with metabolic disorders. Check with your doctor beforehand.

For blokes, 2500kj will be consumed with:


  • Small bowl of fruit salad
  • 1 slice of multigrain toast (no butter)
  • 1 teaspoon of yeast spread (who needs a full tsp?)


  • Undressed salad – cup of lettuce, slice of tomato, 1/4 of a capsicum, 1/2 cup grated carrot, 4 olives, slice of ham, small can of tuna in water


  • 1 grilled fish fillet
  • 1/3 cup of beans
  • 3 florets of broccoli
  • 1 small mashed potato (no butter or milk)

Snacks through the day

  • 1 banana
  • 1 green apple
  • 10 glasses of water (alcohol free on fasting days)

Tomorrow – Anything you want! Just wait until tomorrow. So you can see you are most unlikely to starve. Yet you will start to see weight and girth loss within the first three weeks, but only if you stick to the plan.

How does this plan work? As usual, lots of theories but I think the critical ones are:

  • Breaking the habit of  ‘I am hungry, I will eat’
  • Resetting your metabolism twice per week from growing to repairing (there is some evidence for this one). Repair mode includes resolving inflammation in the body, which is perhaps the single highest health risk for all of us.

And if you still remain to be convinced, imagine the impact on your weekly food shopping bill if you (and everyone else in the house) fasted for two days per week! A reduction of around 25% is possible. What a bonus.

As always, be careful when making changes and be prepared to trial it for at least a month to see if it is right for you and those who live with you.


  • My starting weight – 98.5 kg.
  • Weight four weeks later – 93.2 kg (5.4% of my body weight).
  • This was on the 5:2 fasting plan with limited intake on the two fasting days of around 2000kj (500cal).
  • The initial hunger pangs of weeks one and two are now much less intense.
  • Sweet food (eg. breakfast cereal or jam) is starting to taste too sweet for my palate and leaves a furry mouth feel afterwards.
  • Energy levels are good, still able to do everything I need – yard work, writing, cycling, weight training.
  • Sleep is good – going to bed hungry is no effort if you know you can eat what you want tomorrow.
  • Mood – no complaints from my wife.
  • Productivity – excellent – I have lots more time on the fasting days to get stuff done with no food prep or eating time eating into it (sorry).
  • Savings – probably around 15% on weekly grocery expenses.

‘All Day’ fasting actually results in far more than a 24 hour fast. There is the additional 8 hours from 10pm the previous night (more if you don’t snack after dinner) making a fast time of 32 hours twice per week for a total of 64 hours not eating. Out of a possible 168 hours in a week!  This is 38% of the week in a fasting state. No wonder my body is resetting it’s metabolic priorities and energy metabolism.

This is only one story. Keep an open mind.

Active Surveillance for Prostate Cancer: is it for you?

The decision facing many blokes upon diagnosis of prostate cancer is difficult. Should you opt for surgery, some other treatment or simply monitor the numbers and hope it stays stable or slow growing. The research reported below may help you in your decision. At least it gives you some background when discussing your best options with your urologist and GP.

STOCKHOLM—Active surveillance (AS) for patients with favorable risk prostate cancer (PCa) is safe long-term, with patients much more likely to die from causes other than PCa, according to study findings presented at the European Association of Urology 29th annual congress.

The study, led by Laurence Klotz, MD, of Sunnybrook Health Sciences Centre, University of Toronto, included 993 men (median age 67.8 years) with favorable or intermediate PCa who underwent AS for a median of 8.1 years. A total of 206 men were followed for more than 10 years and 50 were followed for more than 15 years.

Of the 993 men, 149 died (15%), 15 (1.5%) from PCa. The 10- and 15-year actuarial cancer-specific survival rates were 98.1% and 94.3%, respectively. Patients were 9.2 times more likely to die from other causes than from PCa.

In addition, at 5, 10, 15, and 20 years, 75.7%, 63.5%, 55.0%, and 55.0%, respectively, remain untreated and on AS. Metastatic disease developed in an additional 7, who either died of other causes (5) or are alive with disease (2). Post-treatment failure occurred in 6.3% of the total cohort.

“Active surveillance for favorable risk prostate cancer is feasible and appears safe in the 15-20 year time frame,” the authors concluded in their poster presentation.

At entry into AS, patients had a Gleason score of 6 (or 7 for men aged 70 and older), clinical stage T1b-T2b N0 M0, and a PSA level of 10 ng/mL (15 or less in men aged 70 or older). All had elected to be managed with AS. Clinicians offered intervention to patients if they had  Gleason score progression, a PSA doubling time of less than 3 years, or unequivocal clinical progression.

Although AS may be a safe option, a study published recently in the New England Journal of Medicine (2014;370:932-942) found that men with localized PCa are less likely die from the disease if they undergo radical prostatectomy (RP) instead of watchful waiting, especially if they are younger than 65 years. At 18 years of follow-up, RP was associated with an overall significant 44% decreased risk of death from PCa compared with watchful waiting. Men younger than 65 years had a significant 55% risk reduction, whereas older men had a non-significant 25% decreased risk.

Dr. Klotz told Renal & Urology News that the patients on the watchful waiting arm of this study did not have serial biopsies or the opportunity for delayed definitive therapy upon risk reclassification. In addition, most of the patients who died from PCa had intermediate- or high-risk disease at diagnosis.

It Changed Our Thinking

It must be at least fifteen or twenty years ago when I first heard the term ‘under-recovery’. Until then we had labelled chronic, repetitive microtrauma injuries as ‘over-use’ injuries. Believing that the tissues were damaged due to repeated, frequent overloading.

Under-recovery suggested that the loading may have been quite appropriate, provided the tissue (tendon, fascia, muscle, bone, sheath, etc) had sufficient time since the last loading cycle to recover.

The ability to absorb more loading was reframed from one of being too hard on the body, to instead being too impatient and not allowing the normal cycle of post-training stress recovery reach completion.

So we started managing the recovery cycle with the same diligence and vigilance as we did the work cycle of training. Not only did we reduce the injury stress, but it turns out the level of performance would often go up as well. Whether this was due to the change of cycles directly or due to the longer period of training possible because it was not being interrupted by injury is difficult to say, and possibly irrelevant.

However this was a short won victory for common sense. Once the coaches realised sports science could improve the quality of the recovery cycle they increased the frequency and intensity of the loading cycles to maximise training adaptations. Active recovery strategies led to increased loading cycles and the injury and burn-out complications reasserted themselves.

I find the same thing happens in a busy life of work, family, recreation and chores. When I raise the efficiency of managing my tasks I then see gaps into which I can add more tasks…

So, how are YOU doing? How is your RESILIENCE?

Resilience: the current buzzword in business training and life management is RESILIENCE. It is not new, just a rebadging of the ability to bounce back, to roll with the punches to pull yourself up by the boot-straps, and other meaningless babble.

But actually it is not so much overload as it is under-recovery in terms of not quite regaining your equilibrium between the challenges that life will inevitably throw your way.

Each of us will handle this in their own way. Maybe not a rational or appropriate way, but the way we have always used (habit) probably learned when our minds were most plastic (childhood and adolescence).

Recognising your resilience is compromised is the first stage of avoiding burnout, depression, anxiety or other such failures of your coping mechanisms. Taking action and seeking assistance is the next step. Action and time to allow your recovery cycle to prepare you to step back into life’s fray.

Looking on from outside, you may not fully appreciate the range or depth of others’ overloading and risk judging them harshly for what you perceive as failings. Really, really try not to do that. It is not helpful for either of you. Ask how you might help (not fix, just help) them share the load. And if you are part of the problem, get out of the way without taking it personally (tough ask).

Finally, keep an eye on each other – your loved ones, your family, your team mates and employees. Your professional colleagues, teachers, students and most importantly yourself. Be mindful of how others are coping and dealing with their loads before you dump some of yours.

Bedroom TV & Body Weight Gain

A recent study suggests having a TV in a child’s bedroom significantly increases their likelihood of weight gain in the subsequent four years. Perhaps setting them up for a lifetime of battling excess weight.

The study published in JAMA Pediatrics confirmed previous studies linking a bedroom TV to increased risk of being overweight.

Read the study abstract here:

The lead author, Diane Gilbert-Diamond, spoke with Reuters Health and pointed out the TV saturation rate in adolescent bedrooms (71%) and and suggested a responsible parent should remove it to help children get a healthier start in life.

The mechanism of action is not clear with possibilities including disrupted sleep patterns (correlates with weight gain), increased exposure to convenience food advertising and prolonged inactivity periods.

Good luck removing the TV from your teenagers bedroom I say. In fact, the best strategy may be to lead by example and remove any TV from your own bedroom first. Who knows what other benefits might accrue when you have to make your own entertainment…..



Rebuilding Genetic Health following Prostate Cancer

In a small but important study researchers in the USA have found measurable improvements in a health related tag on the end of chromosomes in response to lifestyle and nutrition discipline amongst men who have biopsy diagnosed prostate cancer. Here is a summary from Medscape (Sept 20, 2013)

A comprehensive lifestyle intervention might help prostate cancer patients live to be longer in the tooth and in the telomere, suggest results of a very small pilot study reported online in The Lancet Oncology.

Among 35 men with biopsy-proven, low-risk prostate cancer who opted for active surveillance, a comprehensive lifestyle intervention including diet, activity, stress management, and support was associated with lengthening of telomeres over 5 years compared with a loss of telomere length among controls, report Dean Ornish MD, director of the Preventive Medicine Research Institute, in Sausalito, California, and colleagues.

Telomeres, complexes of DNA and proteins at the end of linear chromosomes, have been shown to be essential for cellular health. Telomere shortening has been associated with increased risk for prostate cancer recurrence in patients who have undergone radical prostatectomy, and it’s theorized that telomere maintenance and lengthening may be associated with better health and longer life.

“This study is the first controlled study to show that any intervention may lengthen telomeres in humans, but it’s not in a vacuum,” Dr. Ornish said in an interview with Medscape Medical News. “There are other, cross-sectional studies showing that people who are under chronic emotional stress tend to have shorter telomeres in direct proportion to the amount of stress they have, or that people who are marathon runners tend to have longer telomeres than those who aren’t.”

The active intervention group included 10 men who were participants in the GEMINAL (Gene Expression Modulation by Intervention with Nutrition and Lifestyle) study. The participants ate a diet low in fat and refined carbohydrates and high in whole fruits and vegetables; exercised aerobically for at least 30 minutes 6 days each week; engaged in stress management programs; and took part in a 1-hour weekly support group. Controls were followed with active surveillance only.

Sure, these guys were supervised and offered support and programs at no charge (I suspect) – but the results show any financial, time or energy sacrifice can help you rebuild genetic integrity which reflects a more robust state of health. This is yet another piece of research evidence demonstrating the value of disciplined indulgence.