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It used to be that radiation therapy for prostate cancer involved weeks or months of repeat visits to a clinic for treatment. Today that’s not necessarily true. Instead of giving small doses (called fractions) per session until the full plan is completed, radiation delivery is moving toward high-dose fractions that can be given with fewer sessions over shorter durations.

This “hypofractionated” strategy is more convenient for patients, and mounting evidence shows it can be accomplished safely. With one technology called stereotactic body radiation therapy (SBRT), patients can finish their treatment plans within a week, as opposed to a month or more. Several devices are available to deliver hypofractionated therapy, so patients may also hear it referred to as CyberKnife or by other brand names.

An SBRT session takes about 20 to 30 minutes, and the experience is similar to receiving an x-ray. Often, doctors will first insert small metal pellets shaped like grains of rice into the prostate gland. Called fiducials, these pellets function as markers that help doctors target the tumor more precisely, so that radiation beams avoid healthy tissue. During treatment, a patient lies still while the radiation-delivery machine rotates around his body, administering the therapy.

How good is SBRT at controlling prostate cancer? Results from a randomized controlled clinical trial show that SBRT and conventional radiotherapy offer the same long-term benefits.

How the study was conducted

The trial enrolled 874 men with localized prostate cancer, meaning cancer that is still confined to the prostate gland. The men ranged between 65 and 74 years in age, and all of them had prostate cancer with a low or intermediate risk of further progression. The study randomized each of the men to one of two groups:

• Treatment group: The 433 men in this group each got SBRT at the same daily dose. The treatment plan was completed after five visits given over a span of one to two weeks.
• Control group: The 441 men in this group got conventional radiotherapy over durations ranging from four to 7.5 weeks.

None of the men received additional hormonal therapy, which is a treatment that blocks the prostate cancer–promoting effects of testosterone.

What the study showed

After a median duration of 74 months (roughly six years), the research found little difference in cancer outcomes. Among men in the treatment group, 26 developed visibly recurring prostate cancer, or a spike in prostate-specific antigen (PSA) levels suggesting that newly-forming tumors were somewhere in the body (this is called a biochemical recurrence). By contrast, 36 men from the control group developed visible cancer or biochemical recurrence. Put another way, 95.8% of men from the SBRT group — and 94.6% of men in the control group — were still free of prostate cancer.

A word of caution

Earlier results published two years into the same study showed higher rates of genitourinary side effects among the SBRT-treated men. Typical genitourinary side effects include inflammatory reactions that increase pain during urination, or that can make men want to urinate more often. Some men develop incontinence or scar tissues that make urination more difficult. In all, 12% of men in the SBRT group experienced genitourinary side effects at two years, compared to 7% of the control subjects.

“Interestingly, patients who were treated with CyberKnife appeared to have lower significant toxicity at two years compared with those treated on other platforms,” said Dr. Nima Aghdam, a radiation oncologist at Beth Israel Deaconess Medical Center and an instructor of radiation oncology at Harvard Medical School. By five years, the differences in side effects between men treated with SBRT or conventional radiation had disappeared.

The authors advised that men might consider conventional radiation instead of SBRT if they have existing urinary problems before being treated for cancer. Patients with baseline urinary problems are “more likely to have long-term toxic effects,” the authors wrote, adding that the new findings should “allow for better patient selection for SBRT, and more careful counseling.”

“This is an important study that validates what’s becoming a standard practice,” said Dr. Marc Garnick, the Gorman Brothers Professor of Medicine at Harvard Medical School and Beth Israel Deaconess Medical Center, and editor in chief of the Harvard Medical School Guide to Prostate Diseases. “The use of a five-day treatment schedule has been well received by patients who live long distances from a radiation facility, given that treatment can be completed during the weekdays of a single week. As with any cancer treatment choice, the selection of the appropriate patient is crucial to minimize any potential side effects, and this can only be done after a careful consideration of the patient’s other medical conditions.”

“This elegant study will put to rest any questions regarding the validity of SBRT as a standard-of-care option for many patients with prostate cancer,” Dr. Aghdam added. “Importantly in this trial, we see excellent outcomes for many patients who were treated with radiation alone. As this approach gains broad acceptance in radiation oncology practices, it remains critical to carefully consider each patient based on their baseline characteristics, and employ the highest level of quality assurance in delivering large doses of radiation in fewer fractions. As the overall duration of radiation therapy gets shorter, every single treatment becomes that much more important.”

About the Author

Charlie Schmidt, Editor, Harvard Medical School Annual Report on Prostate Diseases

Charlie Schmidt is an award-winning freelance science writer based in Portland, Maine. In addition to writing for Harvard Health Publishing, Charlie has written for Science magazine, the Journal of the National Cancer Institute, Environmental Health Perspectives, … See Full Bio View all posts by Charlie Schmidt

About the Reviewer

Marc B. Garnick, MD, Editor in Chief, Harvard Medical School Annual Report on Prostate Diseases; Editorial Advisory Board Member, Harvard Health Publishing

Dr. Marc B. Garnick is an internationally renowned expert in medical oncology and urologic cancer. A clinical professor of medicine at Harvard Medical School, he also maintains an active clinical practice at Beth Israel Deaconess Medical … See Full Bio View all posts by Marc B. Garnick, MD

Although inflammation serves a vital role in the body’s defense and repair systems, chronic inflammation can cause more harm than good. And that may make you wonder: what can I do about it?

In fact, there’s a lot you can do. And you may already be doing it. That’s because some of the most important ways to fight inflammation are measures you should be taking routinely.

Let’s take a look at key elements of fighting chronic inflammation: prevention, detection, and treatment.

Six ways to prevent unhealthy inflammation

Six of the most effective ways to ward off inflammation are:

• Choose a healthy diet. Individual foods have a rather small impact on bodywide inflammation, so no, eating more kale isn’t likely to help much. But making sure you eat lots of fruits and vegetables, whole grains, healthy fats, and legumes — sometimes called an anti-inflammatory diet — may reduce inflammation and lower risk for chronic illnesses like diabetes and heart disease. Not only can these diets help reduce inflammation on their own, but replacing foods that increase inflammation (such as sugary drinks and highly processed foods) benefits your body, too.
• Exercise regularly.Physical activity may help counter some types of inflammation through regulation of the immune system. For example, exercise has anti-inflammatory effects on white blood cells and chemical messengers called cytokines.
• Maintain a healthy weight. Because excess fat in cells stimulates bodywide inflammation, avoiding excess weight is an important way to prevent fat-related inflammation. Keeping your weight in check also reduces the risk of type 2 diabetes, a condition that itself causes chronic inflammation.
• Manage stress. Repeatedly triggered stress hormones contribute to chronic inflammation. Yoga, deep breathing, mindfulness practices, and other forms of relaxation can help calm your nervous system.
• Do not smoke. Toxins inhaled in cigarette smoke trigger inflammation in the airways, damage lung tissue, and increase the risk of lung cancer and other health problems.
• Try to prevent inflammatory conditions, such as
  • Infection: Take measures to avoid infections that may cause chronic inflammation. HIV, hepatitis C, and COVID-19 are examples. Practicing safer sex, not sharing needles, and getting routine vaccinations are examples of effective preventive measures.
  • Cancer: Get cancer screening on the schedule recommended by your doctors. For example, colonoscopy can detect and remove polyps that could later become cancerous.
  • Allergies: By avoiding triggers of asthma, eczema, or allergic reactions you can reduce the burden of inflammation in your body.

Do you need tests to detect inflammation?

While testing for inflammation is not routinely recommended, it can be helpful in some situations. For example, tests for inflammation can help to diagnose certain conditions (such as temporal arteritis) or monitor how well treatment is controlling an inflammatory condition (such as Crohn’s disease or rheumatoid arthritis).

However, there are no perfect tests for inflammation. And the best way to know if inflammation is present is to have routine medical care. Seeing a primary care physician, reviewing your medical history and any symptoms you have, having a physical examination, and having some basic medical tests are reasonable starting points. Such routine care does not typically include tests for inflammation.

How is inflammation treated?

At first glance, treating unhealthy, chronic inflammation may seem simple: you take anti-inflammatory medications, right? Actually, there’s much more to it than that.

Anti-inflammatory medicines can be helpful to treat an inflammatory condition. And we have numerous FDA-approved options that are widely available — many in inexpensive generic versions. What’s more, these medicines have been around for decades.

• Corticosteroids, such as prednisone, are the gold standard. These powerful anti-inflammatory medicines can be lifesaving in a variety of conditions, ranging from asthma to allergic reactions.
• Other anti-inflammatory medicines can also be quite effective for inflammatory conditions. Ibuprofen, naproxen, and aspirin — which may already be in your medicine cabinet — are among the 20 or so nonsteroidal anti-inflammatory drugs (NSAIDs) that come as pills, tablets, liquids taken by mouth, products applied to skin, injections, and even suppositories.

Yet relying on anti-inflammatory medicines alone for chronic inflammation is often not the best choice. That’s because these medicines may need to be taken for long periods of time and often cause unacceptable side effects. It’s far better to seek and treat the cause of inflammation. Taking this approach may cure or contain many types of chronic inflammation. It may also eliminate the need for other anti-inflammatory treatments.

For example, chronic liver inflammation due to hepatitis C infection can lead to liver scarring, cirrhosis, and eventually liver failure. Medicines to reduce inflammation do not solve the problem, aren’t particularly effective, and may cause intolerable side effects. However, treatments available now can cure most cases of chronic hepatitis C. Once completed, there is no need for anti-inflammatory treatment.

Similarly, among people with rheumatoid arthritis, anti-inflammatory medicines such as ibuprofen or steroids may be a short-term approach that helps ease symptoms, yet joint damage may progress unabated. Controlling the underlying condition with medicines like methotrexate or etanercept can protect the joints and eliminate the need for other anti-inflammatory drugs.

The bottom line

Even though we know that chronic inflammation is closely linked to a number of chronic diseases, quashing inflammation isn’t the only approach, or the best one, in all cases.

Fortunately, you can take measures to fight or even prevent unhealthy inflammation. Living an “anti-inflammatory life” isn’t always easy. But if you can do it, there’s an added bonus: measures considered to be anti-inflammatory are generally good for your health, with benefits that reach well beyond reducing inflammation.

About the Author

Robert H. Shmerling, MD, Senior Faculty Editor, Harvard Health Publishing; Editorial Advisory Board Member, Harvard Health Publishing

Dr. Robert H. Shmerling is the former clinical chief of the division of rheumatology at Beth Israel Deaconess Medical Center (BIDMC), and is a current member of the corresponding faculty in medicine at Harvard Medical School. … See Full Bio View all posts by Robert H. Shmerling, MD

News flash: What we eat can play a pivotal role in warding off — or treating — disease and enhancing quality of life. You may already believe this, and certainly mounting evidence supports that idea. But on the cluttered shelf of diets claiming top health benefits, which one ranks as the absolute best?

That’s a trick question. In fact, there is no single best diet. A good diet for me may be different from what’s best for you. And for either of us, there may be several good choices with no clear winner.

How can you choose the right diet for you?

When thinking about what diet might be best for you, ask yourself:

• What goals are most important? A goal might be weight loss, improved health, avoiding disease, or something else.
• How do you define “best”? For some people, best means the diet with the highest number of health benefits. For others, it may focus on one specific health benefit, such as lowering cholesterol. Still other people may prefer a diet that delivers the greatest benefit for the lowest cost. Or a diet that is healthy and also easy to stick with.
• What health problems do you have? One diet may have an advantage over another depending on whether you have cancer, cardiovascular disease, diabetes, or none of these.
• Which foods do you like best? Your tastes, culture, and location may shape your dietary preferences, and powerfully affect how likely you are to stick with a specific diet.

Which diets are high in health benefits?

Two very well studied diets demonstrate clear benefit, including lowering risk for heart disease and stroke and reducing high blood pressure: the Mediterranean diet and the DASH diet.

But the portfolio diet may be as good as or better than these plans, at least for combatting cardiovascular disease that contributes to clogged blood vessels, heart attacks, and stroke. What? You’ve never heard of the portfolio diet? You’re not alone.

What is the portfolio diet?

Just as a financial advisor may recommend having a diverse investment portfolio — not just stocks, not just bonds — the portfolio diet follows suit. This largely plant-based diet focuses on diverse foods and food groups proven to lower harmful blood lipids, including LDL (so-called bad cholesterol) and triglycerides.

If you choose to follow this eating pattern, you simply need to learn which foods have a healthy effect on blood lipids and choose them in place of other foods. For some people, this only requires small tweaks to embrace certain foods while downplaying other choices. Or it may call for a bigger upheaval of longtime eating patterns.

Which foods are encouraged in the portfolio diet?

Below are the basics. Eating more of these foods regularly may help lower levels of harmful blood lipids:

• plant-based proteins such as soy, beans, tofu, peas, nuts, and seeds
• high-fiber foods such as oats, barley, berries, apples, and citrus fruit; other examples include bran, berries, okra, and eggplant
• phytosterols, which are a natural compound in plant-based foods such as whole grains, fruits, vegetables, and nuts (other sources are foods fortified with phytosterols or dietary supplements)
• plant-based oils high in monounsaturated fat such as olive oil, avocado oil, safflower oil, and peanut oil.

See? Some of your favorite foods make the cut. That’s a major strength of this approach: the list of recommended foods is long. So, it’s likely that you’re already eating and enjoying some of the recommended foods.

Which foods are not part of the portfolio diet?

It’s worth highlighting foods that are not on this list, such as

• red meat
• highly processed foods
• refined grains and added sugar, which may contribute to chronic inflammation
• butter, cream, and other dairy products high in saturated fat and cholesterol.

What can the portfolio diet do for you?

Researchers have shown that the portfolio diet can improve blood lipids. But can it also lower the risk of heart attack, stroke, and other cardiovascular problems?

Yes, according to a 2023 study published in Circulation. More than nearly 17,000 people kept careful food diaries for 30 years. Those who most closely followed the portfolio diet, compared with those who followed it the least, were more likely to have favorable lipids and inflammation. They were also 14% less likely to have a heart attack, and 14% less likely to have a stroke.

This was true even after accounting for factors that could affect cardiovascular disease risk, such as taking cholesterol-lowering medications, exercise, smoking, or having diabetes or a family history of cardiovascular disease.

Because this was an observational study, it can’t conclusively prove that the portfolio diet, rather than another factor, was responsible for the observed cardiovascular benefits. And we don’t know how much benefit came from reducing or eliminating certain types of foods, rather than from the specific foods eaten.

Does the portfolio diet help people lose weight or deliver other health advantages?

What about the portfolio diet for weight loss? Although some people lose weight on the portfolio diet, it’s not billed as a weight-loss diet. Understanding its potential benefit for other conditions such as obesity, cognitive decline, diabetes, and cancer awaits further research.

Go beyond diet to boost health

Of course, diet is not the only way to improve cardiovascular health and your overall health. You’ll stay healthier by

• not smoking
• getting regular exercise
• maintaining a healthy blood pressure and weight
• preventing diabetes when possible, or getting good medical care to treat it if necessary
• taking prescribed medications such as cholesterol-lowering drugs.

The bottom line

It’s probably best to move past the idea of there being a single best diet. The overall pattern of your diet and your portion sizes are probably more important. For most people, it’s also a good idea to move away from restrictive diets that are nearly impossible to stick with and toward healthier overall eating patterns. The portfolio diet checks both those boxes.

There’s a lot of overlap between the portfolio diet and other healthy diets. So, no one should be suggesting it’s the best diet ever. But if you’re trying to eat healthier, it’s a great place to start.

About the Author

Robert H. Shmerling, MD, Senior Faculty Editor, Harvard Health Publishing; Editorial Advisory Board Member, Harvard Health Publishing

Dr. Robert H. Shmerling is the former clinical chief of the division of rheumatology at Beth Israel Deaconess Medical Center (BIDMC), and is a current member of the corresponding faculty in medicine at Harvard Medical School. … See Full Bio View all posts by Robert H. Shmerling, MD

As wildfires become more frequent due to climate change and drier conditions, more of us and more of our communities are at risk for harm. Here is information to help you prepare and protect yourself and your family.

How does wildfire smoke affect air quality?

Wildfire smoke contributes greatly to poor air quality. Just like fossil fuel pollution from burning coal, oil, and gas, wildfires create hazardous gases and tiny particles of varying sizes (known as particulate matter, or PM10, PM2.5, PM0.1) that are harmful to breathe. Wildfire smoke also contains other toxins that come from burning buildings and chemical storage.

The smoke can travel to distant regions, carried by weather patterns and jet streams.

How does wildfire smoke affect our health?

The small particles in wildfire smoke are the most worrisome to our health. When we breathe them in, these particles can travel deep into the lungs and sometimes into the bloodstream.

The health effects of wildfire smoke include eye irritation, coughing, wheezing, and difficulty breathing. The smoke may also increase risk for respiratory infections like COVID-19. Other possible serious health effects include heart failure, heart attacks, and strokes.

Who needs to be especially careful?

Those most at risk from wildfire smoke include children, older adults, outdoor workers, and anyone who is pregnant or who has heart or lung conditions.

If you have a chronic health condition, talk to your doctor about how the smoke might affect you. Find out what symptoms should prompt medical attention or adjustment of your medications. This is especially important if you have lung problems or heart problems.

What can you do to prepare for wildfire emergencies?

If you live in an area threatened by wildfires, or where heat and dry conditions make them more likely to occur:

• Create an evacuation plan for your family before a wildfire occurs.
• Make sure that you have several days on hand of medications, water, and food that doesn't need to be cooked. This will help if you need to leave suddenly due to a wildfire or another natural disaster.
• Regularly check this fire and smoke map, which shows current wildfire conditions and has links to state advisories.
• Follow alerts from local officials if you are in the region of an active fire.

What steps can you take to lower health risks during poor air quality days?

These six tips can help you stay healthy during wildfire smoke advisories and at other times when air quality is poor:

• Stay aware of air quality. AirNow.gov shares real-time air quality risk category for your area accompanied by activity guidance. When recommended, stay indoors, close doors, windows, and any outdoor air intake vents.
• Consider buying an air purifier. This is also important even when there are no regional wildfires if you live in a building that is in poor condition. See my prior post for tips about pollution and air purifiers. The EPA recommends avoiding air cleaners that generate ozone, which is also a pollutant.
• Understand your HVAC system if you have one. The quality and cleanliness of your filters counts, so choose high-efficiency filters if possible, and replace these as needed. It's also important to know if your system has outdoor air intake vents.
• Avoid creating indoor pollution. That means no smoking, no vacuuming, and no burning of products like candles or incense. Avoid frying foods or using gas stoves, especially if your stove is not well ventilated.
• Make a "clean room." Choose a room with fewer doors and windows. Run an air purifier that is the appropriate size for this room, especially if you are not using central AC to keep cool.
• Minimize outdoor time and wear a mask outside. Again, ensuring that you have several days of medications and food that doesn't need to be cooked will help. If you must go outdoors, minimize time and level of activity. A well-fitted N95 or KN95 mask or P100 respirator can help keep you from breathing in small particles floating in smoky air (note: automatic PDF download).

About the Author

Wynne Armand, MD, Contributor

Dr. Wynne Armand is a physician at Massachusetts General Hospital (MGH), where she provides primary care; an assistant professor in medicine at Harvard Medical School; and associate director of the MGH Center for the Environment and … See Full Bio View all posts by Wynne Armand, MD