Conversations With Prostate Cancer Experts

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Supplements + Prostate Cancer Patients

Dr. Stephen Freedland is a urologist at Cedars-Sinai in Los Angeles, California, and the Director of the Center for Integrated Research in Cancer and Lifestyle, Co-Director of the Cancer Genetics and Prevention Program and Associate Director for Faculty Development at the Samuel Oschin Comprehensive Cancer Institute.

Dr. Freedland treats the whole patient and not just a man’s prostate cancer.

Prostatepedia spoke with him about diet and prostate cancer.

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Are there any supplements that prevent or delay prostate cancer progression? Or supplements prostate cancer patients should avoid?

Dr. Freedland: All of them. There are no data to show that your general multivitamin supplement does anything beneficial in terms of prostate cancer. No data. Period.

If you look at general multivitamins, the data suggest that they have no effect on prostate cancer risk.

In fact, some studies show that, particularly if you take more than one multivitamin per day, this will increase the risk of aggressive prostate cancer.

Why would it increase the risk?

Dr. Stephen Freedland: Your tumor cells grow faster than normal cells. They need the same vitamins to survive that your regular cells do. Once you provide for your body’s needs, anything else is just going to help the tumor. If you take too high of a dose of some of these vitamins, say antioxidants, they become pro-oxidant.

The vitamins we take are either water-soluble, which means they come out in urine—some say Americans have the most expensive pee in the world!—or they’re fatsoluble, which means you don’t absorb them unless you eat fat.

Vitamins D and E are fat-soluble. Vitamin D is quite beneficial, but you need to consume fat to absorb it. Skimmed milk that’s fortified with Vitamin D won’t help you absorb any of it.

Would you be better off drinking whole milk?

Dr. Freedland: If you drink whole milk with Vitamin D, then you are actually going to absorb the Vitamin D.

Why do so many cancer patients flock to supplements if they’re not beneficial?

Dr. Freedland: Patients want an easy answer and supplements seem to provide one. When the question is how to beat cancer, simple answers are typically not the right answers.

Treating cancer needs a wholesale lifestyle change: lose weight and exercise. While it’s underexplored, stress management is likely very important for cancer too. Low stress helps boost the immune system because you’re in the right state of mind. Social support is also beneficial. There are actually data showing that, for cancer patients, being married is as effective in fighting cancer as getting chemotherapy.

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Exercise Programs For Prostate Cancer

Professor Rob Newton is the Associate Dean of Medical and Exercise Sciences and the Co-Director of the Exercise Medicine Research Institute, School of Medical and Health Sciences at Edith Cowan University in Perth, Australia.

Prostatepedia spoke to Dr. Newton about his exercise recommendations for men with prostate cancer.

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What specific exercise plans do you recommend for prostate cancer patients?

Dr. Newton: At the moment, we have a very generic recommendation from the American Cancer Society: complete 75 to 150 minutes per week of moderate to vigorous aerobic exercise and two or more resistance training sessions per week. That’s the same recommendation that the American College of Sports Medicine gives for any healthy adult, whether he or she has cancer or not. That recommendation needs to be more tailored to the stage of prostate cancer and the treatments the patient is undergoing.

I’m writing a letter to the Journal of Clinical Oncology in response to a paper by a group in Perth that they published in the last edition. The paper recommends that the way forward with the management of cancer will be home-based exercise programs prescribed by physicians, and most likely, walking programs. This is a tragic step backward in terms of the management of cancer with exercise medicine. It’s ineffective.

Compliance in home-based programs is woeful. It’s the wrong medicine. Depending on the problem the patient is experiencing, walking may be the wrong medicine. It’s like giving antibiotics as contraception. This is not the direction in which oncology should go.

For men on active surveillance, we have two principal targets. First, we try to reduce the risk of other chronic diseases. At this stage, the prostate cancer is not progressing that fast, so chances are the patients are going to die of something else.

If they’re overweight, obese, or their blood glucose is out of control, for example, metabolic syndrome will kill them long before their prostate cancer will. You’ve got to say, “Why are you worried about your prostate cancer? You won’t live long enough to get it.” If a man is overweight, physically inactive, or has a poor diet, then the focus should be on controlling that, not on the prostate cancer.

The other target for patients on active surveillance is to stimulate the mechanisms that might inhibit the tumor from developing further. We’re starting to get a good understanding of this. The key is to maintain or increase the amount of muscle in the patient’s body.

Muscle produces strong antitumor drugs. It’s natural, internal medicine, but it produces a range of substances that have an antitumor effect. We need to increase the size of the muscle and then activate that muscle regularly to get it to dispense these chemicals.

We’re unsure at the moment of what specific types of exercise drive the greatest quantity and which specific endogenous medicine will suppress tumor growth. At this stage, that’s why we recommend a combination of resistance exercise and aerobic exercise. That should help to slow the tumor progression.

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Diet + Prostate Cancer: What Do We Know?

Dr. Lorelei Mucci specializes in prostate cancer epidemiology and her research focuses on cancer risk and mortality in populations across the globe.

Prostatepedia spoke with her about epidemiology’s take on the link between diet, lifestyle, and prostate cancer.

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What do we know about diet’s impact on prostate cancer?

Dr. Mucci: Epidemiology studies of diet, lifestyle, and prostate cancer have really evolved a lot over time because of PSA screening and our understanding of the disease’s biologic heterogeneity. With PSA screening, we are both diagnosing more men with prostate cancer and diagnosing more men with a more slow-growing form of prostate cancer.

What we’ve learned is that the relationship between the majority of dietary and lifestyle factors seems to be more associated with the risk of aggressive prostate cancer. We’re starting to see that certain factors are associated with either worse or better survival. It has taken us a while as a field to realize that the relationship of risk factors varies for aggressive versus nonaggressive cancer.

It has also taken us a while to understand the role that PSA screening has played in our studies.

The other consideration with prostate cancer is that it could be many years, if not decades, after diagnosis before a man experiences metastatic disease. Thus, we need long-term follow-up studies to understand the impact of lifestyle factors.

In terms of diet, I don’t think there is yet strong evidence for any particular lifestyle factor to say it is causal. There are some probable factors and some new factors we’re starting to think about.

There is good data on the role of an antioxidant known as lycopene. Lycopene is commonly found in high levels in cooked tomato products such as tomato sauce, but also in things like salsa. What is interesting about lycopene is that it accumulates at high levels in the prostate. A number of epidemiology studies have shown lycopene to be associated with a much lower risk of aggressive prostate cancer. There was a small, randomized study in which men were given capsules of cooked tomato products. The study showed lycopene could make changes in the prostate tumor tissue. So there is probable evidence for cooked tomato products and lycopene in prostate cancer prevention.

We are also starting to see evidence emerge around regular consumption of coffee, either decaffeinated or caffeinated. Coffee is one of the strongest antioxidants available, even stronger than berries. Coffee is interesting for a number of cancers. It seems to be associated with a lower risk of liver cancer, potentially colorectal cancer, and diabetes. In randomized studies, we also see that coffee helps regulate insulin levels after a meal. Insulin may be very important for advanced prostate cancer.

Again, I wouldn’t say this evidence is convincing yet, but we’re starting to see many studies suggesting the benefit of regular coffee consumption.

There is also emerging evidence about fish consumption. In particular, fatty fish like tuna or salmon are associated with a lower risk of aggressive prostate cancer.

On the other side, there is now data suggesting high calcium intake at the levels you’d get more from many supplements may be associated with an increased risk of a more aggressive form of prostate cancer.

Finally, the association between obesity and aggressive prostate cancer is strong. Any dietary factors, or dietary patterns, that contribute to obesity may be associated with more aggressive prostate cancer and with worse outcomes for patients.

Join us to read the remainder of Dr. Mucci’s comments on diet and prostate cancer.

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Carbohydrates + Prostate Cancer

Dr. Stephen Freedland is a urologist at Cedars-Sinai in Los Angeles, California, and the Director of the Center for Integrated Research in Cancer and Lifestyle, Co-Director of the Cancer Genetics and Prevention Program and Associate Director for Faculty Development at the Samuel Oschin Comprehensive Cancer Institute.

Dr. Freedland treats the whole patient and not just a man’s prostate cancer.

Prostatepedia spoke with him about diet and prostate cancer.

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What do you tell your patients about prostate cancer and diet?

Dr. Freedland: Given the link between obesity and prostate cancer, I focus on getting my patients to lose weight. The easiest way to lose weight is to cut out all the extra sugar in your diet: cookies, cake, candy, all of that. A meta-analysis published in the Journal of the American Medical Association of all the popular diets found that the best diet for weight loss was a low-carb diet. That was the best diet. They’re all decent, but low carb is the best.

Is that true primarily for American patients or for everyone?

Dr. Freedland: I think it’s true for everyone. A recent study published in the Lancet followed over 135,000 people in 18 different countries on over five continents. They found that the more carbs you eat, the more likely you are to die earlier. Eat fewer carbs, live longer. Fewer carbs and more fat make you live longer.

This is a landmark study that supports what an increasingly loud minority of us has been saying. Fat is not the problem. Carbs are the problem.

I focus my patients on their carb intake. Let’s focus on the carbohydrates in the diet and see which of those we can get rid of. If you’re having whole-grain oatmeal for breakfast, maybe that can stay. But most people are having pancakes with butter and syrup. We can get rid of that.

While you’re giving up the sugars, cakes, and candies, we focus on what we can put in their place: fruits and vegetables.

Yes, fruits have sugar, but it’s a natural source. As long as patients aren’t juicing, natural fruits contain a lot of fiber that will slow the absorption of sugar in the intestine. Nuts, beans, and those types of things are also good replacements.

I worry that because we’ve been advocating that people cut out fat and tell them to eat lots of fruits and vegetables, people are going to go to the store, buy fat-free ice cream and say, “I had a salad with my dinner so I can eat all the ice cream I want now. I’m being healthy!”

Remember the old food pyramid from the 1980s? Carbs were at the bottom of the pyramid, the largest food group.

Dr. Freedland: Right. Lots of bread. Our entire way of thinking has been very carb-centric. Let’s eat carbs and avoid fat. And the result has been that the obesity rates have almost tripled in the United States in the last 30 years.

What do you say to people who argue that you should have carbs in balance with fat and protein?

Dr. Freedland: Your body doesn’t need carbs. There are animals and people raised without eating a single carb. You can’t survive without eating fat. You can’t survive without eating protein. You can survive without eating carbs.

What protein sources do you recommend?

Dr. Freedland: People get in this mindset that red meat is bad and fish is good. Fish (we think) is good because it contains fish oil, an omega-3 fatty acid. But I found an article that looked at tilapia. It turns out that tilapia doesn’t have much fish oil. If you want fish oil, you know what are better sources than tilapia? Doughnuts and bacon.


Dr. Freedland: Doughnuts and bacon have more fish oil than tilapia per gram.

I guess not all fish are created equal.

Dr. Freedland: Correct. And not all meat is created equal. A nice grass-fed steak probably has as much omega-3 fatty acid as many kinds of fish. The worst protein for prostate cancer is charred meat. Those black lines you get on your steak in charring form heterocyclic amines that can cause cancer. This is true mostly for meat because that’s what you tend to char, but it’s also true for chicken and potentially fish.

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Dr. Mark Moyad: Diet, Lifestyle + Prostate Cancer

Moyad Headshot-2Dr. Mark A. Moyad, the Jenkins/Pokempner Director of Complementary and Alternative Medicine in the Department of Urology at the University of Michigan Medical Center, has published over 150 medical journal articles and 12 books, including The Supplement Handbook: A Trusted Expert’s Guide to What Works & What’s Worthless For More Than 100 Conditions.

Dr. Moyad frames this month’s conversations on diet and lifestyle for prostate cancer.

Join us to read the entire issue.

First, I’d like to say that I find it incredibly wonderful that we’re now talking about diet and exercise for prostate cancer. In the old days, it was unusual to even talk about it, but now you stick out if your institution doesn’t cover diet and exercise. What a wonderful and diverse collection of experts in this issue—such a pleasure to read and learn from some of the best in this field now and in the future.

I always say that heart-healthy is prostate-healthy. Heart-healthy is all healthy. Reducing your cardiac risk as close to zero as possible is the smartest thing you can do as a prostate patient. That’s the top of the pyramid when it comes to diet and exercise for prostate cancer. Maintaining a health weight is the first step in becoming heart-healthy.

Every few years, we realize that more and more cancers are associated with obesity. Now we know that obesity is associated with up to at least 13 types of cancer, not to mention the ongoing, ravaging obesity epidemic.

That said, I don’t believe that we have neither the power nor the right to tell people what diet to follow. It doesn’t matter if you want to go vegan, high fat, or low carb: there’s nothing more important than maintaining a healthy weight and having the heart-healthy numbers to support that healthy weight loss.

The new elephant in the room is alcohol. Alcohol often becomes self-medication in elderly people, but it is one of the largest sabotages to a heart-healthy and prostate-healthy lifestyle.

First, the caloric content of alcohol is high: seven calories per gram. Second, the data clearly show a relationship between excessive insulin production and excessive alcohol exposure. This makes it so easy to gain weight when you drink alcohol. Some of the greatest weight loss I’ve seen in the past 12-months has come when a patient eliminates alcohol. There is also a correlation between alcohol and potentially aggressive prostate cancer. So alcohol makes you gain weight, encourages prostate tumor growth, encourages cardiac risk, and encourages risk of other cancers.

Exercise is important, but we have to be careful as we age. We become very delicate machines. That’s why I agree with Dr. Rob Newton that finding an exercise physiologist is a great idea. We have to be smart about exercise: if you don’t preserve yourself, you won’t be able to stay active and get the benefits of exercise for your prostate cancer.

I’ll also add that the biggest benefit to exercise is a mental health benefit. I love the cardio/metabolic effects of exercise in men on hormonal therapy, but I don’t give a damn if exercise ends up being physically beneficial to cancer patients. What excites me is the impact on the quality of life of a man. Patients are completely different on hormonal therapy when they are regular exercisers. Mentally, they’re still in the game. They’re beautiful to be around.

Socialized exercise also gives you a boost. When you work out in your basement, you’re not getting all the benefits of exercise. When you have a trainer, go to a gym, or work out with support group members, you get an added mental health boost. You can become isolated in exercise.

Finally, I’d like to add that we lose credibility if we don’t follow probability with supplements. The results from the VITAL trial, which looks at vitamin D and cancer in about 26,000 people, will be published next year. I’m going to wait for those results before I recommend higher vitamin D intakes to patients.

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Diet + Lifestyle

In December, Prostatepedia is talking about diet, lifestyle, and prostate cancer.

Dr. Charles E. Myers, Jr. talks about the conversations we’re featuring this month.

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Well-designed randomized controlled clinical trials are the best tool we have for determining these optimal treatment for diseases. Unfortunately, we don’t yet have trials like for the impact of diet and exercise on prostate cancer, but we do have them for exercise and diet’s impact on general health and cardiovascular disease.

In the famous PREDIMED trial, 7,447 subjects who were at high risk for cardiovascular disease but who did not have it were randomized into three groups. One group went on a low fat diet. The other two groups went on a Mediterranean diet: one with olive oil and one with nuts. The trial was supposed to run for 6 years, but stopped at 4.8 years because the two Mediterranean diet groups already showed such a significant reduction in myocardial infarction, stroke, and cardiovascular death.

The Mediterranean diet also reduced the risk of peripheral artery disease, atrial fibrillation, and invasive breast cancer. There was no information about prostate cancer incidence in any of the three groups.

This month, Rob Newton discusses his Movember-funded GAP4 trial testing exercise’s impact on progression-free survival in advanced prostate cancer patients. This randomized controlled trial looks at 890 patients. This trial is exciting: it breaks important new ground in adequately testing lifestyle changes’ impact on key endpoints in prostate cancer treatment. Randomized controlled trial design requires an assessment of the likely impact of the experimental treatment on the outcome of the trial. If the likely benefit is 10%, many more subjects are required than if the benefit is 50%.

This month, Drs. David Levy and Stephen Freedland outline trials that are so designed that they might allow for subsequent randomized trials. Note that the nonprofit Movember financially supports the GAP4 trial. Currently, government funding for such trials is painfully inadequate. The United States was for many years a major source of funding for cancer clinical trials through the National Institute of Health (NIH). But the current political climate in the United States has become definitely anti-science. As a result, an increasing proportion of clinical trials are funded by the pharmaceutical industry as a path to FDA-approval. This has had a positive impact in that we now have a growing list of drugs approved for prostate cancer.

However, pharmaceutical companies have a responsibility to their shareholders to maximize profit. There is no reason for these firms to spend the large sums needed to test the impact of something like diet and exercise. This leaves philanthropy as the only source of support for these large randomized trials. We all need to keep this in mind.

We do now know that your general health and survival benefit from exercise, a prudent diet, maintaining a healthy weight, not smoking, and stress reduction. Existing data support the importance of diet and lifestyle changes in prostate cancer management, but we lack proof provided by high quality randomized trials.

The bottom line is that altering your diet and lifestyle can definitely improve your general health, but may or may not help control your prostate cancer.

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Movember: Social Media + Fundraising

Dr. L. Michael Glodé, recently retired as the Robert Rifkin Chair for Prostate Cancer Research and is Professor Emeritus of Medical Oncology at the University of Colorado in Denver, and has been a pioneer in prostate cancer medical oncology. He is also the author of the popular Prost8blog.

Prostatepedia spoke with him about his approach to the Movember Foundation’s annual moustache-growing campaign.

glode_michael_webHow did you become involved with Movember?

Dr. Glode: I first found out about Movember at one of the Prostate Cancer Foundation (PCF) meetings several years ago. I met one of their leaders, Paul Villanti. Over the years, I met up with Paul at various prostate cancer meetings. Eventually, we had him come out to Colorado to talk about some of Movember’s initiatives and how we could be involved.

What has been your fundraising strategy? What has worked? What hasn’t?

Dr. Glode: The first time I noticed that prostate cancer was beginning to see some public visibility was back in the 1990s when Michael Milken began PCF. I had Komen-envy, because the breast cancer population had done so well in terms of raising visibility and money. There was just nothing like that in prostate cancer until Milken started his work. With his leadership, a lot more people became interested in medical oncology and prostate cancer.

The Movember movement struck me when I heard about it. They started about 10 years ago and were ahead of the curve. They were raising way more money from the general public than had ever been done before, and along with that, raising visibility. I eventually watched one of the TED talks that had to do with them. I thought this is definitely the organization to get behind if you want to do what women have done for breast cancer through the Komen Foundation.

I didn’t do much fundraising at the time. I started growing a mustache every November and talking to my patients about it. Then I started my own blog, which has about 600 followers by now. Facebook and social media came along after that and I reached out to my followers.

Most of the time, friends, family, and a few patients have donated, but occasionally, somebody feels motivated and donates a large sum. In one case, a patient saw my mustache, was interested, and gave a very substantial donation to Movember, which was certainly gratifying.

In the academic world, we have some ambivalence about national organizations versus local initiatives. Over the years, I’ve been the beneficiary of wonderful support from patients who’ve donated lots of money to the University of Colorado. That kind of fundraising is a part of what you do in academics.

But it’s been fun to get involved with a global movement that more closely resembled the Komen Foundation and to be able to watch the fun of growing a moustache and seeing how much money we raise globally. I was very attracted to their combination of raising awareness of prostate cancer and men’s health in a fun way.

What has been your strategy for activating people in your community?

Dr. Glode: I’m growing a moustache, and I usually print up little business cards saying “Please support my moustache,” with a link so they can make a contribution to Movember. I give them to the patients I see during the month of November.

The University of Colorado has a Movember team. We’ve reached out with an email blast to encourage people to join our fundraising team. A lot of the guys are running around the med school with moustaches on. All that works to the good.

One strategy that’s a nascent idea this year is a collaboration with the owner of this hipster barbershop here in Denver called Crisp. It’s a combined barbershop-tattoo parlor. The guys in there had a sign display for Movember a couple years ago. I met with the owner of that shop who’s a very entrepreneurial guy. We’ve been discussing ways we could join doctors and barbers, that ancient path of how barbers were the first surgeons. Everybody in his shop is covered with tattoos and piercings while my colleagues at the university are straight arrow, white coat types. We thought it would be sort of fun.

We’re going to have a combined event at the end of November to get people together and celebrate. Eventually, it would be fun to have the barbers and doctors together on the local TV station to raise awareness. We’re working some of those angles to do what we can to raise awareness.

It’s terrific to try and find ways to get men talking about something other than the miserable quarterback performance on Sunday afternoon.

This particular barbershop is a younger group of people. They have a fairly large Hispanic clientele as well. That’s going to be kind of a fun way to reach some new people with information and awareness. The fact that it’s not just about prostate cancer, but also testicular cancer, suicide prevention, and all that is also wonderful.

Movember takes very serious issues like suicide prevention and prostate cancer and raises awareness with lighthearted and fun things like growing a mustache.

Dr. Glode: Absolutely. That was the spirit in which they started things. When you read about how they all got started, it was just a couple guys in Australia deciding to grow a mustache. It wasn’t until the following year that they said, “This was a fun thing to do. Maybe we could make it into something that would be meaningful in terms of raising money.” It is very organic. It grew from a few guys in a bar to an international movement, which is remarkable.

They started by encouraging guys to take a picture of their mustaches and sharing it through social media.

Dr. Glode: I have to admit that the social media wave just passed me by when I wasn’t looking.

You have a blog. That’s social media.

Dr. Glode: That’s about as far as I got. I was very involved with helping the American Society of Clinical Oncology (ASCO) get started with their first internet presence. I thought up the ASCO online project when I was chairman of the Education Committee about 25 years ago. Back then people said, “My kid could set up a web page in his garage. Why are you asking us for money to get this started?” Now, of course, it’s grown. As with every other organization, your web presence and what you do on the internet is essentially who you are.

Right. It’s your brand presence.

Dr. Glode: I’ve got a Twitter account, but I never use it. I have a Facebook account primarily to keep up with my grandchildren’s pictures and that sort of stuff. I’m 70 this year, and I keep track of some of my high school friends through that. There are people in my high school cohort who must spend hours every day on Facebook. It’s amazing.

I guess if you’re socially or physically isolated it might be a way to connect with people.

Dr. Glode: Yes. It’s very meaningful. Its power is phenomenal.

You mentioned the association between Movember and the Prostate Cancer Foundation early on. Originally, Movember donated all the money to nonprofits in each country. As a fundraiser, are you familiar with where the money goes or how it’s spent?

Dr. Glode: I’m not so familiar how the money is spent. I do know that as an example, the Prostate Cancer Foundation (PCF) has become international. Movember and PCF have aligned goals when it comes to prostate cancer. PCF is instrumental in sponsoring and underwriting some of the best researchers in the world, getting them together at meetings every year.

Movember tends to sponsor projects and spend the money in the same country as the money was raised.

In terms of project management, one of our faculty members has a grant from Movember for TrueNTH, a Movember initiative, and I’ve been asked to be an advisor.

TrueNTH has 10 or 12 pilot projects that they’re working on to see what works and what doesn’t work in terms of using internet capabilities to reach out to people who might be more isolated. They’re looking to provide online counseling in the same way that people talk about couples counseling. They also want to ensure support group-type functions via the internet for people in more isolated communities. It’s a work-in-progress. We have to see how well these various projects pan out in terms of actually reaching the target population.

My experience has been that it’s a pretty small fraction of men who take advantage of support groups. There are usually one or two guys who are the sparkplugs who will start a support group, organize a place to get together once a month with an outside speaker. For example, in Denver there are usually about 10 to 20 men who come. They’re very interested in the latest research findings. My blog goes a long way to help them feel like they’re keeping up.

There is also some advantage in just being able to get together. I don’t think that men generally have the sense of openness that women do in talking about their experiences. That’s just a gender difference. I’m not sure that the internet, or other means of trying to break through that silence, is going to be terribly successful.

If people activate themselves and grow a mustache and talk to their families about it, that’s a great starting point.

A lot of men have first-degree relatives—their sons, their fathers, their uncles, or their brothers—with prostate cancer, but they don’t talk about it at the Thanksgiving table. Getting over that barrier is a great place to start for growing a mustache. You can say, I’m a prostate cancer survivor and prostate cancer is something I really care about. I’m supporting Movember. I encourage you to support my mustache.

It is a way of bringing the topic out into the public discourse.

Dr. Glode: And it’s fun. The fact that Movember has expanded their bucket of interest to include suicide prevention and testicular cancer makes it that much more meaningful.

While we each may only know one or two people who have committed suicide, I’m pretty sure we all know many more who have considered it or who have been depressed in a quiet way.

Dr. Glode: Yes. Men’s overall health is important. Prostate cancer may be the initial discussion, but everybody should know their blood pressure and their cholesterol. Everybody should get off the couch and do more exercise.

I have a terrible moustache myself. My beard is even worse. My experience proves that growing a moustache initiates conversation all the time. Now people are connecting that with Movember.

It gives me the chance to say you should grow your own moustache and try to raise money like me because this is a really great organization and a really great way to contribute to men’s health. I encourage you to grow your own moustache and get your friends and neighbors to support it. It’s a nice conversation starter. It really works pretty well.

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