Study Hints At Mediterranean Diet Slowing Prostate Cancer Progression
Mya Nelson
Mya R. Nelson is a science writer for American Institute for Cancer Research.
For many men diagnosed with prostate cancer, the tumors are slow growing and they may be advised to delay treatment, monitoring their cancer closely. This active surveillance strategy is one option for localized and non-aggressive tumors.
How diet affects the growth of prostate cancer is an active area of research. Some studies have suggested a healthy diet may curb cancer growth but there is no conclusive evidence so far. A study now adds to this research, hinting that the plant-based Mediterranean-style way of eating may slow prostate tumor progression among men on active surveillance.
The study was published in Cancer.
Few of the findings reached scientific significance meaning the finding may be due to chance but the association between a Mediterranean-style diet and slower tumor growth was consistent across a range of groups. The findings need verification, as the paper notes.
Study Design And Population
The AS protocol, designed to safely monitor men for disease progression and evaluate clinical risk stratification, was conducted by a multidisciplinary team of urologic surgeons, radiation oncologists and medical oncologists at MD Anderson Cancer Center . This observational study of patients on AS is registered on clinical.trials.gov , was approved by the Institutional Review Board and required all patients to provide informed consent. Protocol criteria including surveillance frequency and details regarding disease diagnostic upstaging are available elsewhere., A total of 560 MDACC patients who were diagnosed with Gleason score 6 or 7 localised prostate cancer were enroled into this prospective clinical cohort between February 2006 and February 2012. Among these, 501 provided a baseline food frequency questionnaire . Following exclusion of patients with extreme total energy intake , 411 of the remaining patients stayed on AS for at least 6 consecutive months and were included in the final analysis. A subset of these patients completed another FFQ at the first 6-month clinical follow-up.
Can Diet Help Fight Prostate Cancer
Can adopting a healthier diet help fight prostate cancer? That’s a question men newly diagnosed with prostate cancer often ask their doctors.
Several studies have shown that in countries where men eat a typical “Western” diet containing a large amount of meat, the incidence of prostate cancer, especially aggressive prostate cancer, is higher than in countries where plant-based foods are a primary part of the diet. Unfortunately, these studies weren’t designed to prove cause and effect. So for now, definitive answers about prostate cancer and diet aren’t yet in although researchers are actively studying this topic.
Investigators launched a federally funded national study to see whether a diet that’s higher in plant-based foods and lower in animal-based foods than the typical Western diet would help control tumor growth in men with early-stage prostate cancer.
The Men’s Eating and Living study included men 50-80 years old who had small, low-grade tumors and who opted to have their condition followed closely rather than undergoing immediate treatment. The researchers randomly assigned participants to telephone counseling about how to achieve the dietary MEAL goals or to a control group that received standard dietary advice for Americans.
Here’s what the MEAL eating plan looks like:
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More Research Is Needed
It is possible that the findings did not reach significance due to the relatively low number of tumor progression in these men with mostly low risk disease, the paper concludes. Future research is needed to see if the same effects are seen for larger and more diverse patient groups and men with higher-risk prostate cancer.
AICR research found that staying a healthy weight lowers risk of advanced prostate cancer, which is when the tumor has spread to other parts of the body. Eating a healthy diet, high in vegetables and many foods featured in the Mediterranean diet, can play an important role in weight management.
The study was supported by the Department of Defense Prostate Cancer Research Program, the National Cancer Institute and the Cancer Prevention & Research Institute of Texas.
AICR Impact
The American Institute for Cancer Research helps the public understand the relationship between lifestyle, nutrition and cancer risk. We work to prevent cancer through innovative research, community programs and impactful public health initiatives.
What Does Active Surveillance Mean
A patient with localized prostate cancer can opt for active surveillance. But, cancer must be slow-raising, confined, and low-grade.
Active surveillance is a monitoring routine where a physician will closely assess the disease until additional or definitive treatment becomes necessary to halt cancer at a curable stage.
Active surveillance is only suitable for low-volume tumors with a 3+3 Gleason score or a 3+4 Gleason score tumor with a tiny percentage of grade 4 of a prostate cancer grade.
Gleason 3+3 is the lowest grade cancer in the typical Gleason scoring system, while doctors consider Gleason 6 a malignancy.
In other words, the best candidates are those with confined prostate cancer or a small tumor that might grow relatively slowly.
That means a patient has developed low-risk prostate cancer. This prostate cancer is unlikely to impair them during their lifetime.
However, active surveillance has nothing to do with watchful waiting. Watchful waiting is typically suitable for older patients with a decreased life expectancy.
During watchful waiting, the urology expert will not do a series of tests, like a biopsy, since there isnt a curative goal.
Therefore, the treatment that patients do receive is tailored towards symptomatic progression.
Compared to active surveillance, prostate cancer patients procure a schedule of tests, like a biopsy and a PSA test .
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Mediterranean Diet May Slow Pca Progression
For newly diagnosed prostate cancer patients who go on Active Surveillance , there is no rush. This is a good thing, because the main goal of AS is to hold off on the need for treatment as long as possible. And, during monitoring, what triggers the need for intervention? Evidence that the cancer is progressing to a higher Gleason grade. A new study finds that prostate cancer patients on Active Surveillance may slow progression through consistently high adherence to the Mediterranean diet.
It is well established that nutrition plays a key role in either promoting or preventing inflammation, a known precursor for prostate and other cancers. If you knew there was an all-natural method for discouraging inflammation from occurring in your body, would you embrace it and commit to following itwith the understanding that the results will be slow and steady? In fact, this all-natural way is as close as your grocery story, refrigerator and pantry. Its called the Mediterranean diet , and its anti-inflammatory components have been repeatedly shown to reduce prostate cancer risk. Is it a quick fix? No. Does it work over time? Well, compared with the hare in Aesops well-known race fable, the MedDi is definitely a tortoise, but well worth the wait to eventually come out ahead.
Study Looks At Effect Of Diet On Prostate Cancer Progression
Recent studies suggest that nutrients found primarily in vegetables and fruits can help lower the risk of prostate cancer and possibly slow its development, and those diets higher in these foods and lower in fat and meat may provide some protective benefit against the disease or its progression.
“The Men’s Eating and Living Study: A Randomized Trial of Diet to Alter Disease” is assessing whether a diet-based intervention to increase vegetable and fruit consumption can slow disease progression, and improve the quality of life for men with low-grade prostate cancer who are under active surveillance. Men are typically offered the option to undergo active surveillance if they meet very specific criteria, including the presence of a small low-grade tumor in their prostate. If there is a larger tumor in the prostate and/or the disease is of higher grade, then these men will likely be offered active treatment with surgery or radiation.
The active surveillance approach involves careful and close monitoring, and can postpone the side effects of active treatment, or even avoid those undesirable side effects. That is achieved by regular prostate exams and blood tests, and periodic biopsies.
With this approach, active treatment is not begun until the disease shows signs of growth or progression, and still allows the doctors and their teams to treat the disease while it is still in an early curative state.
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Foods To Eat And Avoid
If you would like to replicate the plant-based MEAL diet on your own, foods to eat include:
- Two servings daily of tomatoes and tomato products. Tomatoes are high in lycopene, an antioxidant which may have a protective effect on prostate health.
- Two servings daily of cruciferous vegetables. Vegetables in this group include broccoli, bok choy, Brussel sprouts, horseradish, cauliflower, kale, and turnips. These vegetables are high in isothiocyanates, which may help protect against cancer.
- At least one serving daily of vegetables and fruits high in carotenoids. Carotenoids are a family of antioxidants found in orange and dark green vegetables such as carrots, sweet potatoes, cantaloupes, winter squash, and dark green, leafy vegetables.
- One to two servings daily of whole grains. High-fiber, whole-grain foods include oatmeal, quinoa, barley, millet, buckwheat, and brown rice.
- At least one serving daily of beans or legumes. High in protein and low in fat, beans and legumes include soybeans and soybean products, lentils, peanuts, chickpeas, and carob.
Its not only what you eat, but what you dont eat that counts. The study allows for only one serving a day of any of the following:
- 2 to 3 ounces of red meat
- 2 ounces of processed meat
- other sources of saturated animal fat, such as 1 tablespoon butter, 1 cup whole milk, or 2 egg yolks
Its important to note that
Icipants In Both Study Groups Will Complete The Following Activities:
- Physical measurements â weight, height, and waist and hip measures will be collected 4 times during the study.
- Body Scan – a body scan will measure total body fat, lean mass and total bone density 2 times during the study.
- Exercise testâa treadmill test will be completed 2 times during the study.
- Surveysâa food diary, activity, health, and quality of life surveys will be completed up to 4 times during the study.
- Give blood â blood will be collected 4 times during the study.
- Donate biopsy tissue that is collected as part of routine clinical care for Active Surveillance.
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Assessment Of Diet Quality And Patient Characteristics
Baseline serum PSA, pathologic Gleason score, and summary tumour length were assessed at study enrolment. Measured height and weight, smoking status, and health history were drawn from the medical record. Body mass index was calculated as weight /height 2 and categorised based on the World Health Organisation criteria.
Looking For Men With Prostate Cancer On Active Surveillance
The PALS Study is a study for prostate cancer patients who have chosen Active Surveillance of their cancer. The goal is to learn whether weight loss, through diet and exercise, will improve the health of men with low-grade prostate cancer.
PALS will enroll about 200 overweight or obese men who plan to have a follow-up biopsy for prostate cancer. Men will be followed for 1 year. The 1-year start and end dates overlap with the prostate biopsy that is scheduled as routine care for Active Surveillance.
Study activities will take place at the Fred Hutch Cancer Research Center in Seattle. At the first visit, men will be randomly assigned to either the âPALS Lifestyleâ group or the âComparisonâ group.
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Mediterranean Diet May Reduce Risk For Prostate Cancer Progression
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Adhering to the basic principles of a Mediterranean diet prevented disease progression among men with localized prostate cancer on active surveillance, according to a study published in Cancer.
The Mediterranean diet consistently has been linked to lower risk of cancer, cardiovascular disease and mortality,Carrie Daniel-MacDougall, PhD, associate professor of epidemiology at The University of Texas MD Anderson Cancer Center, said in a press release. This study in men with early-stage prostate cancer gets us another step closer to providing evidence-based dietary recommendations to optimize outcomes in who, along with their families, have many questions in this area.
Prostate cancer is the second most common cancer among men in the United States, and because many cases are low risk and do not require immediate treatment, researchers seek modifiable factors for men managed by active surveillance, according to study background.
Overall, 15% of the men had diabetes and 44% used statins.
Each patient had more than 6 months of follow-up .
Gleason grade progression defined as any increase in Gleason grade after confirmatory biopsy served as the studys primary outcome.
Seventy-six men progressed during the study.
The trend persisted in an analysis of men who did not use statins .
Mediterranean Diet May Help Men With Prostate Cancer
In a study to examine a Mediterranean diet in relation to prostate cancer progression in men on active surveillance, researchers from The University of Texas MD Anderson Cancer Center found that men with localized prostate cancer who reported a baseline dietary pattern that more closely follows the key principles of a Mediterranean-style diet fared better over the course of their disease.
Men with prostate cancer are motivated to find a way to impact the advancement of their disease and improve their quality of life, said Justin Gregg, M.D., assistant professor of Urology and lead author of the study, published recently in the journal Cancer. A Mediterranean diet is non-invasive, good for overall health and, as shown by this study, has the potential to effect the progression of their cancer.
After adjusting for factors known to increase risk of cancer getting worse over time, such as age, prostate-specific antigen and tumor volume, men with a diet that contained more fruits, vegetables, legumes, cereals and fish had a reduced risk of their prostate cancer growing or advancing to a point where many would consider active treatment. The researchers also examined the effect of diabetes and statin use and found a similar risk reduction in these patient groups.
Trial participants were 82.9% Caucasian, 8.1% Black and 9% other or unknown. The median age was 64, 15% of the men were diabetic and 44% used statins.
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Hints Of Slower Tumor Growth
This study followed 410 men newly diagnosed with prostate cancer who were on active surveillance at MD Anderson Cancer Center. All study participants were evaluated every six months for cancer progression. The men answered questions about their dietary habits when they joined the study and the researchers divided the men into three groups, depending upon how much each adhered to the Mediterranean diet style of eating.
The men answered questions about their dietary habits when they joined the study and the researchers assigned points to how well each adhered to the Mediterranean style of eating. The Mediterranean diet highlights plant foods, whole grains, fish and healthy fats while minimizing red meat and sweets. This way of eating, inspired by the people and cultures who lived around the Mediterranean Sea, shares many characteristics of AICRs New American Plate.
After a median of three years follow-up, close to 20 percent 76 men had their cancer progress. Cancer progression was measured using the Gleason score, a grading system drawn from a lab test.
The study found that men who most closely followed the Mediterranean diet had a lower risk of progression among all men. For every one-point increase in the Mediterranean diet score, researchers observed greater than a 10 percent lower risk of progression. Again, these findings could be due to chance.
Eligibility And Exclusion Criteria
Eligible patients are 50 to 80 years of age with biopsy-proven adenocarcinoma of the prostate who were diagnosed within 24 months prior to presentation, had 10 biopsy tissue cores procured at the time of the diagnostic biopsy, had < 25% of biopsy tissue cores positive for cancer, had 50% of any single biopsy tissue core positive for cancer and chose to pursue active surveillance. Biopsy eligibility criteria also include biopsy Gleason sum 6 for men 70 years and biopsy Gleason sum = 7 for men > 70 years. These inclusion criteria are typical for allowing patients with localized prostate cancer to safely pursue active surveillance and represent the current standard of care in the community.- Centralized pathology review is conducted on the prostate biopsy tissue cores by a single pathologist to confirm eligibility.
Other eligibility criteria are clinical stage T2a, serum PSA < 10 ng/mL, life expectancy at least 3 years, and the ability to read and comprehend English language text and to understand spoken English over the telephone.
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What Does The Research Say
The impact of diet on prostate cancer is actively being researched. Several studies indicate that a plant-based eating plan may be the best choice for men with prostate cancer.
Red meat, processed meats, and foods high in fat appear to be bad for those with prostate cancer.
Plant-based foods, such as soy, fruits, and vegetables, could have the opposite effect. Consuming these types of foods may help slow down the growth of prostate cancer in men who have it.
A federally funded Mens Eating and Living study looked at how a diet high in plant-based foods might slow down the progression of prostate cancer.
In phase III of the clinical trial, 478 participants with prostate cancer ate seven or more servings of vegetables, with an emphasis on lycopenes and carotenoids e.g. tomatoes and carrots every day.
About half the group received dietary coaching over the phone, while the other half, a control group, followed dietary advice from the Prostate Cancer Foundation.
While both groups had similar progression of their cancer after two years, researchers are optimistic that large-scale dietary changes in people with prostate cancer are possible. More studies are needed for longer-term effects on plant-based diets.