Review article
An update of research evidence on nutrition and prostate cancer☆

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Abstract

Background

Prostate cancer (PCa) remains a leading cause of mortality in US and other countries. Preclinical and clinical studies have examined the role of nutrition and dietary intake on the incidence and progression of PCa with mixed results.

Objective

The objective of this chapter is to provide an update of recent published literature and highlight progress in the field.

Main findings

Low carbohydrate intake, soy protein, ω3 fat, green teas, tomatoes and tomato products and the herbal mixture-zyflamend showed promise in reducing PCa risk or progression. On the contrary, a higher animal fat intake and a higher β-carotene status may increase risk. A “U” shape relationship may exist between folate, vitamin C, vitamin D and calcium with PCa risk. Conclusion Despite the inconclusive findings, the potential for a role of dietary intake for the prevention and treatment of PCa remains promising. Maintaining a healthy body weight and following a healthy dietary pattern including antioxidant rich fruits and vegetables, reduced animal fat and refined carbohydrates, should be encouraged.

Conclusion

Despite the inconclusive findings, the potential for a role of dietary intake for the prevention and treatment of PCa remains promising. Maintaining a healthy body weight and following a healthy dietary pattern including antioxidant rich fruits and vegetables, reduced animal fat and refined carbohydrates, should be encouraged.

Introduction

Prostate cancer (PCa) is the most common cancer among US men, aside from nonmelanoma skin cancer, and a leading cause of cancer death [1]. Preclinical studies have shown a potential benefit of many nutrients, dietary factors, foods or dietary patterns, on PCa development or progression, however, findings remain inconclusive. The purpose of this review is to build upon our previous review and to provide an update on the role of nutrition and dietary intervention on PCa [2].

Section snippets

Carbohydrates

Various studies have examined the hypothesis that reducing carbohydrates may slow PCa growth by lowering serum insulin or altering the insulin-like growth factor (IGF) that has shown mitogenic and antiapoptotic effects on prostate epithelial cells [3], [4]. Animal studies showed a no-carbohydrate ketogenic [5], [6] or a low-carbohydrate (20% kcal) diet may slow prostate tumor growth [7], [8]. Castrated mice, representing a more advanced castration resistant PCa, fed a low-carbohydrate

Phytochemicals

Plants contain phytochemicals with antioxidant and anti-inflammatory properties, and may be used for chemoprevention and cancer treatment with low toxicity [132], [133]. However, most supporting evidence comes from animal studies [134].

Silibinin is a polyphenolic flavonoid that has shown a diverse effect on PCa. Recent in vitro and in vivo studies showed silibinin may inhihit PCa growth by targeting epidermal growth factor receptor [135], [136], [137], TGFb2 expression [138], mitochondrial

Fruits and vegetables

Fruits and vegetables such as cruciferous and allium vegetables are rich in vitamins, minerals, and phytochemicals and have been shown an inverse relationship with PCa risk in some epidemiologic studies [180], but not all [181], [182]. Potential mechanisms for the phytochemical rich vegetables to benefit PCa include enhancing the immune system, inhibiting cell growth, modulating expression of androgen-responsive genes, and inducing apoptosis [183], [184]. Although whole foods contain multiple

Dietary patterns

Although many single nutrients or food factors have been examined for their association with PCa risk or progression, the results have largely been inconclusive. The inconsistency may relate to the fact that the effect of single nutrients or food factors may be too small to detect and combinations of nutrients or food factors may contribute to a larger effect synergistically [189]. For example, in a cohort of 293,464 men, a high dietary quality, as indicated by the Healthy Eating Index score

Future direction for clinical trials

Multiple epidemiologic, preclinical, and clinical trials support a potential role of dietary intervention as primary or secondary prevention of PCa, or to minimize side effect from PCa treatment [207], [208], [209]. Indeed, more than 40 intervention trials testing various aspects of diet including low fat, low carbohydrate, fish oil, tomato products, lycopene, tea, pomegranate juice, low calorie, and a high vegetable diet on PCa-related outcomes are currently underway (ClinicalTrials.gov).

Conclusion

Determining the ideal diet for PCa prevention and treatment requires additional research. The effect of dietary intervention on PCa-related metabolic changes including glucose and lipids has been well acknowledged. Thus, the best dietary advice for PCa prevention or management as of today include increasing antioxidants rich fruits and vegetables, replacing refined carbohydrates with fiber and nutrient-dense whole grains, replace total and saturated fat with ω-3 rich fat, replacing red meats

Acknowledgments

P.-H. Lin and S. Freedland conducted the review, P.-H. Lin drafted the article and S. Freedland and W. Aronson edited and provided critical input. All authors provided final approval.

References (214)

  • K.E. Bradbury et al.

    Fruit, vegetable, and fiber intake in relation to cancer risk: findings from the European Prospective Investigation into Cancer and Nutrition (EPIC)

    Am J Clin Nutr

    (2014)
  • N. Sawada et al.

    Fiber intake and risk of subsequent prostate cancer in Japanese men

    Am J Clin Nutr

    (2015)
  • D. Aune et al.

    Dairy products, calcium, and prostate cancer risk: a systematic review and meta-analysis of cohort studies

    Am J Clin Nutr

    (2015)
  • G. Ables et al.

    Pleiotropic responses to methionine restriction

    Exp Gerontol

    (2017)
  • H. Xu et al.

    Insulin-Like growth factor 1 related pathways and high-fat diet promotion of transgenic adenocarcinoma mouse prostate (TRAMP) cancer progression

    Actas Urol Esp

    (2015)
  • O.J. Kwon et al.

    High fat diet promotes prostatic basal-to-luminal differentiation and accelerates initiation of prostate epithelial hyperplasia originated from basal cells

    Stem Cell Res

    (2016)
  • E. Cheung et al.

    Oral fenretinide in biochemically recurrent prostate cancer: a California cancer consortium phase II trial

    Clin Genitourin Cancer

    (2009)
  • T.J. Key et al.

    Carotenoids, retinol, tocopherols, and prostate cancer risk: pooled analysis of 15 studies

    Am J Clin Nutr

    (2015)
  • S.M. Collin

    Folate and B12 in prostate cancer

    Adv Clin Chem

    (2013)
  • J.J. Tomaszewski et al.

    Impact of folate intake on prostate cancer recurrence following definitive therapy: data from CaPSURE

    J Urol

    (2014)
  • K.J. Rycyna et al.

    Opposing roles of folate in prostate cancer

    Urology

    (2013)
  • L. Wang et al.

    Vitamin E and C supplementation and risk of cancer in men: posttrial follow-up in the Physicians’ Health Study II randomized trial

    Am J Clin Nutr

    (2014)
  • B.W. Hollis et al.

    Vitamin D3 supplementation, low-risk prostate cancer, and health disparities

    J Steroid Biochem Mol Biol

    (2013)
  • S.K. Holt et al.

    Circulating levels of 25-hydroxyvitamin D and prostate cancer prognosis

    Cancer Epidemiol

    (2013)
  • H.E. Meyer et al.

    Vitamin D, season, and risk of prostate cancer: a nested case-control study within Norwegian health studies

    Am J Clin Nutr

    (2013)

  • United States Cancer Statistics: 1999–2013 Incidence and Mortality Web-based Report

    (2016)
  • P.H. Lin et al.

    Nutrition, dietary interventions and prostate cancer: the latest evidence

    BMC Med

    (2015)
  • J.M. Chan et al.

    Plasma insulin-like growth factor-I and prostate cancer risk: a prospective study

    Science

    (1998)
  • S.J. Freedland et al.

    Carbohydrate restriction, prostate cancer growth, and the insulin-like growth factor axis

    Prostate

    (2008)
  • J.C. Mavropoulos et al.

    The effects of varying dietary carbohydrate and fat content on survival in a murine LNCaP prostate cancer xenograft model

    Cancer Prev Res (Phila)

    (2009)
  • E.M. Masko et al.

    Low-carbohydrate diets and prostate cancer: how low is low enough?

    Cancer Prev Res (Phila)

    (2010)
  • E. Ax et al.

    Dietary patterns and prostate cancer risk: report from the population based ULSAM cohort study of Swedish men

    Nutr Cancer

    (2014)
  • A.C. Vidal et al.

    Carbohydrate intake, glycemic index and prostate cancer risk

    Prostate

    (2015)
  • U. Demir et al.

    Metformin anti-tumor effect via disruption of the MID1 translational regulator complex and AR downregulation in prostate cancer cells

    BMC Cancer

    (2014)
  • A.M. Joshua et al.

    A pilot “window of opportunity” neoadjuvant study of metformin in localised prostate cancer

    Prostate Cancer Prostatic Dis

    (2014)
  • D. Margel et al.

    Metformin use and all-cause and prostate cancer-specific mortality among men with diabetes

    J Clin Oncol

    (2013)
  • E.H. Allott et al.

    Metformin does not affect risk of biochemical recurrence following radical prostatectomy: results from the SEARCH database

    Prostate Cancer Prostatic Dis

    (2013)
  • M. Rieken et al.

    Association of diabetes mellitus and metformin use with biochemical recurrence in patients treated with radical prostatectomy for prostate cancer

    World J Urol

    (2014)
  • D. Margel et al.

    Association between metformin use and risk of prostate cancer and its grade

    J Natl Cancer Inst

    (2013)
  • M. Franciosi et al.

    Metformin therapy and risk of cancer in patients with type 2 diabetes: systematic review

    PLoS One

    (2013)
  • D. Kaushik et al.

    Effect of metformin on prostate cancer outcomes after radical prostatectomy

    Urol Oncol

    (2014)
  • L. Bensimon et al.

    The use of metformin in patients with prostate cancer and the risk of death

    Cancer Epidemiol Biomarkers Prev

    (2014)
  • K.K. Tsilidis et al.

    Metformin does not affect cancer risk: a cohort study in the U.K. Clinical practice research datalink analyzed like an intention-to-treat trial

    Diabetes Care

    (2014)
  • C. Longcope et al.

    Diet and sex hormone-binding globulin

    J Clin Endocrinol Metab

    (2000)
  • R.J. Barnard et al.

    Prostate cancer: another aspect of the insulin-resistance syndrome?

    Obes Rev

    (2002)
  • T. Sheng et al.

    No association between fiber intake and prostate cancer risk: a meta-analysis of epidemiological studies

    World J Surg Oncol

    (2015)
  • R.J. Wang et al.

    Dietary fiber, whole grains, carbohydrate, glycemic index, and glycemic load in relation to risk of prostate cancer

    Onco Targets Ther

    (2015)
  • L. Fontana et al.

    Dietary protein restriction inhibits tumor growth in human xenograft models

    Oncotarget

    (2013)
  • N.J. Young et al.

    A cross-sectional analysis of the association between diet and insulin-like growth factor (IGF)-I, IGF-II, IGF-binding protein (IGFBP)-2, and IGFBP-3 in men in the United Kingdom

    Cancer Causes Control

    (2012)
  • M. Yang et al.

    Dairy intake after prostate cancer diagnosis in relation to disease-specific and total mortality

    Int J Cancer

    (2015)

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    ☆

    Funding sources: 1K24CA160653 (Freedland), NIH P50CA92131 (W. Aronson). This article is the result of work supported with resources and the use of facilities at the Veterans.

    1

    Administration Medical Center, West Los Angeles (W. Aronson).

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