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Prostate Cancer Prevention and Diet Dr Manish Patel Urological Cancer Surgeon Urological Cancer Surgeon Westmead Hospital University of Sydney.

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Presentation on theme: "Prostate Cancer Prevention and Diet Dr Manish Patel Urological Cancer Surgeon Urological Cancer Surgeon Westmead Hospital University of Sydney."— Presentation transcript:

1 Prostate Cancer Prevention and Diet Dr Manish Patel Urological Cancer Surgeon Urological Cancer Surgeon Westmead Hospital University of Sydney

2 Some Relevant Factors Family History of Prostate Cancer Bratt, 2007 –1 First Degree RelativeX2 –3 First Degree RelativeX11 Breast Cancer BRCA1 & BRCA2 gene mutations Lorenzo et al, 2004; Kirchhoff et al, 2004; van Asperen et al, 2005 Number of SNPs related to prostate cancer. –Genetic test for prostate cancer is available.

3 Established medications Aspirin & NSAIDS Thought to act predominantly via COX-2 pathway Almost all studies indicate a significant reduction in prostate cancer incidence Roberts et al, 2002; Habel et al, 2002; Jacobs et al, 2007 Approximately 25-40% reduction in prostate Cancer Risk.. 5-α-reductase inhibitors Prostate Cancer Prevention Trial – reduced prostate cancer development but increased incidence of Gleason 7- 10 tumours Thompson et al, 2003

4 Vitamins Multivitamins NIH Diet & Health Study (10 241/ 295 344) – no overall reduction in incidence at 5 years but increased rate of advanced & fatal disease >7 times/week Lawson et al, 2007 Vitamin E Randomised trial in smokers showed a 31% reduction in incidence and 41% reduction in Prostate Cancer Mortality. Heinonen et al, 1998; Chan et al, 1999; Helzlouer et al, 2000; Virtamo et al, 2004; Rodriguez et al, 2004; Kirsh et al, 2006 Vitamin D No protection in 4 studies for dietary or supplemental vit D Giovannucci et al, 1998; Chan et al, 1998; Kirstal et al, 2002; Chan et al, 2000 FokI ff genotype more susceptible if vit D status is low in Physicians Health Study Li et al, 2007

5 Other supplements Calcium Evidence is contradictory Giovannucci et al1998; Chan et al, 2001; Krystal et al, 2002; Rodriguez et al, 2003; Baron et al, 2005 Meta-analysis of 11 case-control studies – high levels of milk/dairy products increased risk Qin et al, 2004 Selenium Prostate cancer incidence reduced in randomised Nutritional Prevention of Cancer Trial Clark et al 1996; Duffield- Lillico et al, 2003 and Netherlands Cohort Study van den Brandt et al, 2003 Zinc Evidence is highly conflicting indicating both increased risk of advanced disease & lower risk of cancer Key et al, 1997; Kolonel et al, 1998; Krystal et al, 1999; Leitzmann et al, 2003

6 Lycopene & soy/isoflavones Lycopene Protective effect Prospective case-control study Gann et al, 1999 and Health Professional Follow-up Study Giovannucci et al, 2002 but only for men >65 and no family history Wu et al, 2004 No Protective effect Netherlands Cohort Study Schuurman et al, 2002 and Prostate, Lung, Colorectal and Ovarian Cancer Screening Trail Peters et al, 2007 Soy/isoflavones Observational studies relate increased intake with low cancer incidence Sverson et al, 1989; Aldercreutz et al, 1993; Herbert et al, 1998; Jacobsen et al, 1998

7 Fish and Meat Fish Omega-3 fatty acids considered to provide a protective role Zock & Katan, 1998; Schuurman et al, 1999 A low or lack of consumption associated with 2-3 fold higher frequency of disease Terry et al, 2001 Fish >3 times/week associated with a reduced risk of metastatic disease Augustsson et al, 2003 Red meat Mode of actions via mutagens resulting in ROS and activation of arachidonic pathway Shackelford et al, 1999; Esposito et al, 2000; Chetcuti et al, 2001 Majority of case-control and cohort studies show a positive correlation with disease development De Stephani et al, 2000; Ramon et al, 2000; Lee et al, 2000; Chan et al, 2000

8 Other preparations Epilobium & Serenoa Repens No clinical evidence found to support a benefit Saw palmetto administered to TRAMP mice resulted in significant decrease in tumour grade and incidence Wadsworth et al, 2007 Potential unproven candidates sulforaphane, a constituent of several edible cruciferous vegetables Herman- Antosiewicz, 2006 Curcumin Jagetia & Aggarwal, 2007 Pomegranate Adhami & Mukhtar, 2006

9 Green Tea & Red Wine Benefit through polyphenols which induce apoptosis & inhibit proliferation Lee et al, 2006 Chinese case-control study showed a protective effect of green tea with synergy for lycopene Jian et al 2007 but no benefit for green tea in a Japanese study Kikuchi et al 2006 Combined inhibitory effects of green tea polyphenols and selective COX-2 inhibitors in-vitro & in-vivo Adhami et al, 2007 Benefits from red wine due to the polyphenol Resveratrol Slightly lower risks for 4 in Health Professionals Follow- up Study Sutcliffe et al, 2006

10 Conclusions Data on diet and prevention is incomplete Some strategies can do harm Need to keep an open mind and seek more convincing evidence for and against


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