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Prostate Cancer Prevention and Diet

Prostate Cancer Prevention and Diet. Dr Manish Patel Urological Cancer Surgeon Westmead Hospital University of Sydney. Some Relevant Factors. Family History of Prostate Cancer Bratt, 2007 1 First Degree Relative X2 3 First Degree Relative X11

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Prostate Cancer Prevention and Diet

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

  2. Some Relevant Factors • Family History of Prostate CancerBratt, 2007 • 1 First Degree Relative X2 • 3 First Degree Relative X11 • 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 incidenceRoberts 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/weekLawson 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, 2003and • Netherlands Cohort Study van den Brandt et al, 2003 Zinc • Evidence is highly conflicting indicating both increased risk of advanced disease & lower risk of cancerKey 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 studyGann et al, 1999and Health Professional Follow-up Study Giovannucci et al,2002but only for men >65 and no family history Wu et al, 2004 • No Protective effect Netherlands Cohort StudySchuurman et al, 2002and Prostate, Lung, Colorectal and Ovarian Cancer Screening Trail Peters et al, 2007 Soy/isoflavones • Observational studies relate increased intake with low cancer incidenceSverson 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 roleZock & 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 pathwayShackelford 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 vegetablesHerman- Antosiewicz, 2006 • CurcuminJagetia & Aggarwal, 2007 • Pomegranate Adhami & Mukhtar, 2006

  9. Green Tea & Red Wine • Benefit through polyphenols which induce apoptosis & inhibit proliferationLee et al, 2006 • Chinese case-control study showed aprotective effect of green tea with synergy for lycopene Jian et al 2007but 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 glasses of red wine/week but null or slightly increased 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 mindand seek more convincing evidence ‘for’ and ‘against’

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