Study: Nutrition for Prostate Cancer Survivors

reference

Wilson KM, Mucci LA, Drake BF, et al. Consumption of meat, fish, poultry and eggs when diagnosed and risk of prostate cancer progression.Krebs Prev Res (Phila). 2016; 9 (12): 933-941.

Study objective

The connection between the recurrence of prostate cancer and the consumption of red meat, processed and unprocessed red meat, poultry, fish and eggs as a whole should be examined

Participant

The study included 971 men who were treated with radical prostate -specific antigen [PSA] = 5.9 ng/ml); Men took part in Washington University Genetics Study, a cohort of men with prostate cancer diagnosed by biopsy, which were treated in St. Louis between 2003 and 2010.

Target parameters

Details on diagnosis, initial treatment and follow -up examinations were collected from medical records. After diagnosis and before treatment, the men filled a questionnaire with demographic information, smoking and health information as well as a questionnaire for the frequency of food (FFQ). The logistical regression was used to examine the connection between nutrition and high -grade or advanced illness for all 971 participants. Only participants with the pathological stage T3N0M0 (n = 940) were included in the recurrence analysis cohort. The median post -observation period was 3.0 years (area: 1 month to 7 years, 8 months).

Study medication and dosage

The FFQ evaluated the frequency of consumption of 137 individual foods, 77 with questions about the usual portion size and fraud, in the year before the diagnosis. Additional questions about preparation methods, including the frequency of eating fried food and preferences for the cooking degree of meat.

Important knowledge

Consumption of well-done and very well-done red meat was associated with advanced disease at diagnosis (odds ratio [OR] upper vs. lower quartile: 1.74; 95% confidence interval [CI]: 1.05-2.90;Pfor trend=0.01). Less cooked meat and overall meat intake were not associated with advanced disease. There was no association with other nutritional parameters.

The total absorption of red meat was associated with high grade (Gleason 4+3) prostate cancer (Hazard Ratio [HR]: 1,66; KI: 0.93-2.97;Pfor trend = 0.05) at the time of the diagnosis. At the time of the diagnosis, no other nutritional parameters were associated with high -grade prostate cancer.

Of the 940 men in the pathological stage T3N0M0 or lower, 94 had a recurrence of prostate cancer (10 %), which due to an increasing PSA value (n = 79), the beginning of a new treatment (n = 12) or signs of metastases (n = 3). When comparing quintle, the consumption of red meat, fish, poultry or eggs was not associated with a new appearance.

Based on a substitution model, the authors calculated that the replacement of 30 grams of red meat per day would lead to a significantly lower risk of recurrence by 30 grams of poultry or fish (HR: 0.79; 95 %KI: 0.66–0.94). This calculation applied to unprocessed red meat (HR: 0.76; 95 % AI: 0.63–0.92), but not for processed red meat (HR: 1.05; 95 % AI: 0.67–1.64). No other nutritional categories or substitutions achieved statistical significance when comparing the upper quartile of consumption with the lower quartile.

Neither total red meat nor egg intake was significantly associated with disease risk.

Practice implications

While we are looking forward to all data that men can inform men with prostate cancer about which lifestyle decisions slow down the progression of their illness, this study contributes little to our knowledge basis.

The authors state: "Our results support advising men with prostate cancer to replace red meat and eggs in the diet with poultry or fish. This is associated with a reduced risk of recurrence, regardless of stage and severity at diagnosis, and is consistent with previous findings on diet and prostate cancer survival."

The authors of this study imply associations between food components and disease risk, but these associations did not achieve statistical significance. They entered several almost plausible word elections to make these implications, such as the following:

• „Wir haben eine gefunden suggestive positive Assoziation mit Progression nach radikaler Prostatektomie zum Verzehr von Eiern.“
• „Gesamtaufnahme von rotem Fleisch war marginal verbunden mit dem Risiko einer hochgradigen Erkrankung.“
• „Wir haben einen gesehen Vorschlag einer positiven Assoziation für gebratenes Geflügel und eine umgekehrte Assoziation für nicht gebratenes Geflügel und Wiederholung.“
• „Diese Studie eröffnet die Möglichkeit dass der Ersatz von rotem Fleisch und Eiern durch Geflügel oder Fisch das Fortschreiten bei Männern, die wegen Prostatakrebs chirurgisch behandelt wurden, verlangsamen könnte.“

Suggestive associations, marginal associations, possibilities and other twists do not correspond to a statistically significant association.

The authors also resorted to creative comparisons. In an attempt to find high egg intake linked to disease, they compared the peakdecileof consumption against the groundQuartileand were able to report an OR of 1.98 with a 95 % AI from 1.08 to 3.63, and aPValue for trend of 0.08. Note thatP-Value for the trend is greater than 0.05. A similar statistical manipulation was used to imply that very high poultry consumption was associated with progression (HR top decile vs bottom quartile: 0.19; 95% CI: 0.06–0.63;Pfor trend = 0.02).

Suggestive associations, marginal associations, possibilities and other twists do not correspond to a statistically significant association.

Comparisons are usually not carried out in these studies. Equivalent segments of a data record should be used for comparison; For example upper quartile vs. lower quartile. All of these examples describe trends that have not achieved statistical significance and should have been reported as "no association" or "no significant association".

While advocates of accurate reporting prefer that authors report only results that are statistically significant, there may be more generous readers who would like to be informed of strong trends that border on statistical significance. Nevertheless, they expect the choice of language to make it clear that such trends were not significant.

This inaccurate spelling confuses the average reader. The study concludes with information that we already suspected:

"In summary, our results support the advice for men with prostate cancer to replace red meat and eggs in the diet with poultry or fish. This is associated with a lower risk of recurrence regardless of stage and severity at diagnosis and is consistent with previous evidence on prostate cancer diet and survival."

What should we say men with prostate cancer now about nutrition and lifestyle?

The most informative study so far is the study by Kenfield et al. from 2015 via the lifestyle score. On the basis of data from the Health Professionals Follow-Up Study (HPFS; N = 42.701), Kenfield and colleagues developed a "lifestyle score" to classify characteristics that influence prostate cancer. They addressed this evaluation method for the HPFS cohort and the 20,324 men in the Physicians' Health Study (PHS). One point was awarded for each of these properties:

1. Derzeit nicht rauchen oder vor 10 oder mehr Jahren aufgehört haben
2. Body-Mass-Index unter 30 kg/m²
3. Hohe kräftige Aktivität
4. Hohe Aufnahme von Tomaten und fettem Fisch
5. Geringe Aufnahme von verarbeitetem Fleisch

Men with 5 to 6 vs. 0 to 1 points had a 68 % reduced risk of fatal prostate cancer (HR: 0.32; KI: 0.19–0.52) in the HPFS and a risk that is not significantly reduced by 38 % (HR: 0.62; 95 % AI: 0.30-1.26) in the pH. Only for nutritional factors had men with 3 vs. 0 points a 46 % reduced risk (HR: 0.54; 95 %-KI: 0.30–0.96) in the HPFS and a not significantly reduced risk (HR: 0.70; 95 % KI: 0.40). -1.23) in the phs.¹

Based on the Kenfield study, the current study, a 2010 study by Richman,²And a study by 2013 by Kenfield and Richman together,³We can put together this list of recommendations:

• Nicht rauchen.
• Halten Sie einen BMI unter 30 kg/m².
• Trainieren Sie kräftig.
• Essen Sie viel Tomaten und fetten Fisch.
• Begrenzen Sie den Verzehr von verarbeitetem Fleisch.
• Vermeiden Sie durchgebratenes und sehr durchgebratenes Fleisch.
• Ersetzen Sie rotes Fleisch in der Ernährung durch Geflügel oder Fisch.
• Vermeiden Sie Geflügelhaut und Eier.
• Ersetzen Sie einige Kohlenhydrate und tierisches Fett durch pflanzliches Fett.