Epidemiological evidence linking food, nutrition, physical activity and prostate cancer risk: results from the Continuous Update Project World Cancer Congress, Saturday 6 December 2014 Michael Leitzmann Dept. of Epidemiology and Preventive Medicine, University of Regensburg Continuous Update Project Panel member
Prostate cancer incidence and mortality Incidence Mortality GLOBOCAN 2012 (IARC) http://globocan.iarc.fr
Prostate cancer incidence Prostate cancer mortality Europe North America Sub- Saharan Africa Middle East & North Africa La<n America & the Caribbean East & Central Asia India China Oceania Europe North America La<n America & the Caribbean Sub- Saharan Africa China Oceania Middle East & North Africa East & Central Asia India World Cancer Report (IARC 2014)
FOOD, NUTRITION, PHYSICAL ACTIVITY, AND CANCER OF THE PROSTATE Level of evidence DECREASES RISK INCREASES RISK Convincing Probable Foods containing lycopene Foods containing selenium Selenium Diets high in calcium Limited-suggestive Pulses (legumes) Foods containing vitamin E Alpha-tocopherol Processed meat Milk and dairy products Limited-no conclusion Substantial effect on risk unlikely Cereals (grains) and their products; dietary fibre; potatoes; non-starchy vegetables; fruits; meat; poultry; fish; eggs; total fat; plant oils; sugar (sucrose); sugary foods and drinks; coffee; tea; alcohol; carbohydrate; protein; vitamin A; retinol; thiamin; riboflavin; niacin; vitamin C; vitamin D; gamma-tocopherol; vitamin supplements; multivitamins; iron; phosphorus; zinc; other carotenoids; physical activity; energy expenditure; vegetarian diets; Seventh-day Adventist diets; body fatness; abdominal fatness; birth weight; energy intake Beta-carotene
DIET, NUTRITION, PHYSICAL ACTIVITY AND PROSTATE CANCER DECREASES RISK INCREASES RISK STRONG EVIDENCE LIMITED EVIDENCE STRONG EVIDENCE Convincing Probable Limited-suggestive Limited-no conclusion Substantial effect on risk unlikely Beta-carotene Body fatness (advanced prostate cancer) Adult attained height Dairy products Diets high in calcium Low plasma alpha-tocopherol concentrations Low plasma selenium concentrations Cereals (grains) and their products, dietary fibre, potatoes, non-starchy vegetables, fruits, pulses (legumes), processed meat, red meat, poultry, fish, eggs, total fat, saturated fatty acids, monounsaturated fatty acids, polyunsaturated fatty acids, plant oils, sugar (sucrose), sugary foods and drinks, coffee, tea, alcoholic drinks, carbohydrate, protein, vitamin A, retinol, alpha carotene, lycopene, folate, thiamin, riboflavin, niacin, vitamin C, vitamin D, vitamin E supplements, gamma tocopherol, multivitamins, selenium supplements, iron, phosphorus, calcium supplements, zinc, protein, physical activity, energy expenditure, vegetarian diets, Seventh-day Adventist diets, individual dietary patterns, body fatness (non-advanced prostate cancer), birth weight, energy intake
Prostate Cancer Report 2014 Published 19 November 2014 Prospective studies Randomized controlled trials 0 200 400 600 800 0 10 20 30 40 50 Breast Colorectal Prostate Lung Stomach Pancreas Liver Bladder Endometrial Ovary Kidney Oesophageal Polyps Gallbladder 2005 SLR CUP Polyps Lung Stomach Prostate Colorectal Breast Bladder Pancreas Endometrial Kidney Ovary Oesophageal Liver Gallbladder 104 papers included in the report Report available at: http://www.wcrf.org/int/research-we-fund/continuous-update-project-findings-reports/prostate-cancer
Body fatness and prostate cancer BMI Waist circumference Waist to hip ratio Advanced RR=1.12 (1.04-1.21) Studies: 4 RR=1.15 (1.03-1.28) Studies: 4 RR=1.08 (1.04-1.12) Studies: 23 Non-advanced RR=0.95 (0.92-0.98) Studies: 14 RR=1.01 (0.90-1.12) Studies: 4 RR=0.99 (0.90-1.09) Studies: 4
Obesity-related detection biases and biologic mechanisms contributing to the association between obesity and aggressive prostate cancer Allott et al., Eur Urol. 2013;63(5):800 9
Height and prostate cancer Advanced RR=1.04 (1.02-1.06) Studies: 19 Non-advanced RR=1.03 (1.01-1.05) Studies: 10
Total dairy and prostate cancer Advanced Non-advanced Total RR=1.07 (1.02-1.11) Studies: 15 RR=1.09 (1.00-1.18) Studies: 8 RR=0.97 (0.91-1.05) Studies: 10 Fatal RR=1.11 (0.92-1.33) Studies: 5
Total calcium and prostate cancer Non-advanced RR=1.01 (0.98-1.03) Studies: 6 Advanced Total RR=1.02 (1.01-1.04) Studies: 9 RR=1.03 (0.99-1.07) Studies: 7 Fatal RR=1.11 (1.02-1.21) Studies: 2
Dairy calcium and non-dairy calcium and prostate cancer Dairy calcium Non-dairy calcium Total Advanced Total Fatal RR=1.06 (1.02-1.09) Studies: 6 RR=1.03 (1.00-1.07) Studies: 2 RR=1.05 (0.96-1.15) Studies: 2 Nonadvanced Nonadvanced Advanced RR=0.97 (0.90-1.04) Studies: 4 RR=0.97 (0.79-1.20) Studies: 2 RR=1.05 (0.69-1.60) Studies: 2 RR=1.09 (0.89-1.34) Studies: 2
Dietary and supplemental calcium and prostate cancer Dietary calcium Supplemental calcium Total Non-advanced RR=1.05 (1.02-1.09) Studies: 15 Non-advanced Total Advanced RR=0.99 (0.96-1.01) Studies: 4 RR=0.99 (0.96-1.02) Studies: 4 RR=1.07 (1.03-1.12) Studies: 7 RR=1.01 (0.94-1.09) Studies: 5 Advanced Fatal RR=1.29 (1.08-1.54) Studies: 2 RR=1.02 (0.93-1.12) Studies: 10
Proposed relationship between dietary calcium and prostate cancer Giovannucci et al., Cancer Res 1998;58:442-7
Challenges in epidemiologic studies of diet and prostate cancer Changing spectrum of prostate cancer cases due to screening for elevated PSA - Enrichment of cases with early disease Misclassification of exposure - Assessment only in middle age Variation in study quality
Future directions in epidemiologic studies of diet and prostate cancer Tailor hypotheses that are testable using early stage disease Use appropriate study populations Select appropriate cases Conduct analyses by type of case Elucidate mechanisms Methodology for systematically reviewing mechanisms - Continuous Update Project Request For Application: http://www.wcrf.org/int/research-we-fund/continuous-update-projectcup/work-mechanisms
Summary Prostate cancer is the second most common cancer worldwide Strong evidence that greater body fatness (marked by BMI, waist-circumference, and waist-hip ratio) is probably a cause of advanced prostate cancer Strong evidence that developmental factors leading to greater linear growth (marked by adult attained height) are probably a cause of prostate cancer Limited evidence that diets high in calcium or higher consumption of dairy products increases the risk of prostate cancer More evidence needed on characterising mechanisms that underpin the association between calcium and prostate cancer risk A recent paper on dairy products, calcium, and prostate cancer risk by the Continuous Update Project research team in the AJCN: doi: 10.3945/ ajcn.113.067157 More information in the prostate cancer report: /www.wcrf.org/int/research-we-fund/continuous-update-project-findings-reports/prostatecancer
For further information Michael Leitzmann Continuous Update Project Panel member Dept. of Epidemiology and Preventive Medicine, University of Regensburg Michael.Leitzmann@ukr.de @wcrfint facebook.com/wcrfint www.wcrf.org