Encourage Diet and Lifestyle Interventions in Low-Risk Prostate Cancer

Zosia Chustecka

September 10, 2007

September 10, 2007 —— Men with low-risk prostate cancer who opt for active surveillance should be encouraged to make dietary and lifestyle changes that improve their overall quality of life, such as reducing calories and exercising, said Stephen Freedland, MD, from Duke University Medical School, in Durham, North Carolina. "Many patients are uncomfortable about doing 'nothing' for their cancers," he said, and making diet and lifestyle modifications allows patients to take an active role in their management and gain some sense of control.

Dr. Freedland was speaking last week at a plenary session of the inaugural meeting of Innovative Minds in Prostate Cancer Today (IMPaCT), held in Atlanta, Georgia and hosted by the US Department of Defense Prostate Cancer Research Program. Elaborating in an interview, he said the message about making these changes is not new, but it is "not well practiced. We have tended to focus on the tumor when we should be focusing on the patient and take into account all aspects of their health."

The majority of men with prostate cancer will die from other causes, chief among them heart disease, he points out. Hence, these patients should be encouraged to take steps to protect against heart disease. "We should constantly be thinking heart first and prostate second, but what is good for the heart is likely to also be good for the prostate."

The best example is weight reduction, Dr. Freedland commented. "This is one of the most exciting things for me, because I know this will do the heart good, but it may also be good against cancer." At the meeting, he reviewed animal data accumulated over the past 10 years that show reducing calories results in slower tumor growth. "Certainly in animals, this is one of the most potent dietary things that we can do," he told Medscape. "Human data seem to mirror this finding, although they are not as complete," he said. There are now 2 large breast cancer diet studies in which women who lost weight showed a slower tumor growth and those who did not lose weight showed no effect.

Another intervention is to reduce high saturated-fat intake, because this seems to promote tumor growth in animals, and some of the research carried out by his team at Duke points to simple carbohydrates also driving tumor growth. This includes candies, cookies, and ice cream, but also potatoes and white bread, which do not have a lot of nutritional value, he said. He advocates moderation rather than avoiding these items altogether.

"The one other thing is exercise," Dr. Freeland added, "even if you eat the same food but you start exercising, you are going to lose weight." All of these measures will certainly not harm the patients, and hopefully they will make them feel better, protect them against heart disease, and also be good for resisting the cancer, he said. It certainly won't harm them, he added.

"This is what we should be doing with active surveillance," Dr. Freedland commented, "looking after the whole patient, and not just the tumor." This attitude also mirrors the change in the terminology used for the management of this group of patients with low-risk prostate cancer, he continued. The term "watchful waiting" is now falling out of use because of its negative connotations.

"It's important to let the patient know that we are not going to sit and wait for the cancer to spread," Dr Freedland commented. "We're going to sit and wait until we get to a point where we feel uncomfortable about the signs and then plan surgery or radiation. . . . So we're saying we're not doing this today, but we're following you, and we might do it 2 years from now." In addition to active surveillance, the term "expectant management," also used for these patients, might better be termed "deferred curative therapy," he said.

IMPaCT meeting; Atlanta, Georgia; September 5-8, 2007.


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