Abstract
Purpose Given the long-term, although potentially fatal, nature of prostate cancer, there is increasing observational evidence for the reduction in disease progression and mortality through changes in lifestyle factors.Methods We systematically reviewed dietary, nutritional, and physical activity randomized interventions aimed at modifying prostate cancer progression and disease-specific mortality, including a detailed assessment of risk of bias and methodological quality.ResultsForty-four randomized controlled trials of lifestyle interventions, with prostate cancer progression or mortality outcomes, were identified. Substantial heterogeneity of the data prevented a meta-analysis. The included trials involved 3,418 prostate cancer patients, median 64 men per trial, from 13 countries. A trial of a nutritional supplement of pomegranate seed, green tea, broccoli, and turmeric; a trial comparing flaxseed, low-fat diet, flaxseed, and low-fat diet versus usual diet; and a trial supplementing soy, lycopene, selenium, and coenzyme Q10, all demonstrated beneficial effects. These trials were also assessed as having low risk of bias and high methodological quality (as were seven other trials with no evidence of benefit). The remaining trials were either underpowered, at high or unclear risk of bias, inadequately reported, of short duration or measured surrogate outcomes of unproven relationship to mortality or disease progression, which precluded any benefits reported being reliable.ConclusionLarge, well-designed randomized trials with clinical endpoints are recommended for lifestyle modification interventions.Electronic supplementary materialThe online version of this article (doi:10.1007/s10552-015-0659-4) contains supplementary material, which is available to authorized users.
Highlights
Prostate cancer is the most common cancer in men in the Western world [1]
We systematically reviewed dietary, nutritional, and physical activity randomized interventions aimed at modifying prostate cancer progression and disease-specific mortality, including a detailed assessment of risk of bias and methodological quality
Trials that only included a small proportion of prostate cancer patients within their total sample and had analyzed the data as a whole were excluded, for Author, country of data collection
Summary
Prostate cancer is the most common cancer in men in the Western world [1]. In the UK, for example, it accounts for a quarter of newly diagnosed cancers [2] and one in eight men will receive a prostate cancer diagnosis [3]. Prostate cancer may behave more aggressively and is an important cause of morbidity and mortality [4]. Given the long-term chronic, but potentially fatal, nature of the disease, there is growing interest in low-toxicity interventions in the tertiary prevention of morbidity and mortality due to prostate cancer. This is of particular importance as noninvasive
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