Abstract
Despite the considerable number of studies investigating the Mediterranean diet in prostate cancer (PCa) etiology, very few focused on cancer survival. We assessed the pre-diagnostic diet and physical activity in a cohort of 777 men with PCa diagnosed between 1995 and 2002 in north-eastern Italy; adherence to the Mediterranean diet was evaluated through the Mediterranean Diet Score (MDS). Hazard ratios (HR) of death with confidence intervals (CI) were estimated using the Cox model, adjusting for potential confounders. During 10 years of follow-up, 208 patients (26.8%) died, 75 (9.7%) due to PCa. Patients reporting MDS ≥ 5 showed a higher overall survival than those with MDS < 5 (HR = 0.74; 95% CI: 0.56–0.99). Although high physical activity was not significantly associated with overall survival (HR = 0.79; 95% CI: 0.59–1.07), the HR for all-cause death was the lowest (HR = 0.58; 95% CI: 0.38–0.90) for men reporting MDS ≥ 5 and high physical activity compared to those reporting MDS < 5 and low/moderate physical activity. No association emerged for PCa specific survival. Study findings support the beneficial impact of pre-diagnostic adherence to the Mediterranean diet and physical activity on overall survival; they are mainly driven by risk reduction in non-prostate cancer mortality, which however accounts for about 80% of death in men with PCa.
Highlights
IntroductionIn Europe, prostate cancer (PCa) is the most common neoplasm among men (approximately 473,000 new cases/year) and it is the leading cause of cancer deaths
Anthropometric measures were assessed by the interviewer during the interview; according to the definition by the World Health Organization [14], abdominal obesity was defined as waist circumference >102 cm, measured 2 cm above the umbilicus
Adherence to the Mediterranean diet has been associated with reduced incidence of several health outcomes [21], including overall and cancer mortality [5,21]
Summary
In Europe, prostate cancer (PCa) is the most common neoplasm among men (approximately 473,000 new cases/year) and it is the leading cause of cancer deaths The widespread use of prostate-specific antigen (PSA) testing, which started in Italy in the early 1990s [2], has increased the detection of latent, early-stage, and slow-growing tumors, contributing to the increasing overall survival in patients with. PCa. over 560,000 men living after a diagnosis of PCa are estimated in Italy in [3]. Cardiovascular disease is the most frequent cause of death among patients with a PCa diagnosis, especially in those with low-risk PCa [4]. The identification of modifiable lifestyle factors affecting the long-term PCa prognosis is of great relevance
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