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Epidemiology

Diet quality and Gleason grade progression among localised prostate cancer patients on active surveillance

Abstract

Background

High diet quality may support a metabolic and anti-inflammatory state less conducive to tumour progression. We prospectively investigated diet quality in relation to Gleason grade progression among localised prostate cancer patients on active surveillance, a clinical management strategy of disease monitoring and delayed intervention.

Methods

Men with newly diagnosed Gleason score 6 or 7 prostate cancer enroled on a biennial monitoring regimen. Patients completed a food frequency questionnaire (FFQ) at baseline (n = 411) and first 6-month follow-up (n = 263). Cox proportional hazards models were fitted to evaluate multivariable-adjusted associations of diet quality [defined via the Healthy Eating Index (HEI)-2015] with Gleason grade progression.

Results

After a median follow-up of 36 months, 76 men progressed. Following adjustment for clinicopathologic factors, we observed a suggestive inverse association between baseline diet quality and Gleason grade progression [hazard ratio (HR) and 95% confidence interval (CI) for the highest vs. the lowest HEI-2015 tertile: 0.59 (0.32–1.08); Ptrend = 0.06]. We observed no associations with diet quality at 6-month follow-up, nor change in diet quality from baseline.

Conclusions

In localised prostate cancer patients on surveillance, higher diet quality or conformance with United States dietary guidelines at enrolment may lower risk of Gleason grade progression, though additional confirmatory research is needed.

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Acknowledgements

We would like to acknowledge all patients who participated in this study, without whom this investigation would not be possible. We also would like to thank Dr. Sara Strom (retired) for her early contributions to the study and dietary assessment. This work was supported by the National Cancer Institute at the National Institutes of Health (5P30 CA016672-37; MDACC Support Grant, supports C.R.D.) and the Cancer Prevention and Research Institute of Texas (RP170259; post-doctoral fellowship award, supports J.Z.). J.R.G. is supported in part by an Early Investigator Award from the Prostate Cancer Research Programme of the US. Department of Defence Congressionally Directed Medical Research Programme (W81XWH-18-1-0173).

Author contributions

J.R.G.: conceptualisation, data analysis, manuscript preparation and editing. J.Z.: conceptualisation, data analysis, manuscript writing and editing, review and oversight. D.S.L.: concept, data analysis, oversight, editing and review. C.R.: investigation, administration, writing and review. G.B.: data preparation, manuscript editing and review. B.C.: data acquisition, oversight and review. J.K.: conceptualisation, data acquisition, supervision, writing and review. J.D.: conceptualisation, data acquisition, supervision, review and editing. C.R.D.: conceptualisation, data analysis, manuscript writing and editing, and supervision.

Author information

Competing interests

J.D. is consultant for Intuitive and received scientific funding from Janssen and GenomeDX. The other authors declare no competing interests.

Data availability

The datasets generated during and/or analysed during the current study used to support the findings of this study are not publicly available as this dataset is a resource of the University of Texas MD Anderson Cancer Centre; however, information is available from the corresponding author on reasonable request.

Ethics approval and consent to participate

This study is registered on clinical.trials.gov (trial number NCT00490763), and use of de-identified data in this study for analysis was approved as exempt by the University of Texas MD Anderson Cancer Center Institutional Review Board. Informed consent was provided by all patients in this study by virtue of completing and returning the form. The study was performed in accordance with the Declaration of Helsinki.

Consent for publication

This manuscript does not contain any individual person’s data in any form.

Note

This work is published under the standard license to publish agreement. After 12 months the work will become freely available and the license terms will switch to a Creative Commons Attribution 4.0 International (CC BY 4.0).

Correspondence to Carrie R. Daniel.

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