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



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.


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.


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.


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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  1. 1.

    Society, A. C. Cancer Facts & Figures 2018 (American Cancer Society, Atlanta, 2018).

  2. 2.

    Resnick, M. J. et al. Long-term functional outcomes after treatment for localized prostate cancer. N. Engl. J. Med. 368, 436–445 (2013).

  3. 3.

    Cooperberg, M. R., Broering, J. M. & Carroll, P. R. Risk assessment for prostate cancer metastasis and mortality at the time of diagnosis. J. Natl. Cancer Inst. 101, 878–887 (2009).

  4. 4.

    Hoffman, K. E. et al. Physician variation in management of low-risk prostate cancer: a population-based cohort study. JAMA Intern. Med. 174, 1450–1459 (2014).

  5. 5.

    Simpkin, A. J. et al. Systematic review and meta-analysis of factors determining change to radical treatment in active surveillance for localized prostate cancer. Eur. Urol. 67, 993–1005 (2015).

  6. 6.

    Loeb, S. et al. Active surveillance for prostate cancer: a systematic review of clinicopathologic variables and biomarkers for risk stratification. Eur. Urol. 67, 619–626 (2015).

  7. 7.

    Capiod, T., Barry Delongchamps, N., Pigat, N., Souberbielle, J. C., Goffin, V. Do dietary calcium and vitamin D matter in men with prostate cancer? Nat. Rev. Urol. 15, 453–461 (2018).

  8. 8.

    Discacciati, A. & Wolk, A. Lifestyle and dietary factors in prostate cancer prevention. Recent results cancer research. Fortschr. der Krebsforsch. Progres. dans Les. Rech. sur Le. Cancer 202, 27–37 (2014).

  9. 9.

    Gathirua-Mwangi, W. G. & Zhang, J. Dietary factors and risk for advanced prostate cancer. Eur. J. Cancer Prev. 23, 96–109 (2014).

  10. 10.

    World Cancer Research Fund/American Institute for Cancer Research. Diet, Nutrition, Physical Activity and Cancer: a Global Perspective. Continous Update Project Expert Report (2018).

  11. 11.

    Bosire, C. et al. Index-based dietary patterns and the risk of prostate cancer in the NIH-AARP diet and health study. Am. J. Epidemiol. 177, 504–513 (2013).

  12. 12.

    Kenfield, S. A. et al. Mediterranean diet and prostate cancer risk and mortality in the Health Professionals Follow-up Study. Eur. Urol. 65, 887–894 (2014).

  13. 13.

    Moller, E. et al. Mediterranean Diet Score and prostate cancer risk in a Swedish population-based case–control study. J. Nutr. Sci. 2, e15 (2013).

  14. 14.

    Yang, M. et al. Dietary patterns after prostate cancer diagnosis in relation to disease-specific and total mortality. Cancer Prev. Res. (Phila., Pa). 8, 545–551 (2015).

  15. 15.

    Davis, J. W. et al. Disease reclassification risk with stringent criteria and frequent monitoring in men with favourable-risk prostate cancer undergoing active surveillance. BJU Int. 118, 68–76 (2016).

  16. 16.

    Gregg, J. R., et al. Coffee, caffeine metabolism genotype, and disease progression in localized prostate cancer patients managed with active surveillance. J. Urol. 201, 308–314 (2019).

  17. 17.

    Pillow, P. C. et al. Case–control assessment of diet and lung cancer risk in African Americans and Mexican Americans. Nutr. Cancer 29, 169–173 (1997).

  18. 18.

    Palacios, C. et al. Dietary patterns in Puerto Rican and Mexican-American breast cancer survivors: a pilot study. J. Immigr. Minor. Health 19, 341–348 (2017).

  19. 19.

    US Department of Agriculture ARS. USDA National Nutrient Database for Standard Reference, Release 26

  20. 20.

    Krebs-Smith, S. M. et al. Update of the Healthy Eating Index: HEI-2015. J. Acad. Nutr. Diet. 118, 1591–1602 (2018).

  21. 21.

    Babaian, R. J. et al. A comparative analysis of sextant and an extended 11-core multisite directed biopsy strategy. J. Urol. 163, 152–157 (2000).

  22. 22.

    Kirkpatrick, S. I. et al. Applications of the Healthy Eating Index for Surveillance, Epidemiology, and Intervention Research: considerations and caveats. J. Acad. Nutr. Diet. 118, 1603–1621 (2018).

  23. 23.

    Schwingshackl, L., Bogensberger, B. & Hoffmann, G. Diet quality as assessed by the Healthy Eating Index, Alternate Healthy Eating Index, dietary approaches to stop hypertension score, and health outcomes: an updated systematic review and meta-analysis of cohort studies. J. Acad. Nutr. Diet. 118, 74–100.e11 (2018).

  24. 24.

    Liese, A. D. et al. The Dietary Patterns Methods Project: synthesis of findings across cohorts and relevance to dietary guidance. J. Nutr. 145, 393–402 (2015).

  25. 25.

    Richman, E. L. et al. Fat intake after diagnosis and risk of lethal prostate cancer and all-cause mortality. JAMA Intern. Med. 173, 1318–1326 (2013).

  26. 26.

    Frattaroli, J. et al. Clinical events in prostate cancer lifestyle trial: results from two years of follow-up. Urology 72, 1319–1323 (2008).

  27. 27.

    Parsons, J. K. et al. Men’s Eating and Living (MEAL) study (CALGB 70807 [Alliance]): recruitment feasibility and baseline demographics of a randomized trial of diet in men on active surveillance for prostate cancer. BJU Int. 121, 534–539 (2018).

  28. 28.

    Parsons, J. et al. LBA19 The Men’s Eating and Living (MEAL) Study (CALGB 70807 [Alliance]): a randomized clinical trial of a diet intervention in men on active surveillance for prostate cancer. J. Urol. 199, e1077–e1077. (2018).

  29. 29.

    Fernandes, J. V. et al. The role of the mediators of inflammation in cancer development. Pathol. Oncol. Res. 21, 527–534 (2015).

  30. 30.

    Kris-Etherton, P. M. et al. Bioactive compounds in foods: their role in the prevention of cardiovascular disease and cancer. Am. J. Med. 113(Suppl. 9B), 71s–88s (2002).

  31. 31.

    Huang, M. et al. Diet-induced alteration of fatty acid synthase in prostate cancer progression. Oncogenesis 5, e195 (2016).

  32. 32.

    Xu H. et al. Proinflammatory cytokines in prostate cancer development and progression promoted by high-fat diet. BioMed Res. Int. 2015, 249741 (2015).

  33. 33.

    Xu, H., Jiang, H. W. & Ding, Q. Insulin-like growth factor 1 related pathways and high-fat diet promotion of transgenic adenocarcinoma mouse prostate (TRAMP) cancer progression. Actas Urol. Esp. 39, 161–168 (2015).

  34. 34.

    Davies, N. J., Batehup, L. & Thomas, R. The role of diet and physical activity in breast, colorectal, and prostate cancer survivorship: a review of the literature. Br. J. Cancer 105(Suppl. 1), S52–S73 (2011).

  35. 35.

    Aronson, W. J. et al. Growth inhibitory effect of low fat diet on prostate cancer cells: results of a prospective, randomized dietary intervention trial in men with prostate cancer. J. Urol. 183, 345–350 (2010).

  36. 36.

    Hackshaw-McGeagh, L. E. et al. A systematic review of dietary, nutritional, and physical activity interventions for the prevention of prostate cancer progression and mortality. Cancer Causes Control 26, 1521–1550 (2015).

  37. 37.

    Lin, P. H., Aronson, W. & Freedland, S. J. Nutrition, dietary interventions and prostate cancer: the latest evidence. BMC Med. 13, 3 (2015).

  38. 38.

    Er, V. et al. Post-diagnosis serum insulin-like growth factors in relation to dietary and lifestyle changes in the Prostate testing for cancer and Treatment (ProtecT) trial. Cancer Causes Control 28, 877–888 (2017).

  39. 39.

    Vidal, A. C. & Freedland, S. J. Obesity and prostate cancer: a focused update on active surveillance, race, and molecular subtyping. Eur. Urol. 72, 78–83 (2017).

  40. 40.

    Rider, J. R. et al. Long-term outcomes among noncuratively treated men according to prostate cancer risk category in a nationwide, population-based study. Eur. Urol. 63, 88–96 (2013).

  41. 41.

    Hamdy, F. C. et al. 10-Year outcomes after monitoring, surgery, or radiotherapy for localized prostate cancer. N. Engl. J. Med. 375, 1415–1424 (2016).

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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.

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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 (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.


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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