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Prostate Cancer Prevention and Diet

Prostate Cancer Prevention and Diet

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Prostate Cancer Prevention and Diet

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  1. Prostate Cancer Prevention and Diet Dr Manish Patel Urological Cancer Surgeon Westmead Hospital University of Sydney

  2. Some Relevant Factors • Family History of Prostate CancerBratt, 2007 • 1 First Degree Relative X2 • 3 First Degree Relative X11 • Breast Cancer BRCA1 & BRCA2 gene mutations Lorenzo et al, 2004; Kirchhoff et al, 2004; van Asperen et al, 2005 • Number of SNPs related to prostate cancer. • Genetic test for prostate cancer is available.

  3. Established medications Aspirin & NSAIDS • Thought to act predominantly via COX-2 pathway • Almost all studies indicate a significant reduction in prostate cancer incidenceRoberts et al, 2002; Habel et al, 2002; Jacobs et al, 2007 • Approximately 25-40% reduction in prostate Cancer Risk.. 5-α-reductase inhibitors • Prostate Cancer Prevention Trial – reduced prostate cancer development but increased incidence of Gleason 7-10 tumours Thompson et al, 2003

  4. Vitamins Multivitamins • NIH Diet & Health Study (10 241/ 295 344) – no overall reduction in incidence at 5 years but increased rate of advanced & fatal disease >7 times/weekLawson et al, 2007 Vitamin E • Randomised trial in smokers showed a 31% reduction in incidence and 41% reduction in Prostate Cancer Mortality.Heinonen et al, 1998; Chan et al, 1999; Helzlouer et al, 2000; Virtamo et al, 2004; Rodriguez et al, 2004; Kirsh et al, 2006 Vitamin D • No protection in 4 studies for dietary or supplemental vit D Giovannucci et al, 1998; Chan et al, 1998; Kirstal et al, 2002; Chan et al, 2000 • FokI ff genotype more susceptible if vit D status is low in Physicians Health Study Li et al, 2007

  5. Other supplements Calcium • Evidence is contradictory Giovannucci et al1998; Chan et al, 2001; Krystal et al, 2002; Rodriguez et al, 2003; Baron et al, 2005 • Meta-analysis of 11 case-control studies – high levels of milk/dairy products increased risk Qin et al, 2004 Selenium • Prostate cancer incidence reduced in randomised Nutritional Prevention of Cancer Trial Clark et al 1996; Duffield-Lillico et al, 2003and • Netherlands Cohort Study van den Brandt et al, 2003 Zinc • Evidence is highly conflicting indicating both increased risk of advanced disease & lower risk of cancerKey et al, 1997; Kolonel et al, 1998; Krystal et al, 1999; Leitzmann et al, 2003

  6. Lycopene & soy/isoflavones Lycopene • Protective effect Prospective case-control studyGann et al, 1999and Health Professional Follow-up Study Giovannucci et al,2002but only for men >65 and no family history Wu et al, 2004 • No Protective effect Netherlands Cohort StudySchuurman et al, 2002and Prostate, Lung, Colorectal and Ovarian Cancer Screening Trail Peters et al, 2007 Soy/isoflavones • Observational studies relate increased intake with low cancer incidenceSverson et al, 1989; Aldercreutz et al, 1993; Herbert et al, 1998; Jacobsen et al, 1998

  7. Fish and Meat Fish • Omega-3 fatty acids considered to provide a protective roleZock & Katan, 1998; Schuurman et al, 1999 • A low or lack of consumption associated with 2-3 fold higher frequency of disease Terry et al, 2001 • Fish >3 times/week associated with a reduced risk of metastatic disease Augustsson et al, 2003 Red meat • Mode of actions via mutagens resulting in ROS and activation of arachidonic pathwayShackelford et al, 1999; Esposito et al, 2000; Chetcuti et al, 2001 • Majority of case-control and cohort studies show a positive correlation with disease development De Stephani et al, 2000; Ramon et al, 2000; Lee et al, 2000; Chan et al, 2000

  8. Other preparations Epilobium & Serenoa Repens • No clinical evidence found to support a benefit • Saw palmetto administered to TRAMP mice resulted in significant decrease in tumour grade and incidence Wadsworth et al, 2007 Potential unproven candidates • sulforaphane, a constituent of several edible cruciferous vegetablesHerman- Antosiewicz, 2006 • CurcuminJagetia & Aggarwal, 2007 • Pomegranate Adhami & Mukhtar, 2006

  9. Green Tea & Red Wine • Benefit through polyphenols which induce apoptosis & inhibit proliferationLee et al, 2006 • Chinese case-control study showed aprotective effect of green tea with synergy for lycopene Jian et al 2007but no benefit for green tea in a Japanese study Kikuchi et al 2006 • Combined inhibitory effects of green tea polyphenols and selective COX-2 inhibitors in-vitro & in-vivo Adhami et al, 2007 • Benefits from red wine due to the polyphenol Resveratrol • Slightly lower risks for <4 glasses of red wine/week but null or slightly increased risks for >4 in Health Professionals Follow-up Study Sutcliffe et al, 2006

  10. Conclusions • Data on diet and prevention is incomplete • Some strategies can do harm • Need to keep an open mindand seek more convincing evidence ‘for’ and ‘against’