Diet, Exercise + Prostate Cancer
This interview, “Diet, Exercise + Prostate Cancer,” is provided by Grand Rounds in Urology’s content partner, Prostatepedia.
Dr. Stacey Kenfield an epidemiologist and associate professor in the Urology Department at the University of California, San Francisco who explores through her research how dietary and lifestyle factors impact both the risk of aggressive prostate cancer as well as the risk of prostate cancer progression.
Prostatepedia spoke with her about diet, lifestyle, and prostate cancer.
What kinds of diet, exercise, and lifestyle recommendations do you and your team at UCSF make for men with prostate cancer about to undergo surgery, radiation therapy, or androgen deprivation therapy (ADT)?
Dr. Kenfield: There are a number of factors studied in men with localized prostate cancer that have been associated with lowering risk of prostate cancer progression. This list includes: • not smoking, or quitting. If you smoke • maintaining a healthy BMI, <25 kg/m2 • aerobic exercise, as vigorous as possible, for three or more hours per week. Exercise meets the ‘vigorous’ definition when you’re breathing hard, your heart rate is elevated, and you can’t say more than a few words without pausing for breath. Jogging, running, hiking uphill, singles tennis, and racquetball are some activities that are considered vigorous. If you are not doing vigorous exercise, aim for at least four – five hours of moderate activity, such as brisk walking, to get your heart rate up. Keep in mind that light aerobic exercise includes activities that do not cause you to break a sweat or produce shortness of breath, and the goal is to do more than this. You want to at least be in the moderate exercise heart rate zones, where you are working hard enough to raise your heart rate and break a sweat but can still talk in complete sentences. • tomato intake, preferably cooked tomatoes, because these have more bioavailable lycopene • fish intake, at least two servings a week • reducing processed meats when possible • reducing whole-fat dairy products, like whole milk, when possible • cruciferous vegetable intake, like broccoli, cauliflower, Brussels sprouts, and kale, one serving a day • healthy vegetable fats, such as nuts and olive oil, one serving a day • not taking supplements unless you are deficient, or it’s specifically recommended by your physician. Certain supplements are associated with an increased risk of progression (such as selenium) in people with adequate levels.
There are other food choices that are beneficial for overall health, such as eating a variety of fruits and vegetables (preferably five or more servings of vegetables and two-three servings of fruit daily), reducing intake of red meat, eating more whole grain versus refined grain products, and drinking a lot of water, rather than sugar-sweetened beverages, such as lemonade, iced tea, soda, and sports drinks.
What kinds of diet and lifestyle recommendations do you and your team make for men whose cancers are under control—especially in light of possible comorbidities?
Dr. Kenfield: The same diet above applies. The studies I’m referring to included treated and non-treated men and adjusted for the type of prostate cancer treatment in the analysis.
Do you or your team at UCSF have any open and enrolling clinical trials looking at diet, exercise, and lifestyle + prostate cancer treatment and/or survivorship issues?
Dr. Kenfield: Yes, we have many! Open Studies at UCSF for Men with Prostate Cancer & Other Cancers:
1) For Active Surveillance Prostate Cancer Patients
AS Exercise RCT: A Randomized Clinical Trial of Exercise versus Usual Care among Men Opting for Active Surveillance for Prostate Cancer. We are conducting a clinical trial of tailored exercise for men choosing active surveillance for early-stage/low-grade prostate cancer. This study is open to men who are on active surveillance for localized prostate cancer. Participants assigned to the intervention will receive a four-month home-based personalized exercise prescription, free exercise coaching, and a heart-rate monitor. Participants will be asked to come on-site two-three times; those who complete all study assessments may earn up to $500. Participants must come to the UCSF Mission Bay campus at baseline and after 16 weeks (four months later) for exercise testing.
AS Exercise Observational Study: An Observational Study of Exercise among Men Opting for Active Surveillance for Prostate Cancer
We are conducting a study of cardiopulmonary fitness among men choosing active surveillance for early-stage/low-grade prostate cancer. This study is open to men who are on active surveillance for localized prostate cancer. Participants who complete the onetime study assessment will receive $100. This study only requires one visit.
2) For Radical Prostatectomy Prostate Cancer Patients (join prior to surgery)
Prostate 8 Study – II: A Randomized Controlled Trial of Diet & Exercise Interventions among Men with Prostate Cancer – II
Our UCSF research team has developed diet and exercise programs specifically geared toward men with prostate cancer. The purpose of this study is to determine whether a two – year wellness program focused on diet and exercise improves biological, clinical, and quality of life outcomes in men choosing surgery as primary treatment for prostate cancer. Men will enroll prior to radical prostatectomy and are followed for two years. If you participate in this study, you will be randomly assigned to one of four study groups that will receive different educational and supportive tools. All men will receive a nine-week text messaging program focused on your recovery after radical prostatectomy surgery. Those who complete all study assessments may earn up to $250. Men are required to have at least one study visit at the UCSF Mission Bay campus prior to surgery and attend study visits at six months and 24 months. The 12-month study visit can be completed at a LabCorp near you.
3) For Metastatic Castrate-Resistant Prostate Cancer Patients (mCRPC)
CHAMP: A Randomized Controlled Trial of High-intensity Aerobic and Resistance Exercise for Metastatic Prostate Cancer
We are conducting a clinical trial of tailored remote-based exercise for men with advanced prostate cancer to examine the feasibility of this remote format as well as clinical outcomes and quality of life. Participants assigned to an intervention group (aerobic or resistance exercise) will receive a three-month personalized exercise prescription and exercise three times per week at a local gym (with remote monitoring by an exercise specialist). All participants will receive a consultation with an exercise specialist. Those who complete all study assessments may earn up to $100. Participants must come to the UCSF Mission Bay campus at baseline and after 12 weeks (three months later) for exercise testing.
4) For Individuals with a Diagnosis of Prostate, Colorectal, or Bladder Cancer Seeking Participants for Future Study on Diet, Exercise, Sleep & Cancer we are studying if diet, exercise, or other lifestyle habits may slow cancer progression and improve survival in individuals with cancer. We are seeking participants from around the country.
What does it mean to participate?
Dr. Kenfield: • You will be asked to complete surveys on lifestyle behaviors such as diet, exercise, sleep quality, cancer diagnosis and management, other health conditions, and quality of life. • Surveys may be done spread out over time and may take a total of four hours each year. • With permission, we will routinely collect data from your medical records on cancer and other health outcomes. • This type of research takes a long time, and we would like to follow your health status with cancer over time.
• You may opt to not answer questions or surveys or withdraw from the study at any time.
Who can participate?
Dr. Kenfield: Individuals with a diagnosis of prostate, colorectal, or bladder cancer who are able to complete surveys in English and can access the internet with a computer, tablet, or smartphone. In the future, we plan to expand this to individuals with other types of cancer.
If you are interested to learn more or receive information about this study when it is open to enrollment, or want to participate in any of our open studies, please contact us at 415-353-7348 or email: imelda.tenggara@ucsf.edu or urologyresearch@ucsf.edu
Are there any other enrolling clinical trials elsewhere looking at diet, exercise, and lifestyle in men with prostate cancer that you think look exciting?
Dr. Kenfield: The largest (and only) randomized controlled phase III trial of exercise and survival in men with advanced cancer is underway and enrolling in seven countries and at 19 sites and counting. If you live near one of the sites and have metastatic prostate cancer, I encourage you to find out more and participate. We hope to learn whether exercise increases overall survival, and impacts biological, clinical, and quality of life outcomes – if so, this would support exercise being offered as adjunctive therapy along with standard therapy for men with advanced cancer. Please go to https://gap4. movemberprojects.com/ to learn more about the study, and hear from patients who are part of the study and investigators who are conducting the study around the world.
Regarding other studies, there are many open studies that can be explored on clinicaltrials.gov — to search for studies, search under “Prostate Cancer” and add “exercise” as another search term and select “recruiting.” There are over 50 exercise-focused studies recruiting in the U.S. and abroad, and 40 studies focused on dietary factors using these same search parameters. I encourage everyone to be part of one of these trials, so that these trials can enroll quickly and publish their findings as soon as possible to advance the literature and improve survivorship for all.
Going forward, what kinds of research on diet, exercise, and lifestyle would you like to see—i.e. are there any clinical trials that you would like to see launched?
Dr. Kenfield: I’d like to see a large lifestyle-based trial focused on both diet and exercise and clinical outcomes (like disease progression). There are many trials focused on quality of life, and while good, we need more that have a longer duration that focus on clinical outcomes. These are outcomes that tend to occur much farther into the future. Those types of studies are difficult to do within the context of a 5-year grant, so other mechanisms would need to support that type of research. That’s why the Movember Foundation’s Intense Exercise for Survival among Men with Metastatic Castrate-Resistant Prostate Cancer (INTERVAL-GAP4) trial is so important, because this study would not have been possible within a five-year timeframe and with the number of institutions that are involved.
Do you have any diet, exercise, and lifestyle recommendations for the male relatives of men with prostate cancer? What about those without a family history of prostate cancer?
Dr. Kenfield: I’m glad you asked! There have been many studies evaluating diet and lifestyle in men without prostate cancer and risk of developing lethal prostate cancer (which has included either developing metastasis to bones or other organs, excluding lymph nodes, or dying from prostate cancer). We’ve developed and published on a six-factor score, based on a review of the literature at the time. The score included: • Three or more hours/week of vigorous activity and/or seven or more hours/week of brisk walking • Seven or more servings of tomatoes (raw or cooked were included) • One or more servings per week of fish • <Three servings/week of processed meat • BMI (body mass index) less than 30 • Never smoked or quit smoking 10 or more years ago.
Those men doing five or six (compared to none or 1) of these factors had a 68% decreased risk of developing lethal prostate cancer. Considering the dietary factors only, those doing three vs. zero of these factors had a 46% decreased risk of lethal prostate cancer. The same dietary recommendations we make for people with prostate cancer now (see above, first question), would be just as helpful for someone without prostate cancer trying to reduce their risk for developing advanced prostate cancer.
How do you suggest that people make these changes?
Dr. Kenfield: It can seem overwhelming to make a lot of changes at once. Commit to small, sustainable improvements, and gradually make them bigger. If you get off track, get back on track as soon as possible, so that your one or two off days don’t become a new, unwanted habit. And always have a support partner – a friend, family member, or prostate cancer support group member – someone in your life who knows what you are trying to achieve and can support you in making that change. There are a lot of prostate cancer support groups throughout the country, and I spent my spring of 2019 speaking with many members of prostate cancer support groups in 13 U.S. states, to learn what they are doing, in terms of their lifestyle, after their diagnosis. Many of these men did not know about the association between lifestyle behaviors (exercise, diet, and not smoking) and prostate cancer outcomes. It’s critical that we share this knowledge so that every man with prostate cancer knows what they can do to improve their prostate cancer outcomes. Men can access our free materials on our UCSF website. All downloaded materials can be used freely with the proviso that full acknowledgement is made to the publication (Diet and lifestyle considerations for patients with prostate cancer.
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