title: Pilot study of dietary fat restriction and flaxseed supplementation in men with prostate cancer before surgery: exploring the effects on hormonal levels, prostate-specific antigen, and histopathologic features.
abstract: OBJECTIVE
  Dietary fat and fiber affect hormonal levels and may influence cancer progression. Flaxseed is a rich source of lignan and omega-3 fatty acids and may thwart prostate cancer. The potential effects of flaxseed may be enhanced with concomitant fat restriction. We undertook a pilot study to explore whether a flaxseed-supplemented, fat-restricted diet could affect the biomarkers of prostatic neoplasia.
  
  
  METHODS
  Twenty-five patients with prostate cancer who were awaiting prostatectomy were instructed on a low-fat (20% of kilocalories or less), flaxseed-supplemented (30 g/day) diet. The baseline and follow-up levels of prostate-specific antigen, testosterone, free androgen index, and total serum cholesterol were determined. The tumors of diet-treated patients were compared with those of historic cases (matched by age, race, prostate-specific antigen level at diagnosis, and biopsy Gleason sum) with respect to apoptosis (terminal deoxynucleotidyl transferase [TdT]-mediated dUTP-biotin nick end-labeling [TUNEL]) and proliferation (MIB-1).
  
  
  RESULTS
  The average duration on the diet was 34 days (range 21 to 77), during which time significant decreases were observed in total serum cholesterol (201 +/- 39 mg/dL to 174 +/- 42 mg/dL), total testosterone (422 +/- 122 ng/dL to 360 +/- 128 ng/dL), and free androgen index (36.3% +/- 18.9% to 29.3% +/- 16.8%) (all P <0.05). The baseline and follow-up levels of prostate-specific antigen were 8.1 +/- 5.2 ng/mL and 8.5 +/- 7.7 ng/mL, respectively, for the entire sample (P = 0.58); however, among men with Gleason sums of 6 or less (n = 19), the PSA values were 7.1 +/- 3.9 ng/mL and 6.4 +/- 4.1 ng/mL (P = 0.10). The mean proliferation index was 7.4 +/- 7.8 for the historic controls versus 5.0 +/- 4.9 for the diet-treated patients (P = 0.05). The distribution of the apoptotic indexes differed significantly (P = 0.01) between groups, with most historic controls exhibiting TUNEL categorical scores of 0; diet-treated patients largely exhibited scores of 1. Both the proliferation rate and apoptosis were significantly associated with the number of days on the diet (P = 0.049 and P = 0.017, respectively).
  
  
  CONCLUSIONS
  These pilot data suggest that a flaxseed-supplemented, fat-restricted diet may affect prostate cancer biology and associated biomarkers. Further study is needed to determine the benefit of this dietary regimen as either a complementary or preventive therapy.
authors.affiliation: Division of Urologic Surgery, Duke University Medical Center, Durham, North Carolina, USA.
authors.forename: W
authors.initials: W
authors.lastname: Demark-Wahnefried
authors.forename: D T
authors.initials: DT
authors.lastname: Price
authors.forename: T J
authors.initials: TJ
authors.lastname: Polascik
authors.forename: C N
authors.initials: CN
authors.lastname: Robertson
authors.forename: E E
authors.initials: EE
authors.lastname: Anderson
authors.forename: D F
authors.initials: DF
authors.lastname: Paulson
authors.forename: P J
authors.initials: PJ
authors.lastname: Walther
authors.forename: M
authors.initials: M
authors.lastname: Gannon
authors.forename: R T
authors.initials: RT
authors.lastname: Vollmer
mesh_terms: D000328:Adult; D000368:Aged; D001706:Biopsy; D002784:Cholesterol / Q000097:blood; D004041:Dietary Fats; D019587:Dietary Supplements; D019597:Flax; D005500:Follow-Up Studies; D006801:Humans; D020287:In Situ Nick-End Labeling; D008297:Male; D008875:Middle Aged; D010865:Pilot Projects; D011300:Preoperative Care; D017430:Prostate-Specific Antigen / Q000032:analysis; D011471:Prostatic Neoplasms / Q000178:diet therapy* / Q000473:pathology / Q000601:surgery; D013739:Testosterone / Q000097:blood
chemical_list: D004041:Dietary Fats; D013739:Testosterone; D002784:Cholesterol; D017430:Prostate-Specific Antigen