title: Mediterranean diet and prostate cancer risk and mortality in the Health Professionals Follow-up Study.
abstract: BACKGROUND
  Prostate cancer (PCa) mortality rates are lower in the Mediterranean countries compared with northern Europe. Although specific components of the Mediterranean diet (Med-Diet) may influence PCa risk, few studies have assessed the traditional Med-Diet pattern with the risk of incident advanced or lethal PCa or with disease progression among men diagnosed with nonmetastatic PCa.
  
  
  OBJECTIVE
  To determine whether the traditional Med-Diet pattern is associated with risk of incident advanced or lethal PCa and with PCa-specific and overall mortality among men with PCa.
  
  
  METHODS
  We prospectively followed 47 867 men in the Health Professionals Follow-up Study followed from 1986 to 2010. The case-only analysis included 4538 men diagnosed with nonmetastatic PCa, followed from diagnosis to lethal outcome or to January 2010.
  
  
  METHODS
  We used Cox proportional hazards models to examine traditional and alternative Med-Diet scores in relation to PCa incidence outcomes (advanced and lethal disease). In a case-only survival analysis, we examined postdiagnostic Med-Diet and risk of lethal (metastases or PCa death) and fatal PCa as well as overall mortality among men diagnosed with nonmetastatic disease.
  
  
  CONCLUSIONS
  Between 1986 and 2010, 6220 PCa cases were confirmed. The Med-Diet was not associated with risk of advanced or lethal PCa. In the case-only analysis, there was no association between the Med-Diet after diagnosis and risk of lethal or fatal PCa. However, there was a 22% lower risk of overall mortality (hazard ratio: 0.78; 95% confidence interval, 0.67-0.90; p(trend)=0.0007) among men with greater adherence to the Med-Diet after PCa diagnosis. We found similar associations for the alternative score.
  
  
  CONCLUSIONS
  A higher Med-Diet score was not associated with risk of advanced PCa or disease progression. Greater adherence to the Med-Diet after diagnosis of nonmetastatic PCa was associated with lower overall mortality.
authors: Department of Urology, University of California, San Francisco, San Francisco, CA, USA; Department of Epidemiology, Harvard School of Public Health, Boston, MA, USA. Electronic address: KenfieldS@urology.ucsf.edu.
authors: Stacey A
authors: SA
authors: Kenfield
authors: Department of Epidemiology, Harvard School of Public Health, Boston, MA, USA.
authors: Natalie
authors: N
authors: DuPre
authors: Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, CA, USA.
authors: Erin L
authors: EL
authors: Richman
authors: Department of Epidemiology, Harvard School of Public Health, Boston, MA, USA; Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA; Department of Nutrition, Harvard School of Public Health, Boston, MA, USA.
authors: Meir J
authors: MJ
authors: Stampfer
authors: Department of Urology, University of California, San Francisco, San Francisco, CA, USA; Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, CA, USA.
authors: June M
authors: JM
authors: Chan
authors: Department of Epidemiology, Harvard School of Public Health, Boston, MA, USA; Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA; Department of Nutrition, Harvard School of Public Health, Boston, MA, USA.
authors: Edward L
authors: EL
authors: Giovannucci
mesh_terms: D000328:Adult; D000368:Aged; D038441:Diet, Mediterranean / Q000009:adverse effects*; D005500:Follow-Up Studies; D006282:Health Personnel / Q000706:statistics & numerical data*; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D010349:Patient Compliance; D016016:Proportional Hazards Models; D011446:Prospective Studies; D011471:Prostatic Neoplasms / Q000453:epidemiology* / Q000401:mortality / Q000473:pathology; D012307:Risk Factors; D014481:United States / Q000453:epidemiology
keywords: Epidemiology; Mediterranean diet; Mortality; Prostate cancer; Risk
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