Effect of comprehensive lifestyle changes on telomerase activity and telomere length in men with biopsy-proven low-risk prostate cancer: 5-year follow-up of a descriptive pilot study.
BACKGROUND
Telomere shortness in human beings is a prognostic marker of ageing, disease, and premature morbidity. We previously found an association between 3 months of comprehensive lifestyle changes and increased telomerase activity in human immune-system cells. We followed up participants to investigate long-term effects.


METHODS
This follow-up study compared ten men and 25 external controls who had biopsy-proven low-risk prostate cancer and had chosen to undergo active surveillance. Eligible participants were enrolled between 2003 and 2007 from previous studies and selected according to the same criteria. Men in the intervention group followed a programme of comprehensive lifestyle changes (diet, activity, stress management, and social support), and the men in the control group underwent active surveillance alone. We took blood samples at 5 years and compared relative telomere length and telomerase enzymatic activity per viable cell with those at baseline, and assessed their relation to the degree of lifestyle changes.


RESULTS
Relative telomere length increased from baseline by a median of 0·06 telomere to single-copy gene ratio (T/S)units (IQR-0·05 to 0·11) in the lifestyle intervention group, but decreased in the control group (-0·03 T/S units, -0·05 to 0·03, difference p=0·03). When data from the two groups were combined, adherence to lifestyle changes was significantly associated with relative telomere length after adjustment for age and the length of follow-up (for each percentage point increase in lifestyle adherence score, T/S units increased by 0·07, 95% CI 0·02-0·12, p=0·005). At 5 years, telomerase activity had decreased from baseline by 0·25 (-2·25 to 2·23) units in the lifestyle intervention group, and by 1·08 (-3·25 to 1·86) units in the control group (p=0·64), and was not associated with adherence to lifestyle changes (relative risk 0·93, 95% CI 0·72-1·20, p=0·57).


CONCLUSIONS
Our comprehensive lifestyle intervention was associated with increases in relative telomere length after 5 years of follow-up, compared with controls, in this small pilot study. Larger randomised controlled trials are warranted to confirm this finding.


BACKGROUND
US Department of Defense, NIH/NCI, Furlotti Family Foundation, Bahna Foundation, DeJoria Foundation, Walton Family Foundation, Resnick Foundation, Greenbaum Foundation, Natwin Foundation, Safeway Foundation, Prostate Cancer Foundation.
Department of Medicine, University of California San Francisco, San Francisco, CA, USA; Preventive Medicine Research Institute, Sausalito, CA, USA. Electronic address: dean.ornish@pmri.org.
Dean
D
Ornish
Department of Biochemistry and Biophysics, University of California San Francisco, San Francisco, CA, USA.
Jue
J
Lin
Department of Urology, Helen Diller Family Comprehensive Cancer Center, School of Medicine, University of California San Francisco, San Francisco, CA, USA; Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, CA, USA.
June M
JM
Chan
Department of Psychiatry, University of California San Francisco, San Francisco, CA, USA.
Elissa
E
Epel
Preventive Medicine Research Institute, Sausalito, CA, USA.
Colleen
C
Kemp
Department of Biology, San Francisco State University, San Francisco, CA, USA.
Gerdi
G
Weidner
Preventive Medicine Research Institute, Sausalito, CA, USA.
Ruth
R
Marlin
Preventive Medicine Research Institute, Sausalito, CA, USA.
Steven J
SJ
Frenda
Department of Urology, Helen Diller Family Comprehensive Cancer Center, School of Medicine, University of California San Francisco, San Francisco, CA, USA.
Mark Jesus M
MJM
Magbanua
Department of Medicine, University of California San Francisco, San Francisco, CA, USA.
Jennifer
J
Daubenmier
Preventive Medicine Research Institute, Sausalito, CA, USA.
Ivette
I
Estay
Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, CA, USA.
Nancy K
NK
Hills
Department of Orofacial Sciences, University of California San Francisco, San Francisco, CA, USA.
Nita
N
Chainani-Wu
Department of Urology, Helen Diller Family Comprehensive Cancer Center, School of Medicine, University of California San Francisco, San Francisco, CA, USA.
Peter R
PR
Carroll
Department of Biochemistry and Biophysics, University of California San Francisco, San Francisco, CA, USA.
Elizabeth H
EH
Blackburn
D000368:Aged; D016022:Case-Control Studies; D004247:DNA / Q000032:analysis / Q000235:genetics; D004032:Diet; D015444:Exercise; D005500:Follow-Up Studies; D006801:Humans; D008019:Life Style; D008297:Male; D008875:Middle Aged; D010865:Pilot Projects; D016133:Polymerase Chain Reaction; D011379:Prognosis; D011471:Prostatic Neoplasms / Q000201:enzymology / Q000235:genetics / Q000628:therapy*; D019098:Telomerase / Q000235:genetics*; D059505:Telomere Homeostasis / Q000235:genetics*
D004247:DNA; C509186:TERT protein, human; D019098:Telomerase