title: Adherence to dietary and lifestyle recommendations and prostate cancer risk in the prostate testing for cancer and treatment (ProtecT) trial.
abstract: BACKGROUND
  The World Cancer Research Fund (WCRF) and the American Institute for Cancer Research (AICR) published eight recommendations for cancer prevention, but they are not targeted at prostate cancer prevention. We investigated whether adherence to the WCRF/AICR recommendations and a prostate cancer dietary index is associated with prostate cancer risk.
  
  
  METHODS
  We conducted a nested case-control study of 1,806 prostate-specific antigen (PSA)-detected prostate cancer cases and 12,005 controls in the ProtecT trial. We developed a prostate cancer dietary index by incorporating three dietary factors most strongly associated with prostate cancer. Scores were computed to quantify adherence to the WCRF/AICR recommendations and the prostate cancer dietary index separately.
  
  
  RESULTS
  The prostate cancer dietary index score was associated with decreased risk of prostate cancer [OR per 1 score increment: 0.91; 95% confidence interval (CI): 0.84-0.99; Ptrend = 0.04] but the WCRF/AICR index score was not (OR: 0.99; 95% CI: 0.94-1.05; Ptrend = 0.71). There was no heterogeneity in association by prostate cancer stage (P = 0.81) or grade (P = 0.61). Greater adherence to recommendations to increase plant foods (OR per 0.25 index score increment: 0.94; 95% CI: 0.89-0.99; Ptrend = 0.02) and tomato products (OR adherence vs. nonadherence: 0.82; 95% CI: 0.70-0.97; P = 0.02) was inversely associated with overall prostate cancer risk.
  
  
  CONCLUSIONS
  Adherence to the prostate cancer-specific dietary recommendations was associated with decreased risk of prostate cancer. High intake of plant foods and tomato products in particular may help protect against prostate cancer.
  
  
  CONCLUSIONS
  Meeting the WCRF/AICR recommendations alone is insufficient for prostate cancer prevention. Additional dietary recommendations should be developed.
authors.affiliation: School of Social and Community Medicine, University of Bristol, Bristol, United Kingdom. National Institute for Health Research (NIHR) Bristol Nutrition Biomedical Research Unit, Bristol, United Kingdom. Vanessa.Er@bristol.ac.uk.
authors.forename: Vanessa
authors.initials: V
authors.lastname: Er
authors.affiliation: School of Social and Community Medicine, University of Bristol, Bristol, United Kingdom. National Institute for Health Research (NIHR) Bristol Nutrition Biomedical Research Unit, Bristol, United Kingdom.
authors.forename: J Athene
authors.initials: JA
authors.lastname: Lane
authors.affiliation: School of Social and Community Medicine, University of Bristol, Bristol, United Kingdom. National Institute for Health Research (NIHR) Bristol Nutrition Biomedical Research Unit, Bristol, United Kingdom.
authors.forename: Richard M
authors.initials: RM
authors.lastname: Martin
authors.affiliation: School of Social and Community Medicine, University of Bristol, Bristol, United Kingdom.
authors.forename: Pauline
authors.initials: P
authors.lastname: Emmett
authors.affiliation: School of Social and Community Medicine, University of Bristol, Bristol, United Kingdom.
authors.forename: Rebecca
authors.initials: R
authors.lastname: Gilbert
authors.affiliation: School of Social and Community Medicine, University of Bristol, Bristol, United Kingdom.
authors.forename: Kerry N L
authors.initials: KN
authors.lastname: Avery
authors.affiliation: School of Social and Community Medicine, University of Bristol, Bristol, United Kingdom.
authors.forename: Eleanor
authors.initials: E
authors.lastname: Walsh
authors.affiliation: School of Social and Community Medicine, University of Bristol, Bristol, United Kingdom.
authors.forename: Jenny L
authors.initials: JL
authors.lastname: Donovan
authors.affiliation: University Department of Oncology, Addenbrooke's Hospital, Cambridge, United Kingdom.
authors.forename: David E
authors.initials: DE
authors.lastname: Neal
authors.affiliation: Nuffield Department of Surgical Sciences, University of Oxford, John Radcliffe Hospital, Oxford, United Kingdom.
authors.forename: Freddie C
authors.initials: FC
authors.lastname: Hamdy
authors.affiliation: School of Social and Community Medicine, University of Bristol, Bristol, United Kingdom.
authors.forename: Mona
authors.initials: M
authors.lastname: Jeffreys
mesh_terms: D000368:Aged; D016022:Case-Control Studies; D004032:Diet; D006801:Humans; D008019:Life Style; D008297:Male; D008875:Middle Aged; D011471:Prostatic Neoplasms / Q000453:epidemiology*; D040242:Risk Reduction Behavior; D011795:Surveys and Questionnaires