A systematic review of dietary, nutritional, and physical activity interventions for the prevention of prostate cancer progression and mortality.
OBJECTIVE
Given the long-term, although potentially fatal, nature of prostate cancer, there is increasing observational evidence for the reduction in disease progression and mortality through changes in lifestyle factors.


METHODS
We systematically reviewed dietary, nutritional, and physical activity randomized interventions aimed at modifying prostate cancer progression and disease-specific mortality, including a detailed assessment of risk of bias and methodological quality.


RESULTS
Forty-four randomized controlled trials of lifestyle interventions, with prostate cancer progression or mortality outcomes, were identified. Substantial heterogeneity of the data prevented a meta-analysis. The included trials involved 3,418 prostate cancer patients, median 64 men per trial, from 13 countries. A trial of a nutritional supplement of pomegranate seed, green tea, broccoli, and turmeric; a trial comparing flaxseed, low-fat diet, flaxseed, and low-fat diet versus usual diet; and a trial supplementing soy, lycopene, selenium, and coenzyme Q10, all demonstrated beneficial effects. These trials were also assessed as having low risk of bias and high methodological quality (as were seven other trials with no evidence of benefit). The remaining trials were either underpowered, at high or unclear risk of bias, inadequately reported, of short duration or measured surrogate outcomes of unproven relationship to mortality or disease progression, which precluded any benefits reported being reliable.


CONCLUSIONS
Large, well-designed randomized trials with clinical endpoints are recommended for lifestyle modification interventions.
National Institute for Health Research (NIHR) Bristol Nutritional Biomedical Research Unit, University Hospitals Bristol NHS Foundation Trust and the University of Bristol, Bristol, BS2 8AE, UK. lucy.hackshaw@bristol.ac.uk.|School of Social and Community Medicine, University of Bristol, Bristol, BS8 2PS, UK. lucy.hackshaw@bristol.ac.uk.
Lucy E
LE
Hackshaw-McGeagh
National Institute for Health Research (NIHR) Bristol Nutritional Biomedical Research Unit, University Hospitals Bristol NHS Foundation Trust and the University of Bristol, Bristol, BS2 8AE, UK.
Rachel E
RE
Perry
School of Social and Community Medicine, University of Bristol, Bristol, BS8 2PS, UK.|Collaborative Leadership for Applied Health Research and Care (CLAHRC) West, University Hospitals Bristol NHS Foundation Trust and the University of Bristol, Bristol, BS1 3NU, UK.
Verity A
VA
Leach
School of Social and Community Medicine, University of Bristol, Bristol, BS8 2PS, UK.
Sara
S
Qandil
School of Social and Community Medicine, University of Bristol, Bristol, BS8 2PS, UK.
Mona
M
Jeffreys
National Institute for Health Research (NIHR) Bristol Nutritional Biomedical Research Unit, University Hospitals Bristol NHS Foundation Trust and the University of Bristol, Bristol, BS2 8AE, UK.|School of Social and Community Medicine, University of Bristol, Bristol, BS8 2PS, UK.
Richard M
RM
Martin
National Institute for Health Research (NIHR) Bristol Nutritional Biomedical Research Unit, University Hospitals Bristol NHS Foundation Trust and the University of Bristol, Bristol, BS2 8AE, UK.|School of Social and Community Medicine, University of Bristol, Bristol, BS8 2PS, UK.
J Athene
JA
Lane
D000368:Aged; D004032:Diet; D019587:Dietary Supplements; D018450:Disease Progression; D006801:Humans; D008019:Life Style; D008297:Male; D008875:Middle Aged; D009043:Motor Activity / Q000502:physiology*; D011471:Prostatic Neoplasms / Q000517:prevention & control*
Diet; Nutrition; Physical activity; Prostate cancer; Randomized controlled trials; Systematic review