Lifestyle and health-related quality of life of men with prostate cancer managed with active surveillance.

OBJECTIVES: To assess the impact of lifestyle on health-related quality of life (HR-QOL), perceived stress, and self-reported sexual function in men with early-stage prostate cancer electing active surveillance. METHODS: A total of 44 intervention and 49 usual-care control participants were enrolled in a randomized clinical trial examining the effects of lifestyle changes on prostate cancer progression. The intervention consisted of a low-fat, vegan diet, exercise, and stress management. Participants completed the Medical Outcomes Study Short Form-36 Health Status Survey (a measure of mental and physical HR-QOL), the Perceived Stress Scale, the Sexual Function subscale of the University of California, Los Angeles, Prostate Cancer Index, and measures of lifestyle behaviors (to yield an overall lifestyle index) at baseline and 12 months. The data were analyzed using analysis of variance for repeated measures. The relationship between lifestyle and QOL was also analyzed using multiple linear regression analyses. RESULTS: Intervention participants had significantly improved their lifestyle compared with controls at 12 months. The quality-of-life scores were high across groups and time points. However, a healthier lifestyle was related to better QOL at baseline. Participants in both groups who reported a healthier lifestyle also reported better mental and physical HR-QOL and sexual function. Furthermore, participants whose lifestyle improved over time showed enhanced physical HR-QOL and decreased perceived stress. CONCLUSIONS: Men who choose active surveillance for early-stage prostate cancer are able to make comprehensive lifestyle changes. Although the average QOL was already high in this sample, individuals who improved their lifestyle enhanced their QOL further.

Nutrient adequacy of a very low-fat vegan diet.

This study assessed the nutrient adequacy of a very low-fat vegan diet. Thirty-nine men (mean age=65 years) with early stage prostate cancer who chose the "watchful waiting" approach to disease management, were instructed by a registered dietitian and a chef on following a very low-fat (10%) vegan diet with the addition of a fortified soy protein powdered beverage. Three-day food diaries, excluding vitamin and mineral supplements, were analyzed and nutrient values were compared against Dietary Reference Intakes (DRI). Mean dietary intake met the recommended DRIs. On the basis of the Adequate Intake standard, a less than adequate intake was observed for vitamin D. This demonstrates that a very low-fat vegan diet with comprehensive nutrition education emphasizing nutrient-fortified plant foods is nutritionally adequate, with the exception of vitamin D. Vitamin D supplementation, especially for those with limited sun exposure, can help assure nutritional adequacy.

Intensive lifestyle changes may affect the progression of prostate cancer.

PURPOSE: Men with prostate cancer are often advised to make changes in diet and lifestyle, although the impact of these changes has not been well documented. Therefore, we evaluated the effects of comprehensive lifestyle changes on prostate specific antigen (PSA), treatment trends and serum stimulated LNCaP cell growth in men with early, biopsy proven prostate cancer after 1 year. MATERIALS AND METHODS: Patient recruitment was limited to men who had chosen not to undergo any conventional treatment, which provided an unusual opportunity to have a nonintervention randomized control group to avoid the confounding effects of interventions such as radiation, surgery or androgen deprivation therapy. A total of 93 volunteers with serum PSA 4 to 10 ng/ml and cancer Gleason scores less than 7 were randomly assigned to an experimental group that was asked to make comprehensive lifestyle changes or to a usual care control group. RESULTS: None of the experimental group patients but 6 control patients underwent conventional treatment due to an increase in PSA and/or progression of disease on magnetic resonance imaging. PSA decreased 4% in the experimental group but increased 6% in the control group (p = 0.016). The growth of LNCaP prostate cancer cells (American Type Culture Collection, Manassas, Virginia) was inhibited almost 8 times more by serum from the experimental than from the control group (70% vs 9%, p <0.001). Changes in serum PSA and also in LNCaP cell growth were significantly associated with the degree of change in diet and lifestyle. CONCLUSIONS: Intensive lifestyle changes may affect the progression of early, low grade prostate cancer in men. Further studies and longer term followup are warranted.