Epidemiological evidence linking food, nutrition, physical activity and prostate cancer risk: results from the Continuous Update Project

World Cancer Congress, Saturday 6 December 2014 Michael Leitzmann Dept. of Epidemiology and Preventive Medicine, University of Regensburg Continuous Update Project Panel member

Mortality

Incidence

GLOBOCAN 2012 (IARC) http://globocan.iarc.fr

Prostate cancer incidence and mortality

Sub-­‐Saharan  Africa  Middle  East  &  North  Africa  

East  &  Central  Asia  

India  China  

Oceania  La<n  America  &  the  Caribbean  

North  America  

Sub-­‐Saharan  Africa  

Europe  

Sub-­‐Saharan  Africa  

Middle  East  &  North  Africa  

East  &  Central  Asia  

India  

China  Oceania  

La<n  America  &  the  Caribbean  

North  America  

Europe  

World Cancer Report (IARC 2014)

Prostate cancer incidence Prostate cancer mortality

FOOD, NUTRITION, PHYSICAL ACTIVITY, AND CANCER OF THE PROSTATE

Level of evidence

Limited-suggestive

DECREASES RISK INCREASES RISK

Limited-no conclusion

Probable

Convincing

Substantial effect on risk unlikely

Foods containing lycopene Foods containing selenium Selenium

Diets high in calcium

Pulses (legumes) Foods containing vitamin E Alpha-tocopherol

Processed meat Milk and dairy products

Beta-carotene

Cereals (grains) and their products; dietary fibre; potatoes; non-starchy vegetables; fruits; meat; poultry; fish; eggs; total fat; plant oils; sugar (sucrose); sugary foods and drinks; coffee; tea; alcohol; carbohydrate; protein; vitamin A; retinol; thiamin; riboflavin; niacin; vitamin C; vitamin D; gamma-tocopherol; vitamin supplements; multivitamins; iron; phosphorus; zinc; other carotenoids; physical activity; energy expenditure; vegetarian diets; Seventh-day Adventist diets; body fatness; abdominal fatness; birth weight; energy intake

DIET, NUTRITION, PHYSICAL ACTIVITY AND PROSTATE CANCER

Limited-suggestive

DECREASES RISK INCREASES RISK

Limited-no conclusion

Probable

Convincing

Substantial effect on risk unlikely

Body fatness (advanced prostate cancer) Adult attained height Dairy products Diets high in calcium Low plasma alpha-tocopherol concentrations Low plasma selenium concentrations

Beta-carotene

LIMITED EVIDENCE

STRONG EVIDENCE

STRONG EVIDENCE

Cereals (grains) and their products, dietary fibre, potatoes, non-starchy vegetables, fruits, pulses (legumes), processed meat, red meat, poultry, fish, eggs, total fat, saturated fatty acids, monounsaturated fatty acids, polyunsaturated fatty acids, plant oils, sugar (sucrose), sugary foods and drinks, coffee, tea, alcoholic drinks, carbohydrate, protein, vitamin A, retinol, alpha carotene, lycopene, folate, thiamin, riboflavin, niacin, vitamin C, vitamin D, vitamin E supplements, gamma tocopherol, multivitamins, selenium supplements, iron, phosphorus, calcium supplements, zinc, protein, physical activity, energy expenditure, vegetarian diets, Seventh-day Adventist diets, individual dietary patterns, body fatness (non-advanced prostate cancer), birth weight, energy intake

Prostate Cancer Report 2014 Published 19 November 2014

Prospective studies Randomized controlled trials

0 200 400 600 800

Breast Colorectal

Prostate Lung

Stomach Pancreas

Liver Bladder

Endometrial Ovary

Kidney Oesophageal

Polyps Gallbladder

2005 SLR

CUP

0 10 20 30 40 50

Polyps Lung

Stomach Prostate

Colorectal Breast

Bladder Pancreas

Endometrial Kidney Ovary

Oesophageal Liver

Gallbladder

Report available at: http://www.wcrf.org/int/research-we-fund/continuous-update-project-findings-reports/prostate-cancer

104 papers included in the report

RR=1.08 (1.04-1.12) Studies: 23

BMI Waist circumference Waist to hip ratio

RR=0.99 (0.90-1.09) Studies: 4

RR=0.95 (0.92-0.98) Studies: 14

Adv

ance

d N

on-a

dvan

ced

RR=1.01 (0.90-1.12) Studies: 4

Body fatness and prostate cancer

RR=1.12 (1.04-1.21) Studies: 4

RR=1.15 (1.03-1.28) Studies: 4

Allott et al., Eur Urol. 2013;63(5):800–9

Obesity-related detection biases and biologic mechanisms contributing to the association between obesity and aggressive prostate cancer

RR=1.04 (1.02-1.06) Studies: 19

Adv

ance

d N

on-a

dvan

ced

Height and prostate cancer

RR=1.03 (1.01-1.05) Studies: 10

Total dairy and prostate cancer

Non

-adv

ance

d A

dvan

ced

Tota

l Fa

tal

RR=1.07 (1.02-1.11) Studies: 15

RR=1.09 (1.00-1.18) Studies: 8

RR=0.97 (0.91-1.05) Studies: 10

RR=1.11 (0.92-1.33) Studies: 5

Total calcium and prostate cancer

RR=1.01 (0.98-1.03) Studies: 6

Non

-adv

ance

d A

dvan

ced

RR=1.03 (0.99-1.07) Studies: 7

Tota

l Fa

tal

RR=1.02 (1.01-1.04) Studies: 9

RR=1.11 (1.02-1.21) Studies: 2

RR=1.03 (1.00-1.07) Studies: 2

Non

-ad

vanc

ed

Adv

ance

d

RR=1.05 (0.96-1.15) Studies: 2

Tota

l Fa

tal

RR=1.06 (1.02-1.09) Studies: 6

RR=1.05 (0.69-1.60) Studies: 2

RR=0.97 (0.79-1.20) Studies: 2

Non

-ad

vanc

ed

Adv

ance

d

RR=1.09 (0.89-1.34) Studies: 2

Tota

l

RR=0.97 (0.90-1.04) Studies: 4

Dairy calcium and non-dairy calcium and prostate cancer Dairy calcium Non-dairy calcium

Dietary and supplemental calcium and prostate cancer

RR=1.07 (1.03-1.12) Studies: 7

Non

-adv

ance

d A

dvan

ced

RR=1.02 (0.93-1.12) Studies: 10

Tota

l

RR=1.05 (1.02-1.09) Studies: 15 RR=0.99 (0.96-1.02) Studies: 4

Non

-adv

ance

d A

dvan

ced

RR=1.01 (0.94-1.09) Studies: 5 To

tal

Fata

l

RR=0.99 (0.96-1.01) Studies: 4

RR=1.29 (1.08-1.54) Studies: 2

Dietary calcium Supplemental calcium

Proposed relationship between dietary calcium and prostate cancer

Giovannucci et al., Cancer Res 1998;58:442-7

Challenges in epidemiologic studies of diet and prostate cancer

§  Changing spectrum of prostate cancer cases due to screening for elevated PSA -  Enrichment of cases with early disease

§  Misclassification of exposure -  Assessment only in middle age

§  Variation in study quality

Future directions in epidemiologic studies of diet and prostate cancer

§  Tailor hypotheses that are testable using early stage disease

§  Use appropriate study populations

§  Select appropriate cases

§  Conduct analyses by type of case

§  Elucidate mechanisms Methodology for systematically reviewing mechanisms - Continuous Update Project Request For Application: http://www.wcrf.org/int/research-we-fund/continuous-update-project- cup/work-mechanisms

Summary §  Prostate cancer is the second most common cancer worldwide §  Strong evidence that greater body fatness (marked by BMI, waist-circumference, and

waist-hip ratio) is probably a cause of advanced prostate cancer §  Strong evidence that developmental factors leading to greater linear growth (marked by

adult attained height) are probably a cause of prostate cancer §  Limited evidence that diets high in calcium or higher consumption of dairy products

increases the risk of prostate cancer §  More evidence needed on characterising mechanisms that underpin the association

between calcium and prostate cancer risk

§  A recent paper on dairy products, calcium, and prostate cancer risk by the Continuous Update Project research team in the AJCN: doi: 10.3945/ ajcn.113.067157

§  More information in the prostate cancer report:

/www.wcrf.org/int/research-we-fund/continuous-update-project-findings-reports/prostate-cancer

For further information

@wcrfint facebook.com/wcrfint

www.wcrf.org

Michael Leitzmann – Continuous Update Project Panel member Dept. of Epidemiology and Preventive Medicine, University of Regensburg

Michael.Leitzmann@ukr.de