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 AfricaMiddle East & North Africa

East & Central Asia

IndiaChina

OceaniaLatin America& the Caribbean

North America

Sub-Saharan Africa

Europe

Sub-Saharan Africa

Middle East & North Africa

East & Central Asia

India

China

Oceania

Latin 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 lycopeneFoods containing seleniumSelenium

Diets high in calcium

Pulses (legumes)Foods containing vitamin EAlpha-tocopherol

Processed meatMilk 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 productsDiets high in calciumLow plasma alpha-tocopherol concentrationsLow 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 2014Published 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

Ad

van

ced

No

n-a

dv

an

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

RR = Risk Ratio

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

Ad

van

ced

No

n-a

dv

an

ced

Height and prostate cancer

RR=1.03 (1.01-1.05) Studies: 10 RR = Risk Ratio

Total dairy and prostate cancer

No

n-a

dv

an

ced

Ad

van

ced

To

tal

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

RR = Risk Ratio

Total calcium and prostate cancer

RR=1.01 (0.98-1.03) Studies: 6

No

n-a

dv

an

ced

Ad

van

ced

RR=1.03 (0.99-1.07) Studies: 7

To

tal

Fata

l

RR=1.02 (1.01-1.04) Studies: 9

RR=1.11 (1.02-1.21) Studies: 2

RR = Risk Ratio

RR=1.03 (1.00-1.07) Studies: 2

No

n-

ad

van

ced

Ad

van

ced

RR=1.05 (0.96-1.15) Studies: 2

To

tal

Fata

l

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

No

n-

ad

van

ced

Ad

van

ced

RR=1.09 (0.89-1.34) Studies: 2

To

tal

RR=0.97 (0.90-1.04) Studies: 4

Dairy calcium and non-dairy calcium and prostate cancer

Dairy calcium Non-dairy calcium

RR = Risk Ratio

Dietary and supplemental calcium and prostate cancer

RR=1.07 (1.03-1.12) Studies: 7

No

n-a

dv

an

ced

Ad

van

ced

RR=1.02 (0.93-1.12) Studies: 10

To

tal

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

No

n-a

dv

an

ced

Ad

van

ced

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

ota

lF

ata

l

RR=0.99 (0.96-1.01) Studies: 4

RR=1.29 (1.08-1.54) Studies: 2

Dietary calcium Supplemental calcium

RR = Risk Ratio

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 Prostate Specific Antigen

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