Skip to main content
SpringerLink
Log in

Prostate cancer and subsequent nutritional outcomes: the role of diagnosis and treatment

  • Published:
Journal of Cancer Survivorship Aims and scope Submit manuscript

Abstract

Purpose

To comprehensively explore the role of a prostate cancer diagnosis and its treatment to several outcomes including diet, Hemoglobin A1c, and weight status, in a large, nationally representative, cross-sectional study.

Methods

This analysis used five cross sections from the publicly available National Health and Nutrition Evaluation Survey (NHANES) from 2001 to 2010. A sample of 289 men with a history of prostate cancer was matched to a comparison group of 655 men with elevated prostate-specific antigen (> 4 ng/mL) but no reported diagnosis of prostate cancer. Analyses were stratified by diabetic or pre-diabetes status and treatment including surgery, radiotherapy, or both. Outcomes of interest included several broad macronutrient categories, HbA1c, body mass index, and obesity status. Multivariate regression analyses were conducted to clarify the associations of a prostate cancer diagnosis with these outcomes. Demographic and socioeconomic factors, including age, education, race, income, and marital status, were controlled for in all models.

Results

The clinical and demographic characteristics were relatively well balanced between the “at risk” comparison group and the group of men diagnosed with prostate cancer. Diabetic or pre-diabetic men diagnosed with prostate cancer were more likely to be obese (p < 0.05) and have a higher BMI (p < 0.10). On multivariate analysis, compared to controls, men with prostate cancer treated with surgery and radiation therapy were predicted to have a higher BMI (p < 0.01) and were more likely to be obese (p < 0.05). These findings were largely driven by the diabetic and pre-diabetic sample. Further diabetics and pre-diabetics with prostate cancer treated with both radiation and surgery were predicted to consume an average of 72 and 59 more daily grams of carbohydrates and sugar, respectively, compared to controls (p < 0.05).

Conclusion

Men with prostate cancer report fewer behaviors and outcomes consistent with optimal glycemic management including a higher BMI, and in diabetics and pre-diabetics, increased carbohydrate sugar consumption. Men with more intense treatment including surgery and radiotherapy appeared to be more likely to be obese and make poorer dietary carbohydrate and sugar choices compared to men without prostate cancer.

Implications for Cancer Survivors

Men treated for prostate cancer have, on average, very long survivorship periods and are susceptible to diabetes and its complications. Interventions designed to improve diabetes awareness and self-management, especially weight and dietary sugar control, may be useful in this population.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

Notes

  1. See www.pcf.org

  2. Centers for Disease Control and Prevention, National Center for Health Statistics. National Health and Nutrition Examination Survey. Available at: http://www.cdc.gov/nchs/nhanes.htm.

  3. PSA is a blood test that can be used to both screen for the presence of prostate cancer and to monitor disease response to therapy.

  4. However, we use the values derived from the first of such interviews in our analyses.

  5. The distribution of the BMI in the combination of diabetics who received radiotherapy (± surgery) cohort is such that 19 of these 26 patients classified as obese. This, combined with their relatively heavy sampling weights, resulted in several high odds ratios above 10 for these patient groups. Therefore, the magnitudes of the point estimates for the radiotherapy treatment groups in this cohort are less reliable.

References

  1. Miller KD, Siegel RL, Lin CC, Mariotto AB, Kramer JL, Rowland JH, et al. Cancer treatment and survivorship statistics, 2016. CA Cancer J Clin. 2016;66:271–89.

    Article  Google Scholar 

  2. Cao Y, Ma J. Body-mass index, prostate cancer-specific mortality and biochemical recurrence: a systematic review and meta-analysis. Cancer Prev Res (Phila). 2011;4:486–501.

    Article  CAS  Google Scholar 

  3. Friedenreich CM, Wang Q, Neilson HK, Kopciuk KA, McGregor SE, Courneya KS. Physical activity and survival after prostate cancer. Eur Urol. 2016;70:576–85.

    Article  PubMed  Google Scholar 

  4. Kenfield SA, Batista JL, Jahn JL, Downer MK, Van Blarigan EL, Sesso HD, et al. Development and application of a lifestyle score for prevention of lethal prostate cancer. J Natl Cancer Inst. 2016;108:djv329.

    Article  PubMed  Google Scholar 

  5. Chan JM, Holick CN, Leitzmann MF, Rimm EB, Willett WC, Stampfer MJ, et al. Diet after diagnosis and the risk of prostate cancer progression, recurrence, and death (United States). Cancer Causes Control. 2006;17:199–208.

    Article  PubMed  Google Scholar 

  6. Taborelli M, Polesel J, Parpinel M, Stocco C, Birri S, Serraino D, et al. Fruit and vegetables consumption is directly associated to survival after prostate cancer. Mol Nutr Food Res. 2016;61:1600816.

    Article  CAS  Google Scholar 

  7. O’Neill RF, Haseen F, Murray LJ, O’Sullivan JM, Cantwell MM. A randomised controlled trial to evaluate the efficacy of a 6-month dietary and physical activity intervention for patients receiving androgen deprivation therapy for prostate cancer. J Cancer Surviv. 2015;9:431–40.

    Article  PubMed  Google Scholar 

  8. Parsons JK, Pierce JP, Mohler J, Paskett E, Jung S-H, Humphrey P, et al. A randomized trial of diet in men with early stage prostate cancer on active surveillance: rationale and design of the Men’s Eating and Living (MEAL) Study (CALGB 70807 [Alliance]). Contemp Clin Trials. 2014;38:198–203.

    Article  PubMed  PubMed Central  Google Scholar 

  9. Parsons JK, Pierce JP, Mohler J, Paskett E, Jung S-H, Morris MJ, et al. Men's Eating and Living (MEAL) study (CALGB 70807 [Alliance]): recruitment feasibility and baseline demographics of a randomized trial of diet in men on active surveillance for prostate cancer. BJU Int. 2017;121:534–9.

    Article  PubMed  PubMed Central  Google Scholar 

  10. Garber AJ, Abrahamson MJ, Barzilay JI, Blonde L, Bloomgarden ZT, Bush MA, et al. Consensus statement by the American Association of Clinical Endocrinologists and American College of Endocrinology on the Comprehensive Type 2 Diabetes Management Algorithm—2018 Executive Summary. Endocr Pract. 2018;24:91–120.

    Article  PubMed  Google Scholar 

  11. Yao N, Camacho FT, Chukmaitov AS, Fleming ST, Anderson RT. Diabetes management before and after cancer diagnosis: missed opportunity. Ann Transl Med. 2015;3:72.

    PubMed  PubMed Central  Google Scholar 

  12. Griffiths RI, McFadden EC, Stevens RJ, Valderas JM, Lavery BA, Khan NF, et al. Quality of diabetes care in breast, colorectal, and prostate cancer. J Cancer Surviv. 2018;12:803–12.

    Article  PubMed  PubMed Central  Google Scholar 

  13. Mohler J, Bahnson RR, Boston B, Busby JE, D'Amico A, Eastham JA, et al. Prostate Cancer. J Natl Compr Cancer Netw. 2010;8:162–200.

    Article  CAS  Google Scholar 

  14. Cooner WH, Mosley BR, Rutherford CL, Beard JH, Pond HS, Terry WJ, et al. Prostate cancer detection in a clinical urological practice by ultrasonography, digital rectal examination and prostate specific antigen. J Urol. 1990;143:1146–52.

    Article  CAS  PubMed  Google Scholar 

  15. Thompson IM, Pauler DK, Goodman PJ, Tangen CM, Lucia MS, Parnes HL, et al. Prevalence of prostate cancer among men with a prostate-specific antigen level ≤4.0 ng per milliliter. N Engl J Med. 2004;350:2239–46.

    Article  CAS  PubMed  Google Scholar 

  16. Daugherty M, Chelluri R, Bratslavsky G, Byler T. Are we underestimating the rates of incontinence after prostate cancer treatment? Results from NHANES. Int Urol Nephrol. 2017;49:1715–21.

    Article  CAS  PubMed  Google Scholar 

  17. Kahn ME. Diabetic risk taking: the role of information, education and medication. J Risk Uncertain. 1999;18:147–64.

    Article  Google Scholar 

  18. Slade AN. Health investment decisions in response to diabetes information in older Americans. J Health Econ. 2012;31:502–20.

    Article  PubMed  Google Scholar 

  19. Slade AN, Kim H. Dietary responses to a hypertension diagnosis: evidence from the National Health and Nutrition Examination Survey (NHANES) 2007–2010. Behav Med. 2014;40:1–13.

    Article  PubMed  Google Scholar 

  20. Link RE. Laparoscopic radical prostatectomy in obese patients: feasible or foolhardy? Rev Urol. 2005;7:53–7.

    PubMed  PubMed Central  Google Scholar 

  21. Keenan PS. Smoking and weight change after new health diagnoses in older adults. Arch Intern Med. 2009;169:237–42.

    Article  PubMed  PubMed Central  Google Scholar 

  22. Wang Z, McLoone P, Morrison DS. Diet, exercise, obesity, smoking and alcohol consumption in cancer survivors and the general population: a comparative study of 16 282 individuals. Br J Cancer. 2014;112:572.

    Article  PubMed  PubMed Central  Google Scholar 

  23. Westmaas JL, Newton CC, Stevens VL, Flanders WD, Gapstur SM, Jacobs EJ. Does a recent cancer diagnosis predict smoking cessation? An analysis from a large prospective US cohort. J Clin Oncol. 2015;33:1647–52.

    Article  PubMed  Google Scholar 

  24. Newsom JT, Huguet N, McCarthy MJ, Ramage-Morin P, Kaplan MS, Bernier J, et al. Health behavior change following chronic illness in middle and later life. J Gerontol B Psychol Sci Soc Sci. 2012;67B:279–88.

    Article  Google Scholar 

  25. Williams K, Steptoe A, Wardle J. Is a cancer diagnosis a trigger for health behaviour change? Findings from a prospective, population-based study. Br J Cancer. 2013;108:2407–12.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  26. Bluethmann SM, Basen-Engquist K, Vernon SW, Cox M, Gabriel KP, Stansberry SA, et al. Grasping the ‘teachable moment’: time since diagnosis, symptom burden and health behaviors in breast, colorectal and prostate cancer survivors. Psycho-Oncology. 2015;24:1250–7.

    Article  PubMed  PubMed Central  Google Scholar 

  27. Calip GS, Hubbard RA, Stergachis A, Malone KE, Gralow JR, Boudreau DM. Adherence to oral diabetes medications and glycemic control during and following breast cancer treatment. Pharmacoepidemiol Drug Saf. 2015;24:75–85.

    Article  CAS  PubMed  Google Scholar 

  28. Santorelli ML, Steinberg MB, Hirshfield KM, Rhoads GG, Bandera EV, Lin Y, et al. Effects of breast cancer on chronic disease medication adherence among older women. Pharmacoepidemiol Drug Saf. 2016;25:898–907.

    Article  CAS  PubMed  Google Scholar 

  29. Yang J, Neugut AI, Wright JD, Accordino M, Hershman DL. Nonadherence to oral medications for chronic conditions in breast cancer survivors. J Oncol Pract. 2016;12:e800–9.

    Article  PubMed  Google Scholar 

  30. Zanders MMJ, Haak HR, van Herk-Sukel MPP, van de Poll-Franse LV, Johnson JA. Impact of cancer on adherence to glucose-lowering drug treatment in individuals with diabetes. Diabetologia. 2015;58:951–60.

    Article  CAS  PubMed  Google Scholar 

Download references

Acknowledgments

The author would like to acknowledge Dr. Nicholas Serrano and Dr. Michael Waters for helpful comments in previous versions of the manuscript.

Author information

Authors and Affiliations

  1. Massey Cancer Center, Department of Radiation Oncology, Virginia Commonwealth University Health System, Box 980058, Richmond, VA, 23298, USA

    Alexander N. Slade

Authors
  1. Alexander N. Slade
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Alexander N. Slade.

Ethics declarations

Conflict of interest

The author declares that he has no conflicts of interest.

Ethical approval

This article does not contain any studies with human participants performed by any of the authors.

Disclaimers

None.

Additional information

Publisher’s note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Electronic supplementary material

ESM 1

(DOCX 21 kb)

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Slade, A.N. Prostate cancer and subsequent nutritional outcomes: the role of diagnosis and treatment. J Cancer Surviv 13, 171–179 (2019). https://doi.org/10.1007/s11764-019-00739-z

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11764-019-00739-z

Keywords

Search

Navigation