Elsevier

Urology

Volume 72, Issue 6, December 2008, Pages 1319-1323
Urology

Alternative Therapy
Clinical Events in Prostate Cancer Lifestyle Trial: Results From Two Years of Follow-Up

https://doi.org/10.1016/j.urology.2008.04.050Get rights and content

Objectives

Previous research has demonstrated that patients with prostate cancer participating in the Prostate Cancer Lifestyle Trial had a reduction in prostate-specific antigen (PSA) levels, inhibition of LNCaP cell growth, and fewer prostate cancer-related clinical events at the end of 1 year compared with controls. The aim of this study was to examine the clinical events in this trial during a 2-year period.

Methods

The Prostate Cancer Lifestyle Trial was a 1-year randomized controlled clinical trial of 93 patients with early-stage prostate cancer (Gleason score <7, PSA 4-10 ng/mL) undergoing active surveillance. The patients in the experimental arm were encouraged to adopt a low-fat, plant-based diet, to exercise and practice stress management, and to attend group support sessions. The control patients received the usual care.

Results

By 2 years of follow-up, 13 of 49 (27%) control patients and 2 of 43 (5%) experimental patients had undergone conventional prostate cancer treatment (radical prostatectomy, radiotherapy, or androgen deprivation, P < .05). No differences were found between the groups in other clinical events (eg, cardiac), and no deaths occurred. Three of the treated control patients but none of the treated experimental patients had a PSA level of ≥10 ng/mL, and 1 treated control patient but no treated experimental patients had a PSA velocity of >2 ng/mL/y before treatment. No significant differences were found between the untreated experimental and untreated control patients in PSA change or velocity at the end of 2 years.

Conclusions

Patients with early-stage prostate cancer choosing active surveillance might be able to avoid or delay conventional treatment for at least 2 years by making changes in their diet and lifestyle.

Section snippets

Participants

The PCLT consisted of 93 men (mean age 66 ± 8 years) with biopsy-proven prostate cancer (Gleason score <7, PSA 4-10 ng/mL) who had chosen active surveillance and had been randomly assigned to either an experimental or a control group. The experimental group had been prescribed an intensive lifestyle program that included a vegan diet (supplemented with soy,14 fish oil, vitamin E, selenium, and vitamin C), moderate aerobic exercise (walking 30 minutes 6 days weekly), stress management techniques

Clinical Events

Information on clinical events was obtained for 92 of the 93 patients (99%). Event data were missing for 1 experimental patient. For 86 of the 92 patients (93%), the event information was obtained from review of both the study chart and the Health Events questionnaire. For the remaining 6 patients (7%), information was obtained from the study chart review only. Medical records were obtained when possible (93% obtained). Very strong agreement was found between the self-reported and

Comment

The purpose of this study was to assess the clinical events in the PCLT at 2 years after study entry. At 1 year, 0 experimental patients and 6 control patients had undergone conventional prostate cancer therapy.11 The present analyses revealed that this group difference in treatment was still maintained (if not enhanced) at the 2-year mark. Specifically, significantly fewer men in the experimental group had undergone conventional prostate cancer treatment (eg, radical prostatectomy,

Conclusions

The results of our study have shown that participating in an intensive lifestyle program might allow patients choosing active surveillance to delay conventional treatment. Because prostate cancer is often associated with a variable or prolonged natural history, longer follow-up is necessary to determine whether the apparent benefits of the lifestyle change program are maintained beyond 24 months and whether such an approach is safe with regard to cancer control.

Acknowledgment

To Damien McKnight and Caren Raisin for their assistance with data collection, Nancy Mendell for statistical advice, and Bryce Williams for his helpful comments; and to Speaker Nancy Pelosi, Representative John Murtha, and Senators Arlen Specter and Ted Stevens.

References (28)

  • M.A. Moyad et al.

    Lifestyle recommendations to prevent prostate cancerPart I: Time to redirect our attention?

    Urol Clin North Am

    (2004)
  • Overview: Prostate Cancer

  • C.G. Bacon et al.

    The association of treatment-related symptoms with quality-of-life outcomes for localized prostate carcinoma patients

    Cancer

    (2002)
  • M. Pomerantz et al.

    Advances in the treatment of prostate cancer

    Annu Rev Med

    (2007)
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    This research was supported in part by a grant from the Department of the Army (U.S. Army Medical Research Acquisition Activity W81XWH-05-1-0375), the Department of Health and Human Services (Health Resources and Services Administration grant C76HF00803), Department of Defense Uniformed Services University (USU grant MDA905-99-1-0003) by way of the Henry M. Jackson Foundation (grant 600-06971000-236), Prostate Cancer Foundation, and National Institutes of Health grant 5P50CA089520-02 University of California, San Francisco, Prostate Cancer Specialized Program of Research Excellence) and in part by grants from Safeway, Incorporated, and the following foundations: Walton Family, Ellison, Fisher, Gallin, Highmark Blue Cross Blue Shield, Koch, Resnick, Wachner, and Wynn.

    This research does not reflect the position or policy of the U.S. government. None of these agencies were involved in the design or conduct of the study, in the collection, analysis, or interpretation of the data, or in the preparation, review, or approval of the manuscript.

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