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Correlative Analysis of Vitamin D and Omega-3 Fatty Acid Intake in Men on Active Surveillance for Prostate Cancer

      Abstract

      Objective

      To investigate the influence of targeted serum vitamin-D level and omega-6:3 fatty-acid ratio on prostate-specific antigen (PSA) level in men with prostate cancer managed with active surveillance by providing a nutritional intervention and vitamin supplementation.

      Methods

      Sixty-eight patients with biopsy-proven National Comprehensive Cancer Network very-low or low-risk prostate cancer were enrolled in the prostate cancer nutrition and genetics clinic at the Cleveland Clinic from July 2013-December 2019. Patients adhered to a specific dietary regimen devoid of animal-based products and foods containing omega-6 polyunsaturated fatty acids (PUFAs). The supplement regimen consisted of: Omega-3 PUFAs 720mg (3/day); curcumin 2000 mg/day; vitamin D3 dose titrated to achieve serum level of 60 ng/ml; and vitamin B-complex 1000 mg (4 times weekly). Patients underwent periodic monitoring of PSA, serum vitamin D, and PUFA levels and had frequent follow-up with the nutritionist which included a food frequency questionnaire. Interval prostate biopsy was performed as clinically indicated and/or at 9 months.

      Results

      The mean and 95% confidence interval of PSA slope and Vitamin D serum levels slope were 0.11 (0-0.25) ng/mL/month and 4.65 (3.09-5.98) ng/mL/month, respectively. Patients with higher initial vitamin D levels were twice as likely to have a downward PSA trend (OR = 2.04, 95% confidence interval 1.04-4.01, P = .04). Fifty-five patients underwent follow-up biopsy, all showing no progression of disease. Three patients had loose bowel movements that required omega-3 and or curcumin dose adjustments.

      Conclusion

      Intensive nutritional intervention with Vitamin D and Omega-3 PUFA supplementation may benefit men on active surveillance for prostate cancer and further studies are warranted.
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      References

      1. IARC Publications Website - World Cancer Report 2014. Accessed July 30, 2020. https://publications.iarc.fr/Non-Series-Publications/World-Cancer-Reports/World-Cancer-Report-2014

      2. Surveillance, Epidemiology, and End Results (SEER). Cancer Statistics Review (CSR). Accessed July 31, 2020. https://seer.cancer.gov/archive/csr/1975_2013/

        • Sanda MG
        • Cadeddu JA
        • Kirkby E
        • et al.
        Clinically localized prostate cancer: AUA/ASTRO/SUO guideline. Part I: risk stratification, shared decision making, and care options.
        J Urol. 2018; 199: 683-690https://doi.org/10.1016/j.juro.2017.11.095
        • Chan JM
        • Giovannucci E
        • Andersson SO
        • Yuen J
        • Adami HO
        • Wolk A.
        Dairy products, calcium, phosphorous, vitamin D, and risk of prostate cancer (Sweden).
        Cancer Causes Control. 1998; 9: 559-566https://doi.org/10.1023/A:1008823601897
        • Augustin LSA
        • Galeone C
        • Dal Maso L
        • et al.
        Glycemic index, glycemic load and risk of prostate cancer.
        Int J Cancer. 2004; 112: 446-450https://doi.org/10.1002/ijc.20416
        • Giovannucci E
        • Rimm EB
        • Colditz GA
        • et al.
        A prospective study of dietary fat and risk of prostate cancer - PubMed.
        J Natl Cancer Inst. 1993; 85 (Accessed July 31, 2020): 1571-1579
        • Hardin J
        • Cheng I
        • Witte JS.
        Impact of consumption of vegetable, fruit, grain, and high glycemic index foods on aggressive prostate cancer risk.
        Nutr Cancer. 2011; 63: 860-872https://doi.org/10.1080/01635581.2011.582224
        • Gilbert R
        • Metcalfe C
        • Fraser WD
        • et al.
        Associations of circulating 25-hydroxyvitamin D with prostate cancer diagnosis, stage and grade.
        Int J Cancer. 2012; 131: 1187-1196https://doi.org/10.1002/ijc.27327
        • Gilbert R
        • Bonilla C
        • Metcalfe C
        • et al.
        Associations of vitamin D pathway genes with circulating 25-hydroxyvitamin-D, 1,25-dihydroxyvitamin-D, and prostate cancer: a nested case–control study.
        Cancer Causes Control. 2015; 26: 205-218https://doi.org/10.1007/s10552-014-0500-5
        • Murphy AB
        • Nyame Y
        • Martin IK
        • et al.
        Vitamin D deficiency predicts prostate biopsy outcomes.
        Clin Cancer Res. 2014; 20: 2289-2299https://doi.org/10.1158/1078-0432.CCR-13-3085
        • Abel S
        • Riedel S
        • Gelderblom WCA.
        Dietary PUFA and cancer.
        in: Proceedings of the Nutrition Society. 73. Cambridge University Press, 2014: 361-367https://doi.org/10.1017/S0029665114000585
        • Berquin IM
        • Min Y
        • Wu R
        • et al.
        Modulation of prostate cancer genetic risk by omega-3 and omega-6 fatty acids.
        J Clin Invest. 2007; 117: 1866-1875https://doi.org/10.1172/JCI31494
        • Calviello G
        • Resci F
        • Serini S
        • et al.
        Docosahexaenoic acid induces proteasome-dependent degradation of β-catenin, down-regulation of survivin and apoptosis in human colorectal cancer cells not expressing COX-2.
        Carcinogenesis. 2006; 28: 1202-1209https://doi.org/10.1093/carcin/bgl254
        • Chen YQ
        • Edwards IJ
        • Kridel SJ
        • Thornburg T
        • Berquin IM.
        Dietary fat-gene interactions in cancer.
        Cancer Metastasis Rev. 2007; 26: 535-551https://doi.org/10.1007/s10555-007-9075-x
        • Mohler JL
        • Antonarakis ES
        • Armstrong AJ
        • et al.
        Prostate cancer, version 2.2019.
        JNCCN J Natl Compr Cancer Netw. 2019; 17: 479-505https://doi.org/10.6004/jnccn.2019.0023
      3. Food frequency questionnaire at a glance | dietary assessment primer. Accessed August 3, 2020. https://dietassessmentprimer.cancer.gov/profiles/questionnaire/

        • Subar AF
        • Thompson FE
        • Kipnis V
        • et al.
        Comparative validation of the block, willett, and national cancer institute food frequency questionnaires: the eating at America's Table Study.
        Am J Epidemiol. 2001; 154: 1089-1099https://doi.org/10.1093/aje/154.12.1089
        • Garland CF
        • French CB
        • Baggerly LL
        • Heaney RP.
        Vitamin D supplement doses and serum 25-Hydroxyvitamin D in the range associated with cancer prevention.
        Anticancer Res. 2011; (PublishedAccessed July 29, 2020)
        • Jingwi EY
        • Abbas M
        • Ricks-Santi L
        • et al.
        Vitamin D receptor genetic polymorphisms are associated with PSA level, gleason score and prostate cancer risk in african-american men.
        Anticancer Res. 2015; 35 (Accessed October 12, 2020. /pmc/articles/PMC4743656/?report=abstract): 1549-1558
        • Shui IM
        • Mondul AM
        • Lindström S
        • et al.
        Circulating vitamin D, vitamin D-related genetic variation, and risk of fatal prostate cancer in the National Cancer Institute Breast and Prostate Cancer Cohort Consortium.
        Cancer. 2015; 121: 1949-1956https://doi.org/10.1002/cncr.29320
        • Brown MD
        • Hart C
        • Gazi E
        • Gardner P
        • Lockyer N
        • Clarke N.
        Influence of omega-6 PUFA arachidonic acid and bonemarrow adipocytes on metastatic spread from prostate cancer.
        Br J Cancer. 2010; 102: 403-413https://doi.org/10.1038/sj.bjc.6605481
      4. Glycemic index, glycemic load and cancer risk - ScienceDirect. Accessed July 30, 2020. https://www.sciencedirect.com/science/article/pii/S0923753419370346

        • Tantamango-Bartley Y
        • Knutsen SF
        • Knutsen R
        • et al.
        Are strict vegetarians protected against prostate cancer?.
        Am J Clin Nutr. 2016; 103: 153-160https://doi.org/10.3945/ajcn.114.106450
        • Simopoulos AP.
        The importance of the ratio of omega-6/omega-3 essential fatty acids.
        Biomed Pharmacother. 2002; 56: 365-379https://doi.org/10.1016/S0753-3322(02)00253-6
        • Sugano M.
        Characteristics of fats in Japanese diets and current recommendations.
        Lipids. 1996; 31: S283-S286https://doi.org/10.1007/bf02637092
        • Williams CD
        • Whitley BM
        • Hoyo C
        • et al.
        A high ratio of dietary n-6/n-3 polyunsaturated fatty acids is associated with increased risk of prostate cancer.
        Nutr Res. 2011; 31: 1-8https://doi.org/10.1016/j.nutres.2011.01.002
        • Aronson WJ
        • Kobayashi N
        • Barnard RJ
        • et al.
        Phase II prospective randomized trial of a low-fat diet with fish oil supplementation in men undergoing radical prostatectomy.
        Cancer Prev Res. 2011; 4: 2062-2071https://doi.org/10.1158/1940-6207.CAPR-11-0298
        • Galet C
        • Gollapudi K
        • Stepanian S
        • et al.
        Effect of a low-fat fish oil diet on proinflammatory eicosanoids and cell-cycle progression score in men undergoing radical prostatectomy.
        Cancer Prev Res. 2014; 7: 97-104https://doi.org/10.1158/1940-6207.CAPR-13-0261
        • Du Y
        • Long Q
        • Zhang L
        • et al.
        Curcumin inhibits Cancer-associated fibroblast-driven prostate cancer invasion through MAOA/mTOR/HIF-1α signaling.
        Int J Oncol. 2015; 47: 2064-2072https://doi.org/10.3892/ijo.2015.3202
        • Huang H
        • Chen X
        • Li D
        • et al.
        Combination of α-tomatine and curcumin inhibits growth and induces apoptosis in human prostate cancer cells.
        PLoS One. 2015; 10https://doi.org/10.1371/journal.pone.0144293