Sperling Prostate Center

Sticking to the Mediterranean Diet Offers Active Surveillance Benefits

“Slow and steady wins the race.” – From “The Hare and the Tortoise” by Aesop

We often long for quick results, especially when it comes to health. Countless ads for supplements and exercise aids that promise “Fast Results!” draw hordes of consumers. Sadly, many buyers have found, to their great disappointment, that immediate gratification is elusive.

Mediterranean diet may slow PCa progression

For newly diagnosed prostate cancer (PCa) patients who go on Active Surveillance (AS), there is no rush. This is a good thing, because the main goal of AS is to hold off on the need for treatment as long as possible. And, during monitoring, what triggers the need for intervention? Evidence that the cancer is progressing to a higher Gleason grade. A new study finds that prostate cancer (PCa) patients on Active Surveillance (AS) may slow progression through consistently high adherence to the Mediterranean diet.

It is well established that nutrition plays a key role in either promoting or preventing inflammation, a known precursor for prostate and other cancers. If you knew there was an all-natural method for discouraging inflammation from occurring in your body, would you embrace it and commit to following it—with the understanding that the results will be slow and steady? In fact, this all-natural way is as close as your grocery story, refrigerator and pantry. It’s called the Mediterranean diet (MedDi for short), and its anti-inflammatory components have been repeatedly shown to reduce prostate cancer risk. Is it a quick fix? No. Does it work over time? Well, compared with the hare in Aesop’s well-known race fable, the MedDi is definitely a tortoise, but well worth the wait to eventually come out ahead.

Persuasive data from study

In July, 2020 a research team from University of Texas MD Anderson institutions presented their research on 410 PCa patients over an average of 36 months.[i] The newly diagnosed participants were on AS, and they initially completed a baseline food frequency questionnaire. This questionnaire was the basis for determining how closely they stuck to the principles of the MedDi: high in vegetables, fruits, whole grains, beans, nut and seeds, and olive oil. They were then scored, and divided into three groups according to an adherence rating scale of 0-9:

  • Low adherence (Score 0-3) – about 33.5% of participants
  • Medium adherence (Score 4-5) – about 41.5% of participants
  • High adherence (Score 6-9) – about 25%

For the study duration, they were monitored for possible disease progression. During the roughly 3 years of follow up, 76 out of the 410 patients had PCa progression (defined as rise in Gleason grade). Results showed that there was little difference in progression between the low and medium adherence groups. However, those in the high adherence group had the lowest risk of grade progression. Because 3 years is a relatively short period for follow up, it would be interesting if the research team could continue to follow these patients to determine if longer term follow-up would show even greater benefit, suggesting that slow and steady produces a true win during AS.

A dietary suit of armor

Publications during the past decade have consistently associated anti-inflammatory diets, especially the MedDi, with lowering the incidence and progression of PCa. In previous blogs, I have cited works by numerous clinicians and scientists such as:

  • Schneider, et al. (2019), who found that the MedDi was strongly associated with reduced risk of aggressive PCa[ii]
  • Jalilpiran, et al. (2018), who state that the MedDi is linked with lower PCa risk than the Western diet with its high intake of red meat, unhealthy fats and refined foods)[iii]
  • Capurso & Vendiamale (2017), who discuss how the MedDi may offer protection against the initiation and development of PCa.[iv]

In fact, the MedDi offers a broader range of preventive advantages than simply PCa. While it originally gained public awareness because it lowers the risk of cardiovascular disease, a 2017 review of 83 studies shows that close adherence to the MedDi is like wearing a suit of armor against colorectal cancer, liver cancer, head and neck cancer, breast or prostate cancer, and gastric cancer.

The secret, of course, lies in those two words: close adherence. I would add two more: over time. If a mere 3 years of high compliance can help reduce progression during AS, what would 5 or 10 years do?

With an AS goal of deferring treatment as long as possible—with the bonus of preserving urinary and sexual performance plus overall quality of life—the principle of MedDi consistency and commitment hold good. All of us at Sperling Prostate Center applaud the Texas team for giving us a whole new meaning to Aesop’s moral: slow and steady truly wins the race against PCa progression.
NOTE: This content is solely for purposes of information and does not substitute for diagnostic or medical advice. Talk to your doctor if you have health concerns or questions of a personal medical nature.

NOTE: This content is solely for purposes of information and does not substitute for diagnostic or medical advice. Talk to your doctor if you are experiencing pelvic pain, or have any other health concerns or questions of a personal medical nature.

[i] Krader, SG. Men on active surveillance for prostate cancer may benefit from Mediterranean diet. Urology Times, Jul. 28, 2020
[ii] Schneider L, Su LJ, Arab L, Bensen JT et al. Dietary patterns based on the Mediterranean diet and DASH diet are inversely associated with high aggressive prostate cancer in PCaP. Ann Epidemiol. 2019 Jan;29:16-22.e1.
[iii] Jalilpiran Y, Diantinasab M, Zeighami S, Bahmanpour S et al. Western Dietary Pattern, But not Mediterranean Dietary Pattern, Increases the Risk of Prostate Cancer. Nutr Cancer. 2018 Aug-Sep;70(6):851-859.
[iv] Capurso C, Vendemiale G. The Mediterranean Diet Reduces the Risk and Mortality of the Prostate Cancer: A Narrative Review. Front Nutr. 2017; 4: 38.

About Dr. Dan Sperling

Dan Sperling, MD, DABR, is a board certified radiologist who is globally recognized as a leader in multiparametric MRI for the detection and diagnosis of a range of disease conditions. As Medical Director of the Sperling Prostate Center, Sperling Medical Group and Sperling Neurosurgery Associates, he and his team are on the leading edge of significant change in medical practice. He is the co-author of the new patient book Redefining Prostate Cancer, and is a contributing author on over 25 published studies. For more information, contact the Sperling Prostate Center.

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