The document discusses the epidemiological evidence linking food, nutrition, physical activity, and prostate cancer risk, highlighting that greater body fatness and higher adult attained height are probable causes of advanced prostate cancer. It presents limited evidence suggesting that diets high in calcium or dairy may increase prostate cancer risk, emphasizing the need for further research on the mechanisms involved. Overall, the findings suggest a complex interplay of dietary and lifestyle factors in influencing prostate cancer incidence and outcomes.

1. 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

2. Incidence
Mortality
GLOBOCAN 2012 (IARC)
http://globocan.iarc.fr
Prostate cancer incidence and mortality

3. Prostate cancer incidence Prostate cancer mortality
Sub-Saharan Africa
Middle East & North Africa
East & Central Asia
India
China
Oceania
Latin America
& the Caribbean
North America
Europe
Sub-Saharan Africa
Middle East &
North Africa
East &
Central Asia
India
China
Oceania
Europe
North America
Latin America
& the Caribbean
World Cancer Report (IARC 2014)

4. FOOD, NUTRITION, PHYSICAL ACTIVITY,
AND CANCER OF THE PROSTATE
Level of evidence
Convincing
Probable
Limited-suggestive
DECREASES RISK INCREASES RISK
Limited-no conclusion
Substantial effect on risk
unlikely
Foods containing lycopene
Foods containing selenium
Selenium
Diets high in calcium
Pulses (legumes)
Foods containing vitamin E
Alpha-tocopherol
Processed meat
Milk and dairy products
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
Beta-carotene

5. DIET, NUTRITION, PHYSICAL ACTIVITY
AND PROSTATE CANCER
Convincing
Probable
Limited-suggestive
DECREASES RISK INCREASES RISK
Limited-no
conclusion
Substantial effect
on risk unlikely
Body fatness (advanced prostate cancer)
Adult attained height
Dairy products
Diets high in calcium
Low plasma alpha-tocopherol concentrations
Low plasma selenium concentrations
Beta-carotene
STRONG
EVIDENCE
LIMITED
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

6. Prostate Cancer Report 2014
Published 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

7. Body fatness and prostate cancer
BMI Waist circumference Waist to hip ratio
RR=1.08 (1.04-1.12) Studies: 23
RR=0.99 (0.90-1.09)
Studies: 4
RR=0.95 (0.92-0.98) Studies: 14
Non-advanced Advanced
RR=1.12 (1.04-1.21)
Studies: 4
RR=1.01 (0.90-1.12)
Studies: 4
RR=1.15 (1.03-1.28)
Studies: 4
RR = Risk Ratio

8. Obesity-related detection biases and biologic mechanisms contributing to the
association between obesity and aggressive prostate cancer
Allott et al., Eur Urol. 2013;63(5):800–9

9. RR=1.04 (1.02-1.06) Studies: 19
Non-advanced Advanced
Height and prostate cancer
RR = Risk Ratio RR=1.03 (1.01-1.05) Studies: 10

10. Total dairy and prostate cancer
Fatal Advanced Non-advanced Total
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

11. Total calcium and prostate cancer
RR=1.01 (0.98-1.03) Studies: 6
Advanced Non-advanced
RR=1.03 (0.99-1.07) Studies: 7
Fatal Total
RR=1.02 (1.01-1.04) Studies: 9
RR=1.11 (1.02-1.21) Studies: 2
RR = Risk Ratio

12. Dairy calcium and non-dairy calcium and prostate cancer
Dairy calcium Non-dairy calcium
RR=1.03 (1.00-1.07) Studies: 2
Non-
Advanced advanced
RR=1.05 (0.96-1.15) Studies: 2
Fatal Total
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
advanced
Non-Advanced
RR=1.09 (0.89-1.34) Studies: 2
Total
RR=0.97 (0.90-1.04) Studies: 4
RR = Risk Ratio

13. Dietary and supplemental calcium and prostate cancer
Dietary calcium Supplemental calcium
RR=1.07 (1.03-1.12) Studies: 7
Advanced Non-advanced
RR=1.02 (0.93-1.12) Studies: 10
Total
RR=1.05 (1.02-1.09) Studies: 15
RR=0.99 (0.96-1.02) Studies: 4
Advanced Non-advanced
RR=1.01 (0.94-1.09) Studies: 5
Fatal Total
RR=0.99 (0.96-1.01) Studies: 4
RR=1.29 (1.08-1.54) Studies: 2
RR = Risk Ratio

14. Proposed relationship between dietary calcium and prostate cancer
Giovannucci et al., Cancer Res 1998;58:442-7

15. 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

16. 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

17. 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

18. For further information
Michael Leitzmann – Continuous Update Project Panel member
Dept. of Epidemiology and Preventive Medicine, University of Regensburg
Michael.Leitzmann@ukr.de
@wcrfint
facebook.com/wcrfint
www.wcrf.org