Diet change among prostate cancer patients under expectant management

描述(申请人提供)：前列腺癌，每年在20多万美国男性中被诊断出来，仍然是一个重要的死亡原因；在2007年，它将导致大约27,000人死亡。筛查的进步促进了检测的巨大进步，以至于大多数前列腺癌现在都可以在极早期被诊断出来，可以通过手术或放射治疗来治愈。尽管如此，尽管治愈这些早期癌症是可能的，但产生这种治愈的疗法往往会显著降低生活质量。前列腺癌控制的一个并发症是，与症状性或致命性疾病的发病率相比，未诊断的、表面上隐匿的前列腺癌的发病率很高。许多男性的前列腺癌是隐匿性的，没有症状，不会危及生命；这些人会死于他们的疾病，而不是死于他们的疾病。许多筛查发现的前列腺癌，特别是那些在非常早期被诊断出来的癌症，否则可能永远不会导致症状性疾病。鉴于前列腺癌治疗的发病率很高，识别患有早期疾病的男性可以推迟根治性干预将是非常有益的。本研究的重点是低级别、低体积前列腺癌(LGLV前列腺癌)。这些男性的前列腺癌越来越多地通过一种被称为期待管理(EM)的方法进行监测。早期前列腺癌发展为侵袭性疾病的可能性可能会因环境暴露而改变，包括饮食。有观察证据表明，富含水果和蔬菜的饮食与前列腺癌的发病和进展风险呈负相关。了解采用植物密集型饮食是否可以降低LGLV前列腺癌进展到更晚期的风险将是有价值的。这项建议是为了评估强调植物摄入的饮食是否降低了EM患者LGLV前列腺癌进展为一种更具侵袭性的癌症的可能性，该癌症值得积极治疗。干预将通过领先的合作肿瘤学研究小组之一：癌症和白血病B组(CALGB)进行。患者将通过CALGB和合作社区肿瘤学计划的临床站点进行招募。实验患者将接受基于电话的干预，这已被证明改变了前列腺癌患者的饮食习惯；对照组患者将收到NCI发布的一包饮食建议材料。饮食变化将通过24小时回忆和血液胡萝卜素来评估。将通过PSA和适当的临床监测对疾病进行24个月的监测。 与公共健康相关：每年有超过20万美国男性被诊断为前列腺癌。前列腺癌中有相当大一部分是低级别、低体积和明显不痛的。期待治疗不会像干预那样降低生活质量，它可能适用于这类患者；与其说是为了治愈疾病，不如说是为了防止疾病发展为更具侵略性的表型，这是值得研究的。这项建议是为了调查强调植物性饮食的饮食干预是否减缓或阻止前列腺癌的进展。

DESCRIPTION (provided by applicant): Prostate cancer, diagnosed in over 200,000 American men each year, remains a significant cause of mortality; in 2007, it will be responsible for approximately 27,000 deaths. Advances in screening have fostered tremendous improvements in detection, such that most prostate cancers are now diagnosed at extremely early stages amenable to cure by surgery or radiation. Nonetheless, although cure for these early cancers is readily possible, the therapy that produces this cure often significantly diminishes quality of life. A complication of prostate cancer control is that the prevalence of undiagnosed, apparently occult prostate cancer is high relative to the incidence of symptomatic or fatal disease. Prostatic cancer among many men is occult, non-symptomatic and not life-threatening; these men will die with, rather than of, their disease. Many screen-detected prostate cancers, especially those diagnosed at a very early stage, might otherwise never cause symptomatic disease. Given the substantial morbidity of prostate cancer therapy, it would be of great benefit to identify men with early stage disease for whom radical intervention can be delayed. The focus of this study is low grade, low-volume prostate cancer (LGLV prostate cancer). Prostate cancer in these men is increasingly being monitored by an approach known as expectant management (EM). The probability that an early-stage prostate cancer will develop into aggressive disease may be altered by environmental exposures, including diet. There is observational evidence that a diet high in fruits and vegetables is negatively associated with the risk of prostate cancer initiation and progression. It would be valuable to know whether adoption of a plant-intensive diet could decrease the risk that LGLV prostate cancer progresses to more advanced stages. This proposal is to assess whether a diet emphasizing plant consumption decreases the probability that LGLV prostate cancer in EM patients progresses to a more aggressive form of cancer that merits active treatment. The intervention will be conducted through one of the leading cooperative oncology research groups: Cancer and Leukemia Group B (CALGB). Patients will be enrolled through individual CALGB and Cooperative Community Oncology Program clinical sites. Experimental patients will receive a telephone-based intervention that has been shown to alter the dietary practice of prostate cancer patients; control patients will receive a packet of diet-recommendation materials issued by the NCI. Diet change will be evaluated by 24-hour recalls and by blood carotenoids. Disease will be monitored by PSA and appropriate clinical surveillance for 24 months. PUBLIC HEALTH RELEVANCE: Prostate Cancer is diagnosed in over 200,000 American men each year. A substantial proportion of prostate cancer is low-grade, low-volume and apparently indolent. Expectant management, which does not lessen the quality of life as intervention does, may be appropriate for such patients; interventions intended less to cure disease than to forestall its progression to a more aggressive phenotype are worth investigation. This proposal is to investigate whether a dietary intervention emphasizing a plant-based diet slows or blocks progression of prostate cancer.