Factors associated with the use of diet and the use of exercise for prostate cancer by long-term survivors

Autoři: Suzanne Hughes aff001;  Sam Egger aff001;  Chelsea Carle aff001;  David P. Smith aff001;  Suzanne Chambers aff004;  Clare Kahn aff001;  Cristina M. Caperchione aff006;  Annette Moxey aff007;  Dianne L. O’Connell aff001
Působiště autorů: Cancer Research Division, Cancer Council New South Wales, Sydney, New South Wales, Australia aff001;  School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia aff002;  School of Public Health, University of Sydney, Sydney, New South Wales, Australia aff003;  Menzies Health Institute, Queensland, Griffith University, Gold Coast, Queensland, Australia aff004;  Faculty of Health, University of Technology Sydney, Sydney, New South Wales, Australia aff005;  Faculty of Health, Human Performance Research Centre, University of Technology Sydney, Sydney, New South Wales, Australia aff006;  School of Medicine and Public Health, University of Newcastle, Newcastle, New South Wales, Australia aff007
Vyšlo v časopise: PLoS ONE 14(10)
Kategorie: Research Article
doi: 10.1371/journal.pone.0223407



To assess the use of diet and the use of exercise for prostate cancer (and/or its treatments’ side effects) by long-term survivors and whether such use is associated with selected socio-demographic, clinical, health-related quality-of-life (HRQOL) and psychological factors.

Design, setting and participants

Population-based cohort study in New South Wales, Australia of prostate cancer survivors aged <70 years at diagnosis and who returned a 10-year follow-up questionnaire.


Validated instruments assessed patient’s HRQOL and psychological well-being. Poisson regression was used to estimate adjusted relative proportions (RRs) of prostate cancer survivor groups who were currently eating differently (‘using diet’) or exercise differently (‘using exercise’) to help with their prostate cancer.


996 (61.0% of 1634) participants completed the 10-year questionnaire of whom 118 (11.8%; 95%CI[9.8–13.9]) were using diet and 78 (7.8%; 95%CI[6.2–9.5]) were using exercise to help with their prostate cancer. Men were more likely to use diet or use exercise for prostate cancer if they were younger (p-trend = 0.020 for diet, p-trend = 0.045 for exercise), more educated (p-trend<0.001, p-trend = 0.011), support group participants (p-nominal<0.001, p-nominal = 0.005), had higher Gleason score at diagnosis (p-trend<0.001, p-trend = 0.002) and had knowledge of cancer spread (p-nominal = 0.002, p-nominal = 0.001). Use of diet was also associated with receipt of androgen deprivation therapy (RR = 1.59; 95%CI[1.04–2.45]), a greater fear of cancer recurrence (p-trend = 0.010), cognitive avoidance (p-trend = 0.025) and greater perceived control of cancer course (p-trend = 0.014). Use of exercise was also associated with receipt of prostatectomy (RR = 2.02; 95%CI[1.12–3.63]), receipt of androgen deprivation therapy (RR = 2.20; 95%CI[1.34–3.61]) and less satisfaction with medical treatments (p-trend = 0.044).


Few long-term prostate cancer survivors use diet or exercise to help with their prostate cancer. Survivors may benefit from counselling on the scientific evidence supporting healthy eating and regular exercise for improving quality-of-life and cancer-related outcomes.

Klíčová slova:

Cancer detection and diagnosis – Cancer treatment – Diet – Exercise – Prostate cancer – Psychometrics – Questionnaires – Sports and exercise medicine


1. Bray F, Ferlay J, Soerjomataram I, Siegel RL, Torre LA, Jemal A. Global cancer statistics 2018: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA: A Cancer Journal for Clinicians. 2018 Nov;68(6):394–424.

2. Smith BD, Smith GL, Hurria A, Hortobagyi GN, Buchholz TA. Future of cancer incidence in the United States: burdens upon an aging, changing nation. Journal of Clinical Oncology. 2009 Apr 27;27(17):2758–65. doi: 10.1200/JCO.2008.20.8983 19403886

3. Yu XQ, Luo Q, Smith DP, Clements MS, O’Connell DL. Prostate cancer prevalence in New South Wales Australia: A population-based study. Cancer Epidemiology. 2015 Feb 1;39(1):29–36. doi: 10.1016/j.canep.2014.11.009 25530551

4. Menichetti J, Villa S, Magnani T, Avuzzi B, Bosetti D, Marenghi C, et al. Lifestyle interventions to improve the quality-of-life of men with prostate cancer: A systematic review of randomized controlled trials. Critical Reviews in Oncology/hematology. 2016 Dec 1;108:13–22. doi: 10.1016/j.critrevonc.2016.10.007 27931831

5. World Cancer Research Fund/American Institute for Cancer Research. Diet, Nutrition, Physical Activity and Cancer. a Global perspective. Continuous Update Project Expert Report 2018. https://wcrf.org/int/continuous-update-project

6. Demark-Wahnefried W, Polascik TJ, George SL, Switzer BR, Madden JF, Ruffin MT, et al. Flaxseed supplementation (not dietary fat restriction) reduces prostate cancer proliferation rates in men presurgery. Cancer Epidemiology and Prevention Biomarkers. 2008 Dec 1;17(12):3577–87.

7. Schröder FH, Roobol MJ, Boevé ER, de Mutsert R, Zuijdgeest-van Leeuwen SD, Kersten I, et al. Randomized, double-blind, placebo-controlled crossover study in men with prostate cancer and rising PSA: effectiveness of a dietary supplement. European Urology. 2005 Dec 1;48(6):922–31. doi: 10.1016/j.eururo.2005.08.005 16263208

8. Thomas R, Williams M, Sharma H, Chaudry A, Bellamy P. A double-blind, placebo-controlled randomised trial evaluating the effect of a polyphenol-rich whole food supplement on PSA progression in men with prostate cancer—the UK NCRN Pomi-T study. Prostate Cancer and Prostatic Diseases. 2014 Jun;17(2):180. doi: 10.1038/pcan.2014.6 24614693

9. Hackshaw-Mcgeagh L, Perry R, Leach V, Qandil S, Jeffreys M, Martin R, et al. A systematic review of dietary, nutritional, and physical activity interventions for the prevention of prostate cancer progression and mortality. Cancer Causes Control. 2015;26(11):1521–50. doi: 10.1007/s10552-015-0659-4 26354897

10. Vijayvergia N, Denlinger C. Lifestyle factors in cancer survivorship: where we are and where we are headed. Journal of Personalized Medicine. 2015 Sep;5(3):243–63. doi: 10.3390/jpm5030243 26147495

11. Lin PH, Aronson W, Freedland SJ. Nutrition, dietary interventions and prostate cancer: the latest evidence. BMC medicine. 2015 Dec;13(1):3.

12. Van Blarigan EL, Gerstenberger JP, Kenfield SA, Giovannucci EL, Stampfer MJ, Jones LW, et al. Physical activity and prostate tumor vessel morphology: data from the Health Professionals Follow-up Study. Cancer Prevention Research. 2015 Oct 1;8(10):962–7. doi: 10.1158/1940-6207.CAPR-15-0132 26276753

13. Richman EL, Kenfield SA, Stampfer MJ, Paciorek A, Carroll PR, Chan JM. Physical activity after diagnosis and risk of prostate cancer progression: data from the cancer of the prostate strategic urologic research endeavor. Cancer Research. 2011 Jun 1;71(11):3889–95. doi: 10.1158/0008-5472.CAN-10-3932 21610110

14. Kenfield SA, Stampfer MJ, Giovannucci E, Chan JM. Physical activity and survival after prostate cancer diagnosis in the health professionals follow-up study. Journal of Clinical Oncology. 2011 Feb 20;29(6):726. doi: 10.1200/JCO.2010.31.5226 21205749

15. Nilsen TS, Raastad T, Skovlund E, Courneya KS, Langberg CW, Lilleby W, et al. Effects of strength training on body composition, physical functioning, and quality of life in prostate cancer patients during androgen deprivation therapy. Acta Oncologica. 2015 Nov 26;54(10):1805–13. doi: 10.3109/0284186X.2015.1037008 25927504

16. Teleni L, Chan RJ, Chan A, Isenring EA, Vela I, Inder WJ, et al. Exercise improves quality of life in androgen deprivation therapy-treated prostate cancer: systematic review of randomised controlled trials. Endocrine-related Cancer. 2016 Feb 1;23(2):101–12. doi: 10.1530/ERC-15-0456 26584972

17. Taaffe DR, Newton RU, Spry N, Joseph D, Chambers SK, Gardiner RA, et al. Effects of different exercise modalities on fatigue in prostate cancer patients undergoing androgen deprivation therapy: a year-long randomised controlled trial. European Urology. 2017 Aug 1;72(2):293–9. doi: 10.1016/j.eururo.2017.02.019 28249801

18. World Health Organization. Prevention of cardiovascular disease: guideline for assessment and management of cardiovascular risk. 2007 (WHO, Geneva).

19. Skolarus TA, Wolf A, Erb NL, Brooks DD, Rivers BM, Underwood W, et al. American Cancer Society prostate cancer survivorship care guidelines. CA: A Cancer Journal for Clinicians. 2014 Jul 1;64(4):225–49.

20. Egger S, Hughes S, Smith DP, Chambers S, Kahn C, Moxey A, et al. Factors associated with the use of complementary and alternative medicines for prostate cancer by long-term survivors. PloS One. 2018 Mar 7;13(3):e0193686. doi: 10.1371/journal.pone.0193686 29513724

21. Smith DP, Supramaniam R, King MT, Ward J, Berry M, Armstrong BK. Age, health, and education determine supportive care needs of men younger than 70 years with prostate cancer. J Clin Oncol 2007;25:2560–6. doi: 10.1200/JCO.2006.09.8046 17577034

22. Smith DP, King MT, Egger S, Stricker PD, Cozzi P, Ward J, et al. Quality-of-life three years after diagnosis of localised prostate cancer: population based cohort study. BMJ. 2009;339b4817

23. Glover J, Tennant S: Remote Areas Statistical Geography in Australia: Notes on the Accessibility/Remoteness Index for Australia (ARIA + version). Adelaide: Public Health Information Development Unit, University of Adelaide; 2002.

24. Australian Bureau of Statistics. Census of population and housing: socio-economic indexes for areas (SEIFA). Australia data only, 2001. Canberra, Australia: Australian Bureau of Statistics. http://www.abs.gov.au/AUSSTATS/abs@.nsf/ DetailsPage/2033.0.55.0012001?Open Document. Accessed on July 25, 2011.

25. Goldsbury DE, Smith DP, Armstrong BK, O’Connell DL. Using linked routinely collected health data to describe prostate cancer treatment in New South Wales, Australia: a validation study. BMC Health Services Research. 2011 Oct 6;11(1):253.

26. Henderson JW, Donatelle RJ. The relationship between cancer locus of control and complementary and alternative medicine use by women diagnosed with breast cancer. Psycho-Oncology: Journal of the Psychological, Social and Behavioral Dimensions of Cancer. 2003 Jan;12(1):59–67.

27. Greenberg D, Kornblith A, Herndon J: Quality-of-life of adult leukemia survivors treated on clinical trials of cancer and leukemia group B during the period of 1971–1988: predictors for later psychologic distress. Cancer 80: 1936–1944, 1997. doi: 10.1002/(sici)1097-0142(19971115)80:10<1936::aid-cncr10>3.0.co;2-z 9366296

28. Weiss DS, Marmar CR. (1997) The Impact of Event Scale—Revised. In Assessing Psychological Trauma and PTSD (eds Wilson J. P. & Keane T. M.), pp. 399–411. New York: Guilford Press.

29. Zigmond AS, Snaith RP: The Hospital Anxiety And Depression Scale Acta Psychiatr Scand. 1983, 67:361–70. doi: 10.1111/j.1600-0447.1983.tb09716.x 6880820

30. Szymanski KM, Wei JT, Dunn RL, Sanda MG. Development and validation of an abbreviated version of the expanded prostate cancer index composite instrument for measuring health-related quality of life among prostate cancer survivors. Urology. 2010 Nov 1;76(5):1245–50. doi: 10.1016/j.urology.2010.01.027 20350762

31. Litwin MS, Hays RD, Fink A, Ganz PA, Leake B, Brook RH. The UCLA Prostate Cancer Index: development, reliability, and validity of a health-related quality-of-life measure. Med Care 36: 1002–1012, 1998. doi: 10.1097/00005650-199807000-00007 9674618

32. Ware JE, Kosinski M, Keller SD. A 12-Item Short-Form Health Survey: construction of scales and preliminary tests of reliability and validity. Medical Care 1996; 34: 220–233. doi: 10.1097/00005650-199603000-00003 8628042

33. Wei JT, Dunn RL, Litwin MS, Sandler HM, Sanda MG. Development and validation of the expanded prostate cancer index composite (EPIC) for comprehensive assessment of health-related quality-of-life in men with prostate cancer. Urology. 2000 Dec 31;56(6):899–905. doi: 10.1016/s0090-4295(00)00858-x 11113727

34. Zou G. A modified Poisson regression approach to prospective studies with binary data. American Journal of Epidemiology. 2004 Apr 1;159(7):702–6. doi: 10.1093/aje/kwh090 15033648

35. D’Amico AV, Whittington R, Malkowicz SB, Schultz D, Blank K, Broderick GA, et al. Biochemical outcome after radical prostatectomy, external beam radiation therapy, or interstitial radiation therapy for clinically localized prostate cancer. JAMA.1998; 280: 969–974. doi: 10.1001/jama.280.11.969 9749478

36. Agresti A. Categorical Data Analysis, 2nd edn. New York: Wiley, 2002.

37. White IR, Royston P, Wood AM. Multiple imputation using chained equations: issues and guidance for practice. Statistics in Medicine. 2011 Feb 20;30(4):377–99. doi: 10.1002/sim.4067 21225900

38. Demark-Wahnefried W, Peterson B, McBride C, Lipkus I, Clipp E. Current health behaviors and readiness to pursue life-style changes among men and women diagnosed with early stage prostate and breast carcinomas. Cancer. 2000 Feb 1;88(3):674–84. 10649263

39. Blanchard CM, Stein KD, Baker F, Dent MF, Denniston MM, Courneya KS, et al. Association between current lifestyle behaviors and health-related quality of life in breast, colorectal, and prostate cancer survivors. Psychology & Health. 2004 Feb 1;19(1):1–3.

40. Demark-Wahnefried W, Clipp EC, Morey MC, Pieper CF, Sloane R, Snyder DC, et al. Physical function and associations with diet and exercise: Results of a cross-sectional survey among elders with breast or prostate cancer. International Journal of Behavioral Nutrition and Physical Activity. 2004 Dec;1(1):16. doi: 10.1186/1479-5868-1-16 15516261

41. Coups EJ, Ostroff JS A population-based estimate of the prevalence of behavioral risk factors among adult cancer survivors and noncancer controls. Prev Med. 2005; 40:702–711 doi: 10.1016/j.ypmed.2004.09.011 15850868

42. Dahn JR, Penedo FJ, Molton I, Lopez L, Schneiderman N, Antoni MH. Physical activity and sexual functioning after radiotherapy for prostate cancer: beneficial effects for patients undergoing external beam radiotherapy. Urology. 2005 May 1;65(5):953–8. doi: 10.1016/j.urology.2004.11.029 15882730

43. Bellizzi KM, Rowland JH, Jeffery DD, McNeel T. Health behaviors of cancer survivors: examining opportunities for cancer control intervention. J Clin Oncol 2005 Dec 1;23(34):8884–93. doi: 10.1200/JCO.2005.02.2343 16314649

44. Zopf EM, Newton RU, Taaffe DR, Spry N, Cormie P, Joseph D, et al. Associations between aerobic exercise levels and physical and mental health outcomes in men with bone metastatic prostate cancer: a cross-sectional investigation. European Journal of Cancer Care. 2017 Nov;26(6):e12575.

45. Thorsen L, Courneya KS, Stevinson C, Fosså SD. A systematic review of physical activity in prostate cancer survivors: outcomes, prevalence, and determinants. Supportive Care in Cancer. 2008 Sep 1;16(9):987–97. doi: 10.1007/s00520-008-0411-7 18274783

46. American Cancer Society (2002b). Cancer Prevention & Early Detection: Cancer Facts and Figures. Atlanta, Georgia.

47. Avery KN, Donovan JL, Gilbert R, Davis M, Emmett P, Down L, et al. Men with prostate cancer make positive dietary changes following diagnosis and treatment. Cancer Causes & Control. 2013 Jun 1;24(6):1119–28.

48. Hackshaw-McGeagh LE, Penfold CM, Walsh E, Donovan JL, Hamdy FC, Neal DE, et al. Physical activity, alcohol consumption, BMI and smoking status before and after prostate cancer diagnosis in the ProtecT trial: opportunities for lifestyle modification. International Journal of Cancer. 2015 Sep;137(6):1509–15. doi: 10.1002/ijc.29514 25761662

49. Hall JD, Bissonette EA, Boyd JC, Theodorescu D. Motivations and influences on the use of complementary medicine in patients with localized prostate cancer treated with curative intent: results of a pilot study. BJU International. 2003 May;91(7):603–7. doi: 10.1046/j.1464-410x.2003.04181.x 12699468

50. Porter M, Kolva E, Ahl R, Diefenbach MA. Changing patterns of CAM use among prostate cancer patients two years after diagnosis: Reasons for maintenance or discontinuation. Complementary therapies in medicine. 2008 Dec 1;16(6):318–24. doi: 10.1016/j.ctim.2008.04.001 19028331

51. Wilkinson S, Farrelly S, Low J, Chakraborty A, Williams R, Wilkinson S. The use of complementary therapy by men with prostate cancer in the UK. European Journal of Cancer care. 2008 Sep;17(5):492–9. doi: 10.1111/j.1365-2354.2007.00904.x 18637112

52. Patterson RE, Neuhouser ML, Hedderson MM, Schwartz SM, Standish LJ, Bowen DJ. Changes in diet, physical activity, and supplement use among adults diagnosed with cancer. Journal of the American Dietetic Association. 2003 Mar 1;103(3):323–8. doi: 10.1053/jada.2003.50045 12616253

53. Klein EA, Thompson IM, Tangen CM, Crowley JJ, Lucia MS, Goodman PJ, et al. Vitamin E and the risk of prostate cancer: the Selenium and Vitamin E Cancer Prevention Trial (SELECT). Jama. 2011 Oct 12;306(14):1549–56. doi: 10.1001/jama.2011.1437 21990298

Článek vyšel v časopise


2019 Číslo 10

Nejčtenější v tomto čísle

Tomuto tématu se dále věnují…


Zvyšte si kvalifikaci online z pohodlí domova

Léčba bolesti v ordinaci praktického lékaře
nový kurz
Autoři: MUDr. PhDr. Zdeňka Nováková, Ph.D.

Revmatoidní artritida: včas a k cíli
Autoři: MUDr. Heřman Mann

Jistoty a nástrahy antikoagulační léčby aneb kardiolog - neurolog - farmakolog - nefrolog - právník diskutují
Autoři: doc. MUDr. Štěpán Havránek, Ph.D., prof. MUDr. Roman Herzig, Ph.D., doc. MUDr. Karel Urbánek, Ph.D., prim. MUDr. Jan Vachek, MUDr. et Mgr. Jolana Těšínová, Ph.D.

Léčba akutní pooperační bolesti
Autoři: doc. MUDr. Jiří Málek, CSc.

Nové antipsychotikum kariprazin v léčbě schizofrenie
Autoři: prof. MUDr. Cyril Höschl, DrSc., FRCPsych.

Všechny kurzy
Kurzy Doporučená témata Časopisy
Zapomenuté heslo

Nemáte účet?  Registrujte se

Zapomenuté heslo

Zadejte e-mailovou adresu se kterou jste vytvářel(a) účet, budou Vám na ni zaslány informace k nastavení nového hesla.


Nemáte účet?  Registrujte se