5. Giovannucci E, Rimm EB, Liu Y, Stampfer MJ, Willett WC. A prospective
study of tomato products, lycopene, and prostate cancer risk. J Natl Cancer Inst.
6. Ornish D, Lin J, Chan JM, et al. Effect of comprehensive lifestyle changes on
telomerase activity and telomere length in men with biopsy-proven low-risk
prostate cancer: 5-year follow-up of a descriptive pilot study. Lancet Oncol.
2013; 14( 11):1112-1120.
7. Kenfield SA, Stampfer MJ, Chan JM, Giovannucci E. Smoking and prostate
cancer survival and recurrence. JAMA. 2011;305( 24):2548-2555.
8. Richman EL, Kenfield SA, Chavarro JE, et al. Fat intake after diagnosis
and risk of lethal prostate cancer and all-cause mortality. JAMA Intern Med.
9. Kenfield SA, Batista JL, Jahn JL, et al. Development and application of a lifestyle
score for prevention of lethal prostate cancer. J Natl Cancer Inst. 2016;108( 3).
10. Parsons JK, Newman VA, Mohler JL, Pierce JP, Flatt S, Marshall J. Dietary
modification in patients with prostate cancer on active surveillance: A
randomized, multicentre feasibility study. BJU Int. 2008;101( 10):1227-1231.
11. Lippman SM, Klein EA, Goodman PJ, et al. Effect of selenium and vitamin E on
risk of prostate cancer and other cancers: the Selenium and Vitamin E Cancer
Prevention Trial (SELECT). JAMA. 2009;301( 1): 39-51.
12. Parsons JK, Pierce JP, Mohler J, et al. A randomized trial of diet in men with
early stage prostate cancer on active surveillance: Rationale and design of the
Men’s Eating and Living (MEAL) Study (CALGB 70807 [Alliance]). Contemp Clin
Trials. 2014; 38( 2):198-203.
13. Heinonen OP, Albanes D, Virtamo J, et al. Prostate cancer and supplementation
with alpha-tocopherol and beta-carotene: Incidence and mortality in a controlled
trial. J Natl Cancer Inst. 1998;90( 6):440-446.
14. Virtamo J, Pietinen P, Huttunen JK, et al. Incidence of cancer and
mortality following alpha-tocopherol and beta-carotene supplementation:
A postintervention follow-up. JAMA. 2003;290( 4):476-485.
15. Virtamo J, Taylor PR, Kontto J, et al. Effects of alpha-tocopherol and beta-carotene supplementation on cancer incidence and mortality: 18-year
postintervention follow-up of the Alpha-tocopherol, Beta-carotene Cancer
Prevention Study. Int J Cancer. 2014;135( 1):178-185.
16. Gaziano JM, Sesso HD, Christen WG, et al. Multivitamins in the prevention
of cancer in men: the Physicians’ Health Study II randomized controlled trial.
JAMA. 2012;308( 18):1871-1880.
17. Ornish D, Weidner G, Fair WR, et al. Intensive lifestyle changes may affect the
progression of prostate cancer. J Urol. 2005;174( 3):1065-1069; discussion 1069-1070.
REFERENCES (CONTINUED) of beans or legumes per day,
whereas those in the control
group received printed materials
recommending consumption of a
healthy diet. The primary study
outcome is clinical progression,
which is defined as PSA> 10 ng/
mL, PSA doubling time < 3 years,
or increase in tumor volume or
Gleason score. 12 Results from the
study are expected next summer.
The performance of such a
trial serves to fill a considerable
need to quantify the effect of a
well-specified dietary intervention
on PCa progression during active
surveillance. 13 More broadly,
MEAL’s completion is notable for
representing a randomized trial in
low-risk patients, where virtually
no level 1 evidence currently
exists in support of modifying
short-term disease trajectory.
These efforts highlight the breadth
of work on this topic, ranging
from preclinical work addressing
putative mechanisms of disease
prevention to observational studies,
as well as randomized clinical
trials that seek to directly examine
the effect of discrete dietary
and lifestyle interventions. ♦
ACS CLINICAL RESEARCH PROGRAM
TABLE 2. DEFINITIONS OF THE LIFESTYLE SCORE DERIVED FROM THE HPFS
ON THE OCCURRENCE OF LETHAL PCa9
Factor Definition Points
Smoking status Never smoker or quit ≥ 10 years 1
Body mass index < 30 kg/m2 1
Physical activity ≥ 3 hours/week vigorous activity (≥ 6 METs) and/or ≥ 7 hours/week brisk walking 1
Tomatoes ≥ 7 servings/week raw tomatoes, tomato juice, tomato sauce, salsa, pizza 1
Fatty fish ≥ 1 serving/week mackerel, salmon, sardines, blue-fish, swordfish 1
Processed meat < 3 servings/week of beef or pork hot dogs, bacon, salami, bologna, or other processed meat sandwiches, and other processed meats 1
Total points 6