What Are the Links of Prostate Cancer with Physical Activity and Nutrition? : A Systematic Review Article

By Kruk, Joanna; Aboul-Enein, Hassan | Iranian Journal of Public Health, December 2016 | Go to article overview

What Are the Links of Prostate Cancer with Physical Activity and Nutrition? : A Systematic Review Article


Kruk, Joanna, Aboul-Enein, Hassan, Iranian Journal of Public Health


Introduction

"Prostate cancer (PCa) is the second most common malignancy in men worldwide and the third leading cause of cancer death" (1). "According to global statistics, 1,111,689 the PCa incidence and 307,471 total deaths due to this cancer were estimated in 2012" (2). Epidemiological and laboratory findings suggest that PCa is a multifactorial disease undergoing to several non-modifiable risk factors (e.g. older age, race, family history of PCa) (3, 4) and possible modifiable risk factors such as lifestyle (5). Age is the major risk factor; the incidence of the disease increases with age and is more common in men above 50 yr of age being over 80% linked with men aged above 65 yr (3). Environmental factors (smoking, radiation, infections agents, industrial chemicals and air/water pollution, medications, obesity, physical inactivity, unhealthy nutrition) play an important role in the PCa pathology. Only 5%-10% of all cancers are linked with "genetic abnormalities" (6).

During the past two decades, a great interest has been placed in the modifiable risk factors, like physical inactivity (7-9) and diet poor in natural antioxidants (10-12) as the risk factors for cancer, including PCa. Moreover, lifestyle has been reported as an important aspect of quality of life for the PCa survivors and a factor slowing the cancer progression and reducing mortality (13). Biological benefits of regular moderate physical activity (PA) are consistently documented for primary cancer prevention, due to wide spectrum of its interactions (8, 14-18). In this respect, several previous reviews of epidemiological studies worldwide addressed the associations between PA and cancer risk, however, in the case of PCa the research is in the early stage comparing to breast or colorectal cancers. Some degree of a link between nutrition and PCa risk was demonstrated (6, 19-22).

This study provides a brief synthesis of the most important findings and conclusions available from the recent reviews and meta-analyses, concerning PCa incidence, the role of PA and diet in the cancer risk, and presents lately published epidemiologic findings on this topic not included in the previous review reports.

Methods

Four databases (Health Source, Science Direct, Web of Science, and MEDLINE) were searched from 2009 to Dec 2015. The search terms included prostate cancer, physical activity, exercise, diet, vegetables/fruits, nutrition, and supplements. In order to limit the size of the article and the number of references, meta-analyses and reviews of data not included in the analysis of the Second Expert Report (6) and lately published cohort and casecontrol studies on the interesting topic are cited. The reference lists from the relevant articles to check the retrieved data and to obtain additional information were also read. The search was limited to publications in English. Due to high level of heterogeneity in the study design, we have not carried out estimation of the overall quantitative synthesis of data across selected studies but display them in tables.

Results

Prostate cancer incidence

Epidemiologic data have shown large geographical variations in the PCa incidence (Fig. 1).

The highest cancer incidence rates are observed in Australia and Oceania, and Northern America, while South-Central Asia and Northern Africa have the lowest rates (23). In general, PCa rates are 4.83 times higher in the more developed regions in comparison with less developed regions (69.5 vs 14.5 cases per 100000) (23). These geographic differences may be partially due to a fact that prostate-specific-antigen (PSA) screening in developed countries allows to diagnose cancers at earlier stage, as well as to difference in PCa treatment (24). Men who migrate from geographical regions with low PCa mortality to the developed countries with high mortality assume a higher prevalence rate (25). Besides, PCa is more often diagnosed among Afro-Americans (3). …

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