Channing Division of Network Medicine, Harvard Medical School, Brigham and Women's Hospital, Boston, MA, USA.
Adv Exp Med Biol. 2019;1210:1-27. doi: 10.1007/978-3-030-32656-2_1.
A variety of diet and lifestyle factors have been studied with respect to prostate cancer risk in large, prospective cohort studies. In spite of this work, and in contrast to other common cancers, few modifiable risk factors have been firmly established as playing a role in prostate cancer. There are several possible explanations for the lack of well-established risk factors. First, prostate cancer has among the highest heritability of all common cancers; second, early life exposures may play an important role in risk, rather than mid- and later-life exposures assessed in most epidemiological studies. Finally, prostate-specific antigen (PSA) screening plays a critical role in prostate cancer detection and incidence rates, which has important implications for epidemiological studies.Among modifiable risk factors, smoking and obesity are consistently associated with higher risk specifically of advanced prostate cancer. There is also considerable evidence for a positive association between dairy intake and overall prostate cancer risk, and an inverse association between cooked tomato/lycopene intake and risk of advanced disease. Several other dietary factors consistently associated with risk in observational studies, including selenium and vitamin E, have been cast into doubt by results from clinical trials. Results for other well-studied dietary factors, including fat intake, red meat, fish, vitamin D, soy and phytoestrogens are mixed.In practical terms, men concerned with prostate cancer risk should be encouraged to stop smoking, be as physically active as possible, and achieve or maintain a healthy weight. These recommendations also have the advantage of having a positive impact on risk of type 2 diabetes, cardiovascular disease, and other chronic diseases. Reducing dairy intake while increasing consumption of fish and tomato products is also reasonable advice.
各种饮食和生活方式因素已在大型前瞻性队列研究中针对前列腺癌风险进行了研究。尽管进行了这项工作，但与其他常见癌症相反，很少有可改变的风险因素被确定为在前列腺癌中发挥作用。缺乏明确确立的风险因素可能有几个原因。首先，前列腺癌是所有常见癌症中遗传性最高的癌症之一；其次，早期生活暴露可能在风险中起重要作用，而不是大多数流行病学研究中评估的中年和后期生活暴露。最后，前列腺特异性抗原（PSA）筛查在前列腺癌检测和发病率中起着至关重要的作用，这对流行病学研究具有重要意义。在可改变的风险因素中，吸烟和肥胖与晚期前列腺癌的风险增加密切相关。也有大量证据表明，乳制品的摄入与整体前列腺癌风险呈正相关，而煮熟的番茄/番茄红素的摄入与晚期疾病的风险呈负相关。在观察性研究中，与风险密切相关的其他几种饮食因素，包括硒和维生素 E，其结果已被临床试验所质疑。对其他研究充分的饮食因素的研究结果，包括脂肪摄入、红肉、鱼类、维生素 D、大豆和植物雌激素，结果不一。从实际意义上讲，关注前列腺癌风险的男性应鼓励戒烟，尽可能多运动，并保持或维持健康的体重。这些建议还有助于降低 2 型糖尿病、心血管疾病和其他慢性疾病的风险。减少乳制品的摄入，同时增加鱼类和番茄制品的摄入也是合理的建议。
