Prostate cancer and subsequent nutritional outcomes: the role of diagnosis and treatment

  • Alexander N. SladeEmail author



To comprehensively explore the role of a prostate cancer diagnosis and its treatment to several outcomes including diet, Hemoglobin A1c, and weight status, in a large, nationally representative, cross-sectional study.


This analysis used five cross sections from the publicly available National Health and Nutrition Evaluation Survey (NHANES) from 2001 to 2010. A sample of 289 men with a history of prostate cancer was matched to a comparison group of 655 men with elevated prostate-specific antigen (> 4 ng/mL) but no reported diagnosis of prostate cancer. Analyses were stratified by diabetic or pre-diabetes status and treatment including surgery, radiotherapy, or both. Outcomes of interest included several broad macronutrient categories, HbA1c, body mass index, and obesity status. Multivariate regression analyses were conducted to clarify the associations of a prostate cancer diagnosis with these outcomes. Demographic and socioeconomic factors, including age, education, race, income, and marital status, were controlled for in all models.


The clinical and demographic characteristics were relatively well balanced between the “at risk” comparison group and the group of men diagnosed with prostate cancer. Diabetic or pre-diabetic men diagnosed with prostate cancer were more likely to be obese (p < 0.05) and have a higher BMI (p < 0.10). On multivariate analysis, compared to controls, men with prostate cancer treated with surgery and radiation therapy were predicted to have a higher BMI (p < 0.01) and were more likely to be obese (p < 0.05). These findings were largely driven by the diabetic and pre-diabetic sample. Further diabetics and pre-diabetics with prostate cancer treated with both radiation and surgery were predicted to consume an average of 72 and 59 more daily grams of carbohydrates and sugar, respectively, compared to controls (p < 0.05).


Men with prostate cancer report fewer behaviors and outcomes consistent with optimal glycemic management including a higher BMI, and in diabetics and pre-diabetics, increased carbohydrate sugar consumption. Men with more intense treatment including surgery and radiotherapy appeared to be more likely to be obese and make poorer dietary carbohydrate and sugar choices compared to men without prostate cancer.

Implications for Cancer Survivors

Men treated for prostate cancer have, on average, very long survivorship periods and are susceptible to diabetes and its complications. Interventions designed to improve diabetes awareness and self-management, especially weight and dietary sugar control, may be useful in this population.


Prostate cancer survivorship NHANES Nutrition and cancer Diabetes self-management 



The author would like to acknowledge Dr. Nicholas Serrano and Dr. Michael Waters for helpful comments in previous versions of the manuscript.

Compliance with ethical standards

Conflict of interest

The author declares that he has no conflicts of interest.

Ethical approval

This article does not contain any studies with human participants performed by any of the authors.



Supplementary material

11764_2019_739_MOESM1_ESM.docx (21 kb)
ESM 1 (DOCX 21 kb)


  1. 1.
    Miller KD, Siegel RL, Lin CC, Mariotto AB, Kramer JL, Rowland JH, et al. Cancer treatment and survivorship statistics, 2016. CA Cancer J Clin. 2016;66:271–89.CrossRefGoogle Scholar
  2. 2.
    Cao Y, Ma J. Body-mass index, prostate cancer-specific mortality and biochemical recurrence: a systematic review and meta-analysis. Cancer Prev Res (Phila). 2011;4:486–501.CrossRefGoogle Scholar
  3. 3.
    Friedenreich CM, Wang Q, Neilson HK, Kopciuk KA, McGregor SE, Courneya KS. Physical activity and survival after prostate cancer. Eur Urol. 2016;70:576–85.CrossRefGoogle Scholar
  4. 4.
    Kenfield SA, Batista JL, Jahn JL, Downer MK, Van Blarigan EL, Sesso HD, et al. Development and application of a lifestyle score for prevention of lethal prostate cancer. J Natl Cancer Inst. 2016;108:djv329.CrossRefGoogle Scholar
  5. 5.
    Chan JM, Holick CN, Leitzmann MF, Rimm EB, Willett WC, Stampfer MJ, et al. Diet after diagnosis and the risk of prostate cancer progression, recurrence, and death (United States). Cancer Causes Control. 2006;17:199–208.CrossRefGoogle Scholar
  6. 6.
    Taborelli M, Polesel J, Parpinel M, Stocco C, Birri S, Serraino D, et al. Fruit and vegetables consumption is directly associated to survival after prostate cancer. Mol Nutr Food Res. 2016;61:1600816.CrossRefGoogle Scholar
  7. 7.
    O’Neill RF, Haseen F, Murray LJ, O’Sullivan JM, Cantwell MM. A randomised controlled trial to evaluate the efficacy of a 6-month dietary and physical activity intervention for patients receiving androgen deprivation therapy for prostate cancer. J Cancer Surviv. 2015;9:431–40.CrossRefGoogle Scholar
  8. 8.
    Parsons JK, Pierce JP, Mohler J, Paskett E, Jung S-H, Humphrey P, 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;38:198–203.CrossRefGoogle Scholar
  9. 9.
    Parsons JK, Pierce JP, Mohler J, Paskett E, Jung S-H, Morris MJ, et al. Men's Eating and Living (MEAL) study (CALGB 70807 [Alliance]): recruitment feasibility and baseline demographics of a randomized trial of diet in men on active surveillance for prostate cancer. BJU Int. 2017;121:534–9.CrossRefGoogle Scholar
  10. 10.
    Garber AJ, Abrahamson MJ, Barzilay JI, Blonde L, Bloomgarden ZT, Bush MA, et al. Consensus statement by the American Association of Clinical Endocrinologists and American College of Endocrinology on the Comprehensive Type 2 Diabetes Management Algorithm—2018 Executive Summary. Endocr Pract. 2018;24:91–120.CrossRefGoogle Scholar
  11. 11.
    Yao N, Camacho FT, Chukmaitov AS, Fleming ST, Anderson RT. Diabetes management before and after cancer diagnosis: missed opportunity. Ann Transl Med. 2015;3:72.Google Scholar
  12. 12.
    Griffiths RI, McFadden EC, Stevens RJ, Valderas JM, Lavery BA, Khan NF, et al. Quality of diabetes care in breast, colorectal, and prostate cancer. J Cancer Surviv. 2018;12:803–12.CrossRefGoogle Scholar
  13. 13.
    Mohler J, Bahnson RR, Boston B, Busby JE, D'Amico A, Eastham JA, et al. Prostate Cancer. J Natl Compr Cancer Netw. 2010;8:162–200.CrossRefGoogle Scholar
  14. 14.
    Cooner WH, Mosley BR, Rutherford CL, Beard JH, Pond HS, Terry WJ, et al. Prostate cancer detection in a clinical urological practice by ultrasonography, digital rectal examination and prostate specific antigen. J Urol. 1990;143:1146–52.CrossRefGoogle Scholar
  15. 15.
    Thompson IM, Pauler DK, Goodman PJ, Tangen CM, Lucia MS, Parnes HL, et al. Prevalence of prostate cancer among men with a prostate-specific antigen level ≤4.0 ng per milliliter. N Engl J Med. 2004;350:2239–46.CrossRefGoogle Scholar
  16. 16.
    Daugherty M, Chelluri R, Bratslavsky G, Byler T. Are we underestimating the rates of incontinence after prostate cancer treatment? Results from NHANES. Int Urol Nephrol. 2017;49:1715–21.CrossRefGoogle Scholar
  17. 17.
    Kahn ME. Diabetic risk taking: the role of information, education and medication. J Risk Uncertain. 1999;18:147–64.CrossRefGoogle Scholar
  18. 18.
    Slade AN. Health investment decisions in response to diabetes information in older Americans. J Health Econ. 2012;31:502–20.CrossRefGoogle Scholar
  19. 19.
    Slade AN, Kim H. Dietary responses to a hypertension diagnosis: evidence from the National Health and Nutrition Examination Survey (NHANES) 2007–2010. Behav Med. 2014;40:1–13.CrossRefGoogle Scholar
  20. 20.
    Link RE. Laparoscopic radical prostatectomy in obese patients: feasible or foolhardy? Rev Urol. 2005;7:53–7.Google Scholar
  21. 21.
    Keenan PS. Smoking and weight change after new health diagnoses in older adults. Arch Intern Med. 2009;169:237–42.CrossRefGoogle Scholar
  22. 22.
    Wang Z, McLoone P, Morrison DS. Diet, exercise, obesity, smoking and alcohol consumption in cancer survivors and the general population: a comparative study of 16 282 individuals. Br J Cancer. 2014;112:572.CrossRefGoogle Scholar
  23. 23.
    Westmaas JL, Newton CC, Stevens VL, Flanders WD, Gapstur SM, Jacobs EJ. Does a recent cancer diagnosis predict smoking cessation? An analysis from a large prospective US cohort. J Clin Oncol. 2015;33:1647–52.CrossRefGoogle Scholar
  24. 24.
    Newsom JT, Huguet N, McCarthy MJ, Ramage-Morin P, Kaplan MS, Bernier J, et al. Health behavior change following chronic illness in middle and later life. J Gerontol B Psychol Sci Soc Sci. 2012;67B:279–88.CrossRefGoogle Scholar
  25. 25.
    Williams K, Steptoe A, Wardle J. Is a cancer diagnosis a trigger for health behaviour change? Findings from a prospective, population-based study. Br J Cancer. 2013;108:2407–12.CrossRefGoogle Scholar
  26. 26.
    Bluethmann SM, Basen-Engquist K, Vernon SW, Cox M, Gabriel KP, Stansberry SA, et al. Grasping the ‘teachable moment’: time since diagnosis, symptom burden and health behaviors in breast, colorectal and prostate cancer survivors. Psycho-Oncology. 2015;24:1250–7.CrossRefGoogle Scholar
  27. 27.
    Calip GS, Hubbard RA, Stergachis A, Malone KE, Gralow JR, Boudreau DM. Adherence to oral diabetes medications and glycemic control during and following breast cancer treatment. Pharmacoepidemiol Drug Saf. 2015;24:75–85.CrossRefGoogle Scholar
  28. 28.
    Santorelli ML, Steinberg MB, Hirshfield KM, Rhoads GG, Bandera EV, Lin Y, et al. Effects of breast cancer on chronic disease medication adherence among older women. Pharmacoepidemiol Drug Saf. 2016;25:898–907.CrossRefGoogle Scholar
  29. 29.
    Yang J, Neugut AI, Wright JD, Accordino M, Hershman DL. Nonadherence to oral medications for chronic conditions in breast cancer survivors. J Oncol Pract. 2016;12:e800–9.CrossRefGoogle Scholar
  30. 30.
    Zanders MMJ, Haak HR, van Herk-Sukel MPP, van de Poll-Franse LV, Johnson JA. Impact of cancer on adherence to glucose-lowering drug treatment in individuals with diabetes. Diabetologia. 2015;58:951–60.CrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Massey Cancer Center, Department of Radiation OncologyVirginia Commonwealth University Health SystemRichmondUSA

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