Total fruit and prostate cancer.
Total prostate cancer risk: Data about total fruits in relation to total prostate cancer risk was provided by 16 cohorts,
including a total of 27,557 cases. A significantly increased risk was found in one cohort, including 637 cases (Schuurman AG [10]). No other (non)significant
associations were found. The average RR = 1.03 (excluding incomplete data from Kurahashi N [19], Tseng M [13], Wu K [7]).
Inclusion of intermediate levels of consumption:
Significantly increased risks were found at the levels of consumption of 151 g/day (Chan JM [11]), and 51-96 g/day (Gonzalez A [21]). Though the trend was
significant, no (non)significant effects were found in one cohort (Schuurman AG [10]).
No (non)significant protective effect was found at any level of consumption in any cohort.
Advanced stage prostate cancer risk: Data about advanced prostate cancer risk was provided by 5 cohorts, including a total of 4,226 cases.
A significant protective effect was found in one cohort (Giovannucci E [7]). No other associations were found. The average RR = 0.95
Prostate cancer mortality: Data about total fruits in relation to prostate cancer death was provided by 4 cohorts of small size, including a total of 456 cases.
No associations were found. The average RR = 0.98 (excluding incomplete data from Snowdon DA [1]).
Conclusion: Few associations were found with any end point. No evidence was found for an association between total fruits and total prostate cancer risk,
advanced prostate cancer risk, or prostate cancer mortality. In addition, no evidence was found for an association when advanced cancer and mortality are considered
as one single end point (RR = 0.95), or when advanced prostate cancer is stratified in disease stage and grade.
| Author | Cohort name | Cases | Relative Risk (RR) |
|---|---|---|---|
| 24) George SM (2008) | The NIH-AARP Diet and Health Study | 17,034 | RR = 1.01 (0.95-1.06; P = 0.766). |
| 23) Ambrosini GL (2008) | No cohort name | 97 | RR = 0.94 (0.46-1.89; P = 0.848). |
| 21) Gonzalez A (2007) | The VITAL Cohort | 763 | HR = 1.19 (0.96-1.47). |
| 19) Kurahashi N (2008) | The JPHC Study | 201 | No association (P = 0.97). |
| 18) Kirsh VA (2007) | The Prostate, Lung, Colorectal and Ovarian Cancer Screening Trial | 1,338 | RR = 0.94 (0.77-1.15; P = 0.84). |
| 17) Stram DO (2006) | The Multiethnic Cohort Study | 3,922 | RR = 1.05 (0.94-1.16; P = 0.603). |
| 15) Key TJ (2004) | The EPIC Study | 1,104 | RR = 1.06 (0.84-1.34; P = 0.741). |
| 14) Allen NE (2004) | The Hiroshima/Nagasaki Life Span Study | 196 | RR = 1.20 (0.83-1.74; P = 0.40). |
| 13) Tseng M (2004) | The NHEFS Cohort | 136 | No association. |
| 11) Chan JM (2000) | The ATBC Study | 184 | RR = 1.3 (0.8-2.2; P = 0.13). |
| 10) Schuurman AG (1998) | The Netherlands Cohort Study | 637 | RR = 1.31 (0.96-1.79; P = 0.02). |
| 7) Wu K (2004) | The Health Professionals Follow-up Study (1993-1998) | 436 | No association. |
| 7) Giovannucci E (1995) | The Health Professionals Follow-up Study (1986-1992) | 773 | RR = 0.84 (0.59-1.84; P = 0.21). |
| 6) Le Marchand L (1994) | No cohort name | 198 | RR = 1.0 (0.7-1.6; P = 0.99). |
| 3) Severson RK (1989) | The Japan-Hawaii Study | 174 | RR = 1.57 (0.95-2.61). |
| 2) Shibata A (1992) | The Leisure World Study | 208 | RR = 1.04 (0.74-1.46). |
| 1) Mills PK (1989) | The Adventist Health Study | 156 | RR = 1.07 (0.72-1.58; P = 0.37). |
| Total number of cases: 27,557 | Average RR = 1.03 |
| Author | Cohort name | Cases | End point | Relative Risk (RR) |
|---|---|---|---|---|
| 24) George SM (2008) | The NIH-AARP Diet and Health Study | 1,778 | Advanced prostate cancer risk | RR = 0.98 (0.83-1.15; P = 0.91). |
| 18) Kirsh VA (2007) | The Prostate, Lung, Colorectal and Ovarian Cancer Screening Trial | Aggressive: 520. Extraprostatic: Not defined. | Aggressive or extraprostatic cancer | Aggressive cancer: RR = 0.90 (0.65-1.25; P = 0.99). Extraprostatic cancer: RR = 1.05 (0.61-1.83; P = 0.92). |
| 17) Stram DO (2006) | The Multiethnic Cohort Study | 1,345 | Non-localized or high grade disease | RR = 1.01 (0.85-1.20; P = 0.769). |
| 10) Schuurman AG (1998) | The Netherlands Cohort Study | 160 | Poorly- or undifferentiated prostate cancer | RR = 1.02 (0.99-1.06). |
| 7) Giovannucci E (1998) | The Health Professionals Follow-up Study | 423 | Advanced prostate cancer risk | RR = 0.63 (0.43-0.93). |
| Total number of cases: 4,226 | Average RR = 0.95 |
| Author | Cohort name | Cases | Relative Risk (RR) |
|---|---|---|---|
| 22) Smit E (2007) | The Puerto Rico Heart Health Program | 167 | OR = 1.13 (0.45-2.79; P = 0.30). |
| 12) Appleby PN (2002) | The Health Food Shoppers Study | 41 | RR = 0.66 (0.34-1.29). |
| 5) Hsing AW (1990) | The Lutheran Brotherhood Cohort Study | 149 | RR = 0.9 (0.6-1.4). |
| 1) Snowdon DA (1984) | The Adventist Health Study | 99 | No association. |
| Total number of cases: 456 | Average RR = 0.98 |
| Author | Cohort name | Subjects | Years of follow-up | Cases | End point | Consumption of | Relative Risk (RR) | Adjustments | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| 24) George SM (2008) | The National Institutes of Health-AARP Diet and Health Study. | 288,109 men aged 50-71. (USA) | 1995-2003 | Total: 17,034. Advanced: 1,778. | Prostate cancer incidence | Fruit |
1 cup = 237 mL. One cup is 1 cup of raw/cooked fruit, 1 cup of 100% juice, or 0.5 cup of dried fruit. Age, smoking, energy intake, BMI, alcohol, physical activity, education , race, marital status, family history, and vegetable intake. |
23) Ambrosini GL (2008) | No cohort name. | 1985 blue asbestos-exposed men. | (Australia) Median 12.7 | (1990-96 to 2004) 97 | Prostate cancer incidence | Total fruit (not defined, but including peaces, apricots, rockmelon, fresh oranges, and orange juice) |
RR = 0.94 (0.46-1.89; P = 0.848) for the highest vs lowest tertile of consumption. | Amount specific data (serves per day): 0-1: RR = 1. > 1-2.3: RR = 1.08 (0.62-1.87). > 2.3: RR = 0.94 (0.46-1.89). Age, total fruit and vegetable intake, randomly assigned retinol or beta carotene supplement and source fo crocidolite exposure. |
21) Gonzalez A (2007) | The VITamins And Lifestyle (VITAL) cohort. | 35,244 men aged 50-76. | (USA) 3.3 | (2000-02 to 2004) 763 | Prostate cancer risk | Fruit (not defined) |
HR = 1.19 (0.96-1.47; No P-value) for the highest vs lowest quartile of consumption. | Amount specific data (servings/day): 0-0.63: HR = 1. 0.64-1.20: HR = 1.25 (1.01-1.54). 1.21-2.06: HR = 1.21 (0.98-1.49). > 2.06: HR = 1.19 (0.96-1.47). Age. |
19) Kurahashi N (2008) | The Japan Public Health Center-based Prospective Study | 14,203 men aged 40-69 who provided blood samples. | (Nested case-control) 12.8 | (1990-93 to 2005) 201 | Prostate cancer incidence | Fruit (not defined) | No difference in consumption was found between cases (87.8 g/d) and controls (88.2 g/d; P = 0.97). | Age and cohort |
18) Kirsh VA. (2007) | The screening arm of the Prostate, Lung, Colorectal and Ovarian Cancer Screening Trial. | 29,361 men aged 55-74. | (USA) mean 4.2 | (1993-2001) 1,338? | of which 520 aggressive (Stage III-IV or gleason score ≥ 7), and ? extraprostatic (Stage III-IV only) prostate cancer risk | All fruits (not defined) |
|
age, total energy, race, study center, family history of prostate cancer, BMI, smoking status, physical activity, supplemental vitamine E intake, total fat intake, red meat intake, diabetes, aspirin use, and previous number of prostate cancer screening examinations during the follow-up period. |
Results were not statistically significantly altered by additional adjustment for total fruit or vegetable intake (as appropriate) and tomato intake or for history of PSA tests before study enrollment. 17) Stram DO. (2006) | The multiethnic cohort study. | 82,486 African-American, Japanese-American, Native-Hawaiian, Latino and White males aged 45-75. | (USA) 1993-96 to 2001 | 3,922? | (1,345 nonlocalized and high grade disease) prostate cancer risk | All fruits and juices (not defined) |
|
age, BMI, education and family history of prostate cancer |
15) Key TJ (2004) | The EPIC Study. | 130.544 men aged 20-97 in 7 countries. | 4.8 | (1993-99 to 2000) 1,104 | Prostate cancer risk | Total fruits (not defined) |
RR = 1.06 (0.84-1.34; P = 0.741) for the top compared to the bottom quintile. | Amount specific data (g/day): 53.2: RR = 1. 110.1: RR = 1.01 (0.84-1.20). 169.2: RR = 0.89 (0.74-1.08). 239.5: RR = 0.92 (0.76-1.12). 410.7: RR = 1.06 (0.84-1.34). There was no association between total fruit consumption and prostate cancer risk in any of the individual countries, and no evidence of heterogeneity between countries in the linear association between fruit intake and risk. Restricting the analysis to men diagnosed with prostate cancer under the age of 65 years also made no appreciable difference to the associations. 7 countries included in this analysis: Denmark, Germany, Italy, The Netherlands, Spain, Sweden and the UK. Stratified for recruitment center and adjusted for height, weight and energy intake. Various potential confounding variables, including education level, smoking and physical activity, were not clearly associated with prostate cancer risk; these variables were therefore omitted from the final analysis. |
Adjustment for total vegetables made no material difference. 14) Allen NE (2004) | The Hiroshima/Nagasaki Life Span Study. | 18,115 men. | (Japan) mean 16.9 | (1963-1996) 196 | Prostate cancer risk | Fruit (not defined) |
RR = 1.20 (0.83-1.74; P = 0.40) for the highest vs lowest tertile of consumption. | Amount specific data (times/week): < 2: RR = 1. 2-4: RR = 1.27 (0.88-1.83). Almost daily: RR = 1.20 (0.83-1.74). age, calendar period, city of residence, ratiation dose and education level |
13) Tseng M (2004) | The National Health and Nutrition Examination Survey Epidemiological Follow-up Study (NHANES) I Epidemiological Follow-up Study (NHEFS) | 3,779 men aged 25-74. | (USA) 1982-84 to 1992 | 136? | Invasive prostate cancer incidence | (excluding in situ cases) Fruit (not defined) | Men with an intermediate level (not defined) of fruit intake had a nonsignificantly elevated risk: RR = 1.3 (0.8-2.1; No P-value) for the 2nd vs 1st tertile of consumption (no other data shown). | ? |
11) Chan JM (2000) | The Alpha-Tocopherol Beta-Carotene Cancer Prevention Study (ATBC Study). | 27,062 male smokers aged 50-69. | (Finland) 1985-1993 | 184? | Stage 2-4 prostate cancer risk | Fruits (not defined, but including berries) |
RR = 1.3 (0.8-2.2; P = 0.13) for the highest vs lowest quintile of consumption. | Amount specific data (g): 25: RR = 1. 67: RR = 1.4 (0.8-2.2). 108: RR = 1.3 (0.8-2.1). 151: RR = 1.8 (1.1-2.8). 230: RR = 1.3 (0.8-2.2). supplementation group (alpha-tocopherol, beta-carotene, both or placebo), education, age, BMI, energy, number of years as a smoker. |
10) Schuurman AG (1998) | The Netherlands Cohort Study. | 58,279 men aged 55-69 | 6.3 | ((1986-1992) 637 | (191 well differentiated, 229 moderately differentiated, and 160 poorly- or undifferentiated) prostate cancer risk | Total fruit (defined as: oranges, mandarins, grapefruit, processed orange/grapefruit juice, grapes, apples and pears, bananas, strawberries, raisins/other dried fruit) |
RR = 1.31 (0.96-1.79; P = 0.02) for the highest vs the lowest quintile of consumption. | Amount specific data (g/day): 34.0: RR = 1. 91.0: RR = 1.06 (0.77-1.46). 136.0: RR = 0.92 (0.66-1.27). 187.0: RR = 1.16 (0.85-1.58). 286.4: RR = 1.31 (0.96-1.79).
RRs between subgroups of tumor sizes did not differ to a large extent and were mostly around the null value; the same applied to latent and nonlatent tumors (data not shown). Age, family history of prostate cancer, socioeconomic status and total vegetables. |
7) Chan JM (2006) | The Health Professionals Follow-up Study. | Post-diagnostic food group consumption of 392 progression outcomes among 1,202 men diagnosed with incident localized/regional (not metastatic [Stage D]) prostate cancer | Average 6 | (1986-2000) 392? | [among which: PSA recurrences (312), metastases (7), or prostate cancer mortality (50)] prostate cancer progression | Fruits (included raisins, prunes, bananas, cantaloupe, apples/pears, oranges, apple juice, orange juice (with and without calcium), grapefruit, grapefruit juice, other fruit juices, strawberries, blueberries, peaches/apricots/plums, avocado, watermelon, and applesauce) |
RR = 0.90 (0.62-1.28; No P-value) for the highest vs lowest quartile of consumption. | Amount specific data (Quartiles not defined): Q1: RR = 1. Q2: RR = 1.19 (0.88-1.59). Q3: RR = 0.86 (0.62-1.20). Q4: RR = 0.90 (0.62-1.28). HR for one serving/day increase = 0.96 (No 95% CI; P = 0.23). The more modest results for a two serving/week increase, which better reflects the more likely changes for less commonly eaten foods, was 0.99. Associations within strata of known treatment groups (i.e. surgery, radiation, or hormones), and prognostic group (i.e. low, intermediate, or high) were similar. RR = adjusted for age, total energy, pre-diagnostic diet (continuous variables), and all other post-diagnostic food groups (grains, vegetables, fruits, red meat, milk, fish, tomato sauce, fresh tomato products). |
HR = adjusted for all pre-and post-diagnostic food group consumption. Models were additionally adjusted for smoking habits, exercise level, body mass index, family history of prostate cancer, and race. There was little evidence of confounding by these factors, and they were not included in the primary multivariate analyses 7) Wu K (2004) | The Health Professionals Follow-up Study. | 18,259 US men aged 40-75. | (Nested case-control) 1993-1998 | 436 | Prostate cancer incidence | (excluding Stage A1 cases) Fruit (not defined) | Fruit intake was similar between cases and controls (no data shown). | Unadjusted. |
7) Giovannucci E (1998) | The Health Professionals Follow-Up Study. | 47,781 men aged 40-75. | (USA) 1986-1994. | 423? | Advanced prostate cancer risk (extraprostatic/ stage C or D) | Total fruit (not defined) | Inversely associated with risk of advanced prostate cancer: RR = 0.63 (0.43-0.93) for > 5 servings vs < or = 1 serving/day. | This inverse association did not persist when total fructose was included in this model: RR = 0.87 (0.55-1.356). age, energy |
7) Giovannucci E (1995) | The Health Professionals Follow-Up Study. | 47,894 men aged 40-75. | (USA) 1986-1992 | 773? | Non-stage A1 prostate cancer risk | Fruit (not defined) | RR = 0.84 (0.59-1.84; P = 0.21) for consumption > 4 vs < 1 servings/day. | Age and energy. |
6) Le Marchand L (1994) | No cohort name. | 20,316 men of various ethnicities aged ≥ 45. | 1975-80 to 1989 | 198? | Invasive prostate cancer risk | Fresh fruits (not defined) |
RR = 1.0 (0.7-1.6; P = 0.99) for the highest vs lowest quartile of consumption. | Amount specific data (gm/week): 414: RR = 1. Not defined: RR = 0.9 (0.6-1.5). Not defined: RR = 0.7 (0.4-1.4). 974: RR = 1.0 (0.7-1.6). Age, ethnicity, and income. |
3) Severson RK (1989) | The Japan-Hawaii Cancer Study. | 7999 men of Japanese ancestry. | 18-21 | (1965-68 to 1986) 174 | Prostate cancer risk | Fruit (not defined) |
RR = 1.57 (0.95-2.61; no P value) for the highest vs lowest tertile of consumption. | Amount specific data (times): ≤ 1/wk: RR = 1. 2-4/wk: RR = 0.74 (0.37-1.46). ≥ 5/wk: RR = 1.57 (0.95-2.61). Age. |
2) Shibata A. (1992) | The Leisure World Study. | 11,580 residents of a retirement community. | (USA) 1981-1989 | 208 | Prostate cancer risk | Fruits (Cantaloupe, mangos, watermelon, apricots, nectarines [including apricot nectar], peaches, papayas, persimmons, sour cherries, prunes, prune juice, apples, applesauce [not apple juice], bananas, avocados, guacamole, pineapple, pineapple juice, blackberries, blueberries, raspberries, boysenberries, loganberries, sweet cherries, fruit cocktail, oranges, tangerines, mandarin oranges, orange juice, white grapefruit and juice, pink/red grapefruit and juice, honeydew, casaba melons, strawberries, cranberry juice cocktail, plums, rhubarb, grapes, pears, figs, raisins, dates) |
RR = 1.04 (0.74-1.46; No P-value) for the highest vs lowest tertile of consumption. | Amount specific data (servings/day): < 2.2: RR = 1. 2.2-< 3.5: RR = 1.05 (0.75-1.47). ≥ 3.5: RR = 1.04 (0.74-1.46). Age and smoking. |
Adjustment for BMI or physical activity did not materially alter the results (data not shown). 1) Mills PK (1989) | The Adventist Health Study. | 14,000 non-Hispanic white Adventist men aged ≥ 25. | (USA) 6 | (1976-1982) 156 | prostate cancer risk | Fruit index (canned or frozen fruit, fresh citrus fruit, other fresh fruit, and dried fruit) |
RR = 1.07 (0.72-1.58; P = 0.37) for the highest vs lowest tertile of consumption. | Amount specific data (Frequency of use): < 12 X/mo: RR = 1. < 12-60 X/mo: RR = 0.95 (0.41-2.22; P = 0.45). ≥ 60 X/mo: RR = 1.07 (0.72-1.58; P = 0.37). Age, education, current use of meat, poultry, or fish, current use of fish only, beans/lentils/peas, citrus fruit, dry fruit, nuts and tomatoes. |
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