Diet and Exercise: Living With Prostate Cancer

let's move on to June Chand who will be our last speaker in this session a lot of folks asking me about diet and exercise and recommendations during the lunch break and we're lucky enough to have Jun is an expert in this area and it leaves a group that's been doing research in this area for quite some time so Jun hi good afternoon I'd just like to thank my colleagues and the organizers for inviting me to be here and thank all of you for being here for a pretty long and intensive day so I applaud you for your patience and interest so several just before I get started so I'm a professor of epidemiology biostatistics and urology I am a cancer epidemiologist by training you're trying to get this thing to Engel down everyone still hear me in the back great so how much time should I take because we got weird schedules I want to know it's 2:40 okay okay first of all I brought these they were hot off the press they got to deliver to my house last night and they could not get into your bags so these are general guides postcards on healthy eating tips made in collaboration with our Cancer Centre Community Advisory Board and so just feel free to pass them out I did bring about 300 those are general healthy tips then the other thing to make sure people know is working with Stan and supported by the Department of Urology Peter Carol and Stan they supported that we printed some of our diet and exercise guides next slide okay honestly if it's not Paul I talk so these guides if they're not in your bag they also should be on your USB Drive or you can get them free off our website so look like Google lifestyle studies at urology UCSF Stan might still have a few of the blue booklets left we were short of the blue booklets yesterday I carried an 80 of them this morning with me so please take them I do not want to carry them home it was very heavy okay so we have limited time so I was trying to think what should I do in this limited time well since now you have these guides which we created in conjunction with the Cancer Center nutritionist my team and I and with Stan and several great other patient advocate volunteers we're really dedicated to the cause of making sure everybody understands good tips for diet and exercise so I've kind of just put up here our biggest all right these are your good starting tips for those of you who are sitting in the room with me you understand I generally promote foods first focusing on the foods and then there are many other levels of advice that you can get to which actually withstand urging we got two in that blue book so for some of you ask me questions in the room I found many of those we did answer them in that book if I if I said I'm not quite sure I think so I looked it's in the book so please reference that book the blue one so the first one is overall diet and lifestyle second one is really just focused on diet so we know a lot of things that could potentially benefit people I want to say that we have changed as a research scientist we had to change how we study prostate cancer because of PSA screening it was not sufficient to look at primary prevention of total prostate cancer because of screening we now understand there's indolent disease there's aggressive disease so a lot of our research is really focused on once you've been diagnosed what can people do to prevent getting the bad kind the aggressive tumors the tumors that will metastasize cause fatality lethality and death so that's this list is our best guess at that so it's really focused on people after diagnosis what can you do them okay so today because we have limited time and now you have all those books I just wanted to provide a little update or some updates um some of the work our team is doing and where things have come from so on the these might go a little fast but in the book you'll see us talk about exercise our team published in 2011 two pivotal studies linking exercise to prostate cancer specific outcomes it's well known that exercise helps all cause death so the green bar here is the outcome of all cause death the blue bar is the outcome of prostate cancer mortality and Stan told me use the mouse pointer okay here we go so right here so the way you read these charts if you're not used to it you're looking at a relative risk so you're looking at the risk associated with doing more exercise versus less so three is less forty-eight is a lot right here in the middle that's about thirty minutes of walking six most days of the week or 30 minutes of jogging three days a week not surprisingly you see a benefit the green bar right goes down so your risk is lower it's statistically significantly lower that's what this little black vertical bar tells you it's beneath the one line for all cause death it's trending down for the blue but it's not statistically significant what was novel in our publication was that at the highest levels of physical activity a benefit was seen for prostate cancer specific death that was novel in 2011 and at that level that's pretty intense though that's like an hour of jogging every single day not everybody does this we know this okay so at the same time we had a different study so that study was done at about 2,700 men with localized prostate cancer looking at the outcome of metastatic disease or prostate cancer specific death at the same time we had another study done here in about 1500 men looking at prostate cancer recurrence developing in men originally diagnosed with non metastatic disease what was interesting about this study is the men weren't doing that level of intensity of activity so we couldn't actually study it but we could look at walking pace and how much people said they were walking and the interesting trend that's shown in this graph is basically depicting that there was a lower risk of prostate cancer recurrence associated with faster walking pace self-reported faster walking pace okay so that's in the books but also to share it here so since that so those both Stowe studies came out in 2011 I'm happy to share that there's more data out there now substantiating these initial results and actually potentially good news for some people even at lower levels of activity so in 2011 we were like oh god seven hours of jogging a day how are you going to get people to do that to get a better fit right or walking really fast walking really fast as what we've aimed for we have a number of clinical trials that I'll tell you about a little bit later focused on brisk walking because of that finding however in the interim here's the study that came out of the cancer prevention study too focused on over 5,000 men also again diagnosed with prostate cancer so again we're just looking at exercise after diagnosis and they saw a benefit for prostate cancer death at much lower levels so the comparison there that seventeen point five versus three that's much closer if you look back here on this slide to that middle category of like 30 minutes of jogging or a 30 minute walk most days of the week right so that may be much more doable for people so that was a heartening result so recreation exercise how to benefit for prostate cancer death and then another study came out so there's now the fourth study looking at prostate cancer deaths and physical activity after diagnosis so this study just to explain the lines here this is all cause death basically the dotted line is people who are have more activity and then the red line is people with less activity and so you see a separation of the curves and they're having better survival with the dotted line Katsura all cause death and prostate cancer death and again this is I checked this level of activity here is incorrect they duplicated the figure from up there so the comparison for recreation activity again was at that more moderate level of a bit of a walk most days of the week right so the takeaway from all that if you can do this that's great keep doing that if you want to get heart you know more intense activity I strongly recommend going to a trainer getting consults working on not just aerobic activity but also strength training flexibility coordination but the really great news is I feels better now from our studies plus the other ones that came out that you can say even a walk is gonna help something is gonna help not being sedentary may actually offer a benefit not just for all cause death but for prostate cancer specific mortality that's where the data are trending these are not with the caveat those are not clinical trials these are observational data it's done by surveying large groups of people like yourselves times like 10,000 and and then looking at what happens to people so there are some limitations however at this moment the best data that we look at as scientists looks like this is great right so keep moving and keep exercising it if you were sitting in my session during lunch I know people that are all different places and I just want to share something that was told to me a few weeks ago by a bladder and a prostate cancer survivor and he said you know June I don't exercise I'm not really an athlete I hate going to the gym I've never seen myself this way but he's like you know what though I went to this talk like from a support group and he said the doctor just said do something somethings better than nothing a little bit helps and that was enough to get him out the door and he said he just started taking a walk he started taking his aged mother who has a walker out for a walk regularly and now he's kept up that habit for those of you who heard me earlier if I can't get in my exercising today here's my embarrassing story I will literally be at home talking to my son and doing this or I'll be standing in from the TV or folding laundry or waiting for water to boil in my kitchen because the data actually do suggest that just substituting light physical activity as opposed to not to pick on Rahul actually has a mortality benefit not just for prostate cancer for all people for death okay so for it there are big studies now that Ashley just show light if you can substitute light physical activity 10 minutes of this versus 10 minutes of that it actually has a benefit on your health so my hope is that we don't have places like this my like my vision is that we have conference rooms or classrooms where there's bigger spaces and it's socially acceptable that you can be listening in class and doing this that's my vision but I'm weird so okay but I share that because I do want to inspire people I told someone else if you'd really a couch potato to like stand up and do that during the commercials try that with yourself one day one show and see how it goes okay again a lot of the dietary stuff is in those booklets I'm not gonna belabor all those details but I just wanted to put again some updates out there for you so here's a nice picture of things we would recommend to eat one of the things in our studies that we asked was also what if you did all that and you did the vigorous exercise and you were normal weight and you didn't smoke how much benefit could there possibly be so this is a study that we published it is cited in our book but basically again you're looking for the downward trend below the one line if people did five of six of those healthy diet and physical activity things and not smoked there was about a 68 percent lower risk of lethal prostate cancer so this was done in men and again diagnosed with non metastatic disease initially looking at their habits close in time to the time of diagnosis after diagnosis and then what happened to them later over time and then again this other slide over here is just showing the benefit solely for diet so my takeaway is that diet and exercise could have a benefit if you do all the things that's good and the diet things by themselves also have a benefit but not you know for a while the data for exercise we're trending stronger so we wanted to know is it really just that people who eat well also exercise and it's just substituting the effect but it does suggest that diet also has a separate effect if you're curious the thing down here that we were recommending healthy body weight three hours or more vigorous activity a week or seven hours per week of brisk walking not smoking or quit more than 10 years ago eating tomatoes cooked tomatoes preferably fatty fish avoiding processed meat those were what was in there so this is great and based on just if we did an estimate that if everybody in our study did the five or six things versus none it's possible there's just an estimate population data and not a trial it's possible that for every hundred people that met get lethal prostate cancer you'd prevent about forty of those cases forty to forty it was forty seven but let's just be conservative say forty so so that was promising however how many people do all those things you don't have to raise your hand what do you guess though how what percentage of people do you think do those things what percentage I heard twenty do them well okay say they do them it's less probably less than 10% in our study at range between 7.5 and 10% depending on when we assess it self-reported data keep you in mind that's data from a study of health professionals okay so in the general population what percentage of people are probably doing that a whole lot less or let's just say less okay so one of the other areas of research that we're now pursuing is how to help people do these things one is to get the word out and then also to provide supportive tools so we've had a pilot study that was published this year - any of you participated in the study thank you very much this was called the prostate 8 study led by my colleague stacy canfield and so basically in this study we asked the question if we provide people with the date the information like what you got in those books and some supportive tools which could be in the format of a Fitbit or in that case it was the old time that you clip on some text messaging systems that would give you reminders a few times a week some shopping guides some menus some recipes we're trying to come with a sustainable package and to see if people would make lifestyle changes in a short term so the study ran for 12 months in patients who are pursuing after surveillance or surgery here at UCSF again we the guide that what we recommended is shown here on the board basically the similar wise said healthy fats vigorous activity cruciferous tomatoes fish don't eat processed meat avoid tobacco and we did talk about don't take supplements as s you've refused it with the health professional because we are aware you should be aware there are some large scale studies have looked at common single supplements actually possibly not being good for prostate cancer there in the books I can take questions later if you have questions about that but we just wanted people to be aware that educational level that that could happen there could be adverse effects so it was kind of nice we showed in a short-term for some of the dietary metrics we old remove the bar so people in the study in the intervention arm adopted some of the dietary practices it's a little bit harder for physical activity was what we noticed so this was a pilot the other thing is people by and large people liked the tools the text messaging the website etc so those are the percentage who are satisfied and you know good or better so that's good so where are we now we have a number of clinical trials open here at UCSF pursuing these questions so the first one up there geared at men on active surveillance we're really trying to zero in on the aerobic exercise and what is that doing biologically that might trigger pathways that are beneficial for deterring cancer progression the second one is prostate so building off that pilot study I just showed you this is taking feedback from all the participants in that first pilot study creating a better box of tools hopefully tailored more to what people want and it's still called frosted aid because we like the name but there's actually 15 recommendations now and what the people should do and giving tools so we have that running now that's a little bit longer we're trying to see if we can sustain the intervention over a longer period two years the first one was just three months and now we're really also curious about pursuing the question all if you recall everything I've quoted so far with studies that started in men who had non metastatic disease and then progression forward we're very interested in also addressing well what if you started or what if you have advanced disease now is this going to offer benefit are these things going to help there's a few provocative pieces of data out there that suggest a exercise is safe and it might help but we wanted to do a bigger trial so we are now involved after in two trials this one's here based at UCSF thank you to Eric and a-hole and others here who've referred patients for this but again this is high-intensity interval training aerobic or strength for men with metastatic disease looking at biological outcomes as well as just feasibility can people do this do they like it so again all of these are open here you do not have to be I want to be very clear you don't have to be a patient here at UCSF to be in these studies you do we this is open to the community we do ask that you do come twice though to the fitness center over at Mission Bay to have exercise orientation some blood work done and an exercise test so two times during the study period so it's open to the community if you're interested please contact us right there urology research at UCSF done edu or my name is June Janet you see us off dot edu okay so lastly some other initiatives that we're working on so like this morning or this afternoon in the lunch room we get asked all kinds of great questions from people about specific supplements or specific dietary practices and the truth is while we've done some really exciting great work in cancer survivors there's not as enough date and not that much data actually on what happens after diagnosis going forward or going after that and so we're actually initiating initiating a first-of-its-kind new digital cohort study focused on cancer survivors we will pilot it in prostate bladder and colorectal cancer patients open to everybody it will be digital we are in a phase of trying to do some user testing and focus groups again if you're interested please contact us we're very interested in broad participation diverse participation we're hoping that this is a kind of study that can actually collect the data that other studies haven't in the past like I take tumeric or I do intermittent fasting or I do this and we're trying to work on improving our nutritional data collection methods that are allow us easily hopefully not a burden on the participant to collect this sort of data so that's one effort and then path is focused on men we also want to know what do men with advanced sorry with advanced prostate cancer on androgen deprivation therapy what are they interested in seeing or doing in terms of tools and again that's targeted at broad populations including hopefully more diverse populations so we are open and looking for participants in these things this summer ok so hopefully everybody got the cards I got put that up there just to remind me to make sure I handed them out Oh okay hope there should be a stack somewhere okay so the cards again these cards are general tips we made these for everybody like this is not geared for prostate cancer the booklet it will be fine for prostate cancer - that's not contradict ated but we tried to broaden it out because oftentimes people don't live just by themselves you have a family we like to promote wellness all around and then the the booklets though are targeted for men with prostate cancer so in summary right now the data do suggest that a healthy diet regular exercise even a little bit or a lot could really be beneficial for men to deter cancer progression after diagnosis and to clarify and I know other folks said this earlier we recommend this in the context of treatments this is not in lieu of I heard someone else already cite the controversial you know the study that was published earlier this year but this is in this is adjunctive this is in addition to your great care that you're gonna get from your oncologist and your surgeons and we're working on trying to improve this and the reach of our studies for everybody we thank you in advance of any for participation in the work and just a note for folks to put perspective on this all of these the all of these studies take a lot of time but at this point I just give me a minute I want to share that I think we're at a very interesting time in terms of understanding the potential impact of diet and exercise post diagnosis for cancer survivorship and if anyone in here is familiar with the Women's Health Initiative which was looking at breast diet and breast cancer starting in the 1990s it's a study where their initial results were no no no no doesn't does not look like there's a benefit for breast cancer they cited things like well women didn't really follow the diet we never really hit our goals in terms of diet twenty years later it took a long time 20 years later follow up women who are randomized to that diet which was eat a lot of fruits and veggies be low-fat eat grains had a breast cancer specific benefit this is news has been coming out over the last two or three years so to me we're not we may not get to a stage where we can afford to do a big randomized clinical trial in another for another cancer type these things are expensive but I looked at those data I was like well that's heartening it took a long time but it was heartening so for me I feel better than I used to even like five years ago to say I think it might benefit you so with that thank all my colleagues and all the participants thank you very much [Applause] there's a bunch of really good questions here I think I'm gonna pick a couple and then hopefully they'll be time to grab June first question is can you define what our process meets and is just avoiding nitrates enough that's a loaded question so the question is avoiding processed meat so yes typically processed meats are things that say they have nitrates and nitrites in them wh I'll put those on a carcinogen list a couple years ago I forgot exactly when but is it enough to avoid that and do with the uncured it's a better step it's what I would I would lean that way as at a personal level that's what I look for if I'm shopping and every now and then I might yeah I've got a son who likes salami so it's like you got all these so many arguments in your day okay I got the uncured really expensive one but the other thing so I can't guarantee you it's one better step it's probably better not to do it not to have the processed meat at all but uncured and avoid the nitrates and nitrites one thing people did tell me and you can talk to Greta who helped with the book there are some natural natural curing things that we're not sure are that better so sometimes that they got sick they're like technically cured with celery extract I'm not sure that's necessarily better so there's like that's to be determined research wise this is a question we get a lot in the clinic can you comment on a low carb and ketogenic diet as it relates to prostate cancer patient you know if you want to abstain then you're gonna have seen that's I would recommend its look in the book first of all I think I think Greta addresses that because that is a very common question those things are tricky so any route of any bigger nutritional change I really do believe you should talk to a nutritionist at least for an initial consult because every individual is different and as other needs besides just prostate cancer and so I'm gonna pass on that specific I mean I would echo that the nutrition group here it really is fantastic and so I you know refer a lot of my patients over to Greta and her group you know they're really terrific I got two questions on lycopene supplements of lycopene is a carotenoid it's rich in red colored fruits and vegetables particularly in tomato products it's had a long and interesting history so in the mid 90s some of the earliest dietary studies looking at died and prostate cancer singled out tomatoes as a potential protective factor for preventing the development of prostate cancer studies published since then focused on tomatoes or lycopene on both sides of the fence nothing not that it's going to harm you but whether or not this the benefit is there I would say I think there's potentially a benefit some of the latest data that I see is that it's it might actually be beneficial for people where specific type of mutation and their tumors so we're sort of narrowing down where we think this is helpful it is why we put eat cooked tomatoes in our recommendations [Applause] [Music] you

Channel: University of California Television (UCTV)

Views: 32,019

Keywords: Prostate, Cancer, Diet, Exercise

Id: eCzgE2mGRcE

Length: 26min 42sec (1602 seconds)

Published: Sat Jun 22 2019