Mediterranean Diet and Prostate Cancer Risk and Mortality in the Health Professionals Follow-up Study
Kenfield SA, Dupre N, Richman EL, Stampfer MJ, Chan JM, Giovannucci EL.Eur Urol. 2013 Aug 13. pii: S0302-2838(13)00830-0. doi: 10.1016/j.eururo.2013.08.009. [Epub ahead of print]


Department of Urology, University of California, San Francisco, San Francisco, CA, USA; Department of Epidemiology, Harvard School of Public Health, Boston, MA, USA. Electronic address:



Prostate cancer (PCa) mortality rates are lower in the Mediterranean countries compared with northern Europe. Although specific components of the Mediterranean diet (Med-Diet) may influence PCa risk, few studies have assessed the traditional Med-Diet pattern with the risk of incident advanced or lethal PCa or with disease progression among men diagnosed with nonmetastaticPCa.


To determine whether the traditional Med-Diet pattern is associated with risk of incident advanced or lethal PCa and with PCa-specific and overall mortality among men with PCa.


We prospectively followed 47 867 men in the Health Professionals Follow-up Study followed from 1986 to 2010. The case-only analysis included 4538 men diagnosed with nonmetastaticPCa, followed from diagnosis to lethal outcome or to January 2010.


We used Cox proportional hazards models to examine traditional and alternative Med-Diet scores in relation to PCa incidence outcomes (advanced and lethal disease). In a case-only survival analysis, we examined postdiagnostic Med-Diet and risk of lethal (metastases or PCa death) and fatal PCa as well as overall mortality among men diagnosed with nonmetastatic disease.


Between 1986 and 2010, 6220 PCa cases were confirmed. The Med-Diet was not associated with risk of advanced or lethal PCa. In the case-only analysis, there was no association between the Med-Diet after diagnosis and risk of lethal or fatal PCa. However, there was a 22% lower risk of overall mortality (hazard ratio: 0.78; 95% confidence interval, 0.67-0.90; ptrend=0.0007) among men with greater adherence to the Med-Diet after PCa diagnosis. We found similar associations for the alternative score.


A higher Med-Diet score was not associated with risk of advanced PCa or disease progression. Greater adherence to the Med-Diet after diagnosis of nonmetastaticPCa was associated with lower overall mortality.