High serum folate is associated with reduced biochemical recurrence after radical prostatectomy: Results from the SEARCH Database

Abstract

Introduction:To analyze the association between serum levels of folate and risk of biochemical recurrence after radical prostatectomy among men from the Shared Equal Access Regional Cancer Hospital (SEARCH) database. Materials and Methods: Retrospective analysis of 135 subjects from the SEARCH database treated between 1991-2009 with available preoperative serum folate levels. Patients' characteristics at the time of the surgery were analyzed with ranksum and linear regression. Uni-and multivariable analyses of folate levels (log-transformed) and time to biochemical recurrence were performed with Cox proportional hazards. Results: The median preoperative folate level was 11.6ng/mL (reference = 1.5-20.0ng/mL). Folate levels were significantly lower among African-American men than Caucasians (P = 0.003). In univariable analysis, higher folate levels were associated with more recent year of surgery (P < 0.001) and lower preoperative PSA (P = 0.003). In univariable analysis, there was a trend towards lower risk of biochemical recurrence among men with high folate levels (HR = 0.61, 95%CI = 0.37-1.03, P = 0.064). After adjustments for patients characteristics' and pre-and post-operative clinical and pathological findings, higher serum levels of folate were independently associated with lower risk for biochemical recurrence (HR = 0.42, 95%CI = 0.20-0.89, P = 0.023). Conclusion: In a cohort of men undergoing radical prostatectomy at several VAs across the country, higher serum folate levels were associated with lower PSA and lower risk for biochemical failure. While the source of the folate in the serum in this study is unknown (i.e. diet vs. supplement), these findings, if confirmed, suggest a potential role of folic acid supplementation or increased consumption of folate rich foods to reduce the risk of recurrence.

Nutrition, dietary interventions and prostate cancer: the latest evidence

“…Two meta-analyses also showed that circulating folate levels were positively associated with an increased risk of PCa [ 92 , 93 ], while dietary or supplemental folate had no effect on PCa risk [ 94 ] in a cohort study with 58,279 men in the Netherlands [ 95 ] and a case–control study in Italy and Switzerland [ 96 ]. In fact, one study of a cohort of men undergoing radical prostatectomy at several Veterans Administration facilities across the US even showed that higher serum folate levels were associated with lower PSA and, thus, lower risk for biochemical failure [ 97 ]. Another study using data from the 2007 to 2010 National Health and Nutrition Examination Survey showed that a higher folate status may be protective against elevated PSA levels among 3,293 men, 40-years old and older, without diagnosed PCa [ 98 ].…”

Perceived influences on post-diagnostic dietary change among a group of men with prostate cancer

“…); and that a diet high in folate (found in some fruits, beans and green vegetables) is associated with lower prostate cancer recurrence (Moreira et al . ). Moreover, the consumption of green tea, lycopene (found mainly in cooked tomatoes), omega‐3 fatty acids (found mainly in oily fish) and soya has also been linked to reductions in the risk of prostate cancer progression (Davies et al .…”

“…There are indications that dietary modifications after diagnosis can significantly decrease prostate-specific antigen (PSA) levels (the recurrence of the cancer is indicated by high PSA levels) (e.g. Dalais et al 2004); that a diet high in fat is associated with prostate cancer progression and mortality (Berkow et al 2007); and that a diet high in folate (found in some fruits, beans and green vegetables) is associated with lower prostate cancer recurrence (Moreira et al 2013). Moreover, the consumption of green tea, lycopene (found mainly in cooked tomatoes), omega-3 fatty acids (found mainly in oily fish) and soya has also been linked to reductions in the risk of prostate cancer progression (Davies et al 2011).…”

Post-diagnostic dietary changes in prostate cancer: associations with patients’ wellbeing and the perceptions of GPs

“…This can explain why patients in the first study who rely on their doctor for advice were less likely to change their diet. GPs were also sceptical on the role of diet in prostate cancer after diagnosis even though benefits in prostate-specific antigen (PSA) levels (Dalais et al, 2004), mortality, progression (Berkow, Barnard, Saxe, & Ankerberg-Nobis, 2007) and recurrence (Moreira et al, 2013) are reported. Therefore, enhancing GPs' ability to provide dietary advice has the potential to benefit patients who rely on their advice while a need is reported to improve nutritional training in most of primary care colleges in Europe (Pineiro et al, 2005).…”