Impact of Folate Intake on Prostate Cancer Recurrence Following Definitive Therapy: Data from CaPSURE™

Abstract

Purpose A randomized, placebo controlled clinical trial of folic acid supplementation for the chemoprevention of colorectal adenoma revealed an increased incidence of prostate cancer in the treatment group. Limited data exist on postdiagnostic folate/folic acid intake and the risk of prostate cancer progression. We prospectively examined the association between postdiagnostic folate consumption and the risk of prostate cancer recurrence after radical prostatectomy, external beam radiation therapy and brachytherapy. Materials and Methods This study was done in 1,153 men treated with radical prostatectomy, external beam radiation therapy and brachytherapy who had clinical stage T1-T2c prostate adenocarcinoma and participated in the CaPSURE Diet and Lifestyle substudy by completing the semiquantitative Food Frequency Questionnaire in 2004 to 2005. We used Cox proportional hazards regression to analyze the association between folate intake and prostate cancer progression. Results Prostate cancer progressed in 101 men (8.76%) during a mean 34-month followup. After multivariate adjustment we observed no evidence of an association of the intake of total folate, dietary folate or dietary folate equivalents with prostate cancer recurrence. On secondary analysis by treatment after radical prostatectomy patients in the lowest decile of dietary folate intake had a 2.6-fold increase in the risk of recurrence (HR 2.56, 95% CI 1.23–5.29, p = 0.01). In patients treated with external beam radiation and brachytherapy we observed no evidence of an association between prostate cancer progression and increased folate intake. Conclusions Results suggest that the consumption of foods and multivitamins that contain folate is not associated with prostate cancer progression after definitive treatment.

Impact of Metabolic Diseases, Drugs, and Dietary Factors on Prostate Cancer Risk, Recurrence, and Survival: A Systematic Review by the European Association of Urology Section of Oncological Urology

“…In another study from the same cohort in men with M0 disease at presentation [53], total folate and dietary folate intake was not associated with PCa recurrence. However, patients with severely deficient dietary folate intake (lowest decile, range 123-252 mg) were at a 2.6-fold increase risk of PCa progression after radical prostatectomy (HR 2.56, 95% CI 1.23-5.29, p = 0.01).…”

Circulating Folate and Vitamin B12 and Risk of Prostate Cancer: A Collaborative Analysis of Individual Participant Data from Six Cohorts Including 6875 Cases and 8104 Controls

“…There has been little research into whether folate intake in men with PCa might affect the progression of the disease, but the data available have not shown any evidence of an association of folate intake with PrCa progression [20] or survival [21]. To understand better the potential role of folate in PCa progression, more data are needed from large observational studies (or randomised trials) with long-term follow-up, circulating folate, and PCa tissue to investigate whether higher circulating concentrations are associated with quantifiable local molecular changes.…”

Epidemiology of Prostate Cancer

“…However, a recent meta-analysis reported that higher concentrations of vitamin B 12 and folate have a modest 12% increased risk of prostate cancer [155]. In people who have prostate cancer, available data do not show an effect of consumption of folate on disease progression [156] or survival [157]. In conclusion, the association of folate and vitamin B 12 with prostate cancer is unclear and requires further investigation.…”