The European Association of Urology just published a short paper summarizing dietary recommendations for men on ADT. As a context for this paper the authors note that, “dietary interventions for mitigating ADT side effects are promising, but few interventions have focused on diet alone and they offer limited evidence of benefit.”
The authors thus acknowledge that there has not been much research on diet specific for men on ADT. They also write, “longer-term studies that incorporate longitudinal compliance measures and collect progression outcomes or intermediate biomarkers of prognosis are needed in cancer patients, and specifically in patients treated with ADT.” That's a fancy way of saying that we need more research on compliance.
The authors flag a study that is underway and looks at whether a digital platform can help support patients who try to make lifestyle changes while receiving ADT. Their study recognizes that the challenge is not so much about getting relevant nutritional information to patients, but in getting patients to comply with the recommendations.
The paper has two interesting tables.
The first one lists recommendations for preventing heart disease and for reducing cancer death overall, including prostate cancer death. It is noteworthy that the data are not specific to men on ADT, but are nevertheless in line with the recommendations in the ADT book on a heart healthy diet for men on ADT.
The second table lays out a few of the questions that patients might ask about diet when starting on ADT. And it offers some answers to those questions. These include recommendations relevant to avoiding osteoporosis and weight gain. The table also informs patients that evidence for benefit from supplements is negligible, except perhaps for vitamin D and calcium (plus vitamin B12, if one is on a vegan diet.)
What is interesting is a discrepancy between Table 1 and Table 2. In terms of alcohol consumption for heart health, Table 1 recommends limiting one’s alcohol consumption to one or two drinks per day…and avoiding it completely, if one wants to reduce the risk of dying from cancer in general. The table also suggests limiting alcohol consumption to five or less drinks per week, to reduce the risk of lethal prostate cancer.
Table 2 has a more lenient and perhaps more realistic recommendation, which is prefaced with: those who aren't drinking, obviously shouldn't start. However, for those that do like to drink, recommendations are to limit one’s intake to one or two drinks per day.
Despite these inconsistencies, the authors do a good job laying out what we know and need to know in order to arrive at helping men on ADT maintain the best nutritional status. At the moment, there is no easily managed diet for overcoming most of the detrimental metabolic side effects ADT.
Reference:
Kenfield, S., Van Blarigan, E., Graff, R., Borno, H., Macaire, G., & Chan, J. (2023). Nutrition Guidance for Patients on Androgen Deprivation Therapy. European Urology Focus, S2405-4569(23)00060-3.