Evaluating Dietary Change and a Mediterranean Diet Intervention Among Medically Underserved Men with Prostate Cancer - Project summary/abstract African American (AA) men are at higher risk of prostate cancer diagnosis and metastasis, and men of all races and ethnicities with low socioeconomic status are also at risk of adverse prostate cancer outcomes. There is great interest in determining noninvasive interventions, such as dietary change, that can slow or stop disease progression, especially because prostate cancer treatment can negatively affect men’s quality of life and because many men with localized disease will ultimately die of causes other than cancer (most commonly cardiovascular disease). Such interventions are especially desirable for men on active surveillance (AS), a treatment strategy whereby a low-risk tumor is actively monitored for signs of progression, at which point patients may undergo radical treatment. Unfortunately, while studies suggest that lifestyle changes may modify factors associated with prostate cancer progression, no dietary intervention has been shown to slow prostate cancer progression rates, and none have been developed specifically for underrepresented minority men with prostate cancer, who are at increased risk of adverse outcomes. Our group has shown that a Mediterranean- type diet may be associated with decreased risk of progression over time in men on AS. As shown in the landmark PREDIMED study, a Mediterranean diet protects against major cardiovascular events, likely due to its known lipid-lowering and anti-inflammatory effects. It also has a direct effect on the gut microbiome, which is increasingly recognized for its role in metabolism and cancer therapy. In this proposal, we aim to define dietary patterns and barriers to dietary change among underrepresented minority men with localized prostate cancer. We will also adapt the PREDIMED diet intervention for this group, allowing us to then determine the feasibility of enrolling to and performing the intervention in a medically underserved population. We will first form focus groups of AA and Hispanic men diagnosed with prostate cancer (and their significant others) and perform qualitative analyses to determine dietary habits and cultural factors related to diet. In parallel, we will complete adaptation of the PREDIMED diet intervention, after which we will perform a pilot feasibility study of the adapted dietary intervention among 25 men recently diagnosed with localized prostate cancer at a large safety net hospital. We will also assess noninvasive biomarkers, including a lipid-based signature described by our group and gut microbiome composition, for their association with dietary change in the intervention study population. This will allow identification of candidate markers of prostate cancer response to dietary intervention for use in future clinical trials. This award will allow the PI to gain experience in designing and administering a behavioral intervention while taking part in a structured learning plan consisting of mentorship and formalized coursework in health disparities research and nutritional interventions. This training, coupled with experience gained in this award, will provide the foundation needed for an independently funded career as a surgeon-scientist dedicated to improving the lives of medically underserved men with prostate cancer.
