Related Experiment Video
Updated: Nov 22, 2025
A New Technique for Treating Low-risk Prostate Cancer—Super Active Surveillance
Published on: November 7, 2025
Adherence to the Mediterranean diet and grade group progression in localized prostate cancer: An active surveillance
Justin R Gregg1, Xiaotao Zhang2, Brian F Chapin1
1Department of Urology, The University of Texas MD Anderson Cancer Center, Houston, Texas.
Background:
The Mediterranean diet (MD) may be beneficial for men with localized prostate cancer (PCa) on active surveillance (AS) because of its anti-inflammatory, antilipidemic, and chemopreventive properties. This study prospectively investigated adherence to the MD with Gleason score progression and explored associations by diabetes status, statin use, and other factors.
Methods:
Men with newly diagnosed PCa on an AS protocol (n = 410) completed a baseline food frequency questionnaire, and the MD score was calculated across 9 energy-adjusted food groups. Cox proportional hazards models were fit to evaluate multivariable-adjusted associations of the MD score with progression-free survival; progression was defined as an increase in the Gleason grade group (GG) score over a biennial monitoring regimen.
Results:
In this cohort, 15% of the men were diabetic, 44% of the men used statins, and 76 men progressed (median follow-up, 36 months). After adjustments for clinical factors, higher adherence to the MD was associated with a lower risk of GG progression among all men (hazard ratio [HR] per 1-unit increase in MD score, 0.88; 95% confidence interval [CI], 0.77-1.01), non-White men (HR per 1-unit increase in MD score, 0.64; 95% CI, 0.45-0.92; P for interaction = .07), and men without diabetes (HR per 1-unit increase in MD score, 0.82; 95% CI, 0.71-0.96; P for interaction = .03). When joint effects of the MD score and statin use were examined, a similar risk reduction was observed among men with high MD scores who did not use statins in comparison with men with low/moderate MD scores with no statin use.
Conclusions:
The MD is associated with a lower risk of GG progression in men on AS, and this is consistent with prior reports about the MD and reduced cancer morbidity and mortality.
Insights
Adhering to the Mediterranean diet may lower the risk of Gleason grade progression in men with prostate cancer on active surveillance. This dietary pattern shows particular benefit for non-White men and those without diabetes.
Area of Science:
- Oncology
- Nutrition Science
- Preventive Medicine
Background:
- The Mediterranean diet (MD) possesses anti-inflammatory and chemopreventive properties.
- It is hypothesized to be beneficial for men with localized prostate cancer (PCa) on active surveillance (AS).
Purpose of the Study:
- To prospectively investigate the association between adherence to the MD and Gleason score progression in men with PCa on AS.
- To explore these associations based on diabetes status and statin use.
Main Methods:
- A cohort of 410 men newly diagnosed with PCa on AS completed a baseline food frequency questionnaire.
- The MD score was calculated, and Cox proportional hazards models assessed associations with progression-free survival, defined as an increase in Gleason grade group (GG) score.
Main Results:
- Higher MD adherence was linked to a reduced risk of GG progression (HR 0.88; 95% CI 0.77-1.01).
- This association was more pronounced in non-White men (HR 0.64; 95% CI 0.45-0.92) and men without diabetes (HR 0.82; 95% CI 0.71-0.96).
- Men with high MD scores and no statin use showed a similar risk reduction compared to those with low/moderate MD scores and no statin use.
Conclusions:
- The MD is associated with a lower risk of Gleason grade progression in men on active surveillance for prostate cancer.
- Findings align with existing research on the MD's role in reducing cancer morbidity and mortality.
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