Neoadjuvant Dietary Intervention in Intermediate Risk Prostate Cancer

PRIMARY OBJECTIVE:

I. To determine the feasibility of a neoadjuvant feeding study prior to radical prostatectomy in a racially diverse group of men diagnosed with intermediate risk prostate cancer, defined as the percentage of patients who enter the pre-intervention equilibration period and begin the dietary intervention.

SECONDARY OBJECTIVES:

I. Determine the tolerance of Mediterranean diet as defined by compliance with diet of 70% or greater total calories consumed during study period from the Mediterranean diet.

II. Determine the effects of controlled dietary interventions on metabolic parameters.

III. Determine the total number of potentially eligible patients who are approached by study coordinators and enter the equilibration period.

IV. Determine the effects of controlled dietary interventions on the fecal microbiome.

V. Create a well annotated bank of clinical data and samples, including but not limited to periprostatic fat, for use in future research and analysis.

VI. Examine the safety of controlled dietary interventions in patients with a diagnosis of prostate cancer.

VII. Determine changes in Cav-1-sphingolipid signature following Mediterranean diet consumption.

VIII. Compare Cav-1-sphingolipid levels following dietary interventions in with a separate cohort of men who do not undergo pre-operative dietary intervention.

OUTLINE:

Patients participate in the Mediterranean diet for 6 days per week for 4 weeks before undergoing standard of care radical prostatectomy.

After completion of study treatment, patients are followed up at 4-8 weeks.

Inclusion criteria

• Histologically confirmed adenocarcinoma of the prostate that is localized based on prostate magnetic resonance imaging (MRI) and meets National Comprehensive Cancer Network (NCCN) intermediate risk criteria (as follows):

• Clinical T2b-T2c or lower disease
• Gleason Grade group 2 or 3 on biopsy
• Prostate specific antigen (PSA) =< 20 ng/mL
• Desires radical prostatectomy (open or robotic) for prostate cancer management and is a surgical candidate as determined by the treating urologic oncologist
• Adult men > 30 and < 75 years old (African American or non-Hispanic white)
• Meet one of the following criteria for overweight or obesity:

• Body Mass Index (BMI) between 26 and 39
• Waist circumference >= 40 inches
• Willingness to exclusively consume all the provided meals
• Willingness to comply with all study procedures and scheduled visits
• Reside in the greater Houston/outlying areas and/or willing to travel for study-related visits at MD Anderson

Exclusion criteria

• Major dietary restrictions or food allergies
• Food aversions or preferences that preclude following a Mediterranean diet, such as unwillingness to eat vegetables, grains, animal products or fish
• Medical contraindications to the intervention diet as determined by the treating physician
• Current self-reported smoker or heavy drinker (defined as >14 drinks per week) or current self-reported illicit drug use
• Prostate cancer that meets NCCN high and very high risk criteria (as follows):

• pT3a or higher disease
• Grade group 4 or 5 adenocarcinoma of prostate
• PSA > 20ng/mL