Dr. Hamilton-Reeves discusses weight management in patients with prostate cancer

In this video, Jill M. Hamilton Reeves, PhD, RD, CSO, shares notable findings from the Journal of Urology paper “Impact of Weight Management on Obesity-Driven Biomarkers of Prostate Cancer Progression.” Hamilton-Reeves is an associate professor of dietetics and nutrition at the University of Kansas Medical Center in Kansas City.

Transcription:

What were some of the notable findings? Were any of them surprising to you and your coauthors?

There are the basic findings of, well, did you get the guys to lose weight. This is not our first study. We have a feasibility study that was published a few years ago, where, to get that funding, the reviewers were very concerned that men just wouldn't sign up for this; they would not be interested. The study design of that particular trial was really interesting [in] that we actually had guys choose, do they want to do the intervention or not? Which, of course, is not a randomized trial that has the same kind of gold standard as like what we did in this trial. But we found that the guys were willing to do it. And in fact, many of the guys on that trial asked how they could help us design the next step. We called them ambassadors. They came in, and they told us what they liked, they told us what they didn't like. It was a very candid conversation. We asked them about the randomized design. They had concerns about some patients getting the intervention and some patients not. They felt very strongly that everyone in the study really needed to understand the relationship between nutrition and prostate cancer. Whether or not they got the intervention or not didn't seem to bother them as much. That went into how we put this trial together, that there was a control arm, but it was an active control, where they received educational materials about the relationship between nutrition and prostate cancer, and about prostate cancer itself. And then the intervention group received the guidance, the coaching, for weight loss...learning how to put their food together, and exercise. The biggest finding was that the guys lost the weight. They lost 5.5% of their body weight. In fact, they kind of got on a roll with the routine. Many of them, after their surgery, in the 6 months' time where we really were just focused on making sure that the guys didn't gain weight back after surgery, they had incorporated so many of the lifestyle factors that they just kept losing. By the end of the trial, 6 months after their surgery, the average amount of percent body weight loss was 11%. That part was surprising. The 11% was surprising; the 5.5%, I was very confident that our our design would work because it did in the feasibility study, and it's a very standard weight management type of protocol. There were also some other pleasant surprises. They lost a lot of what we call visceral adipose tissue, and that's basically adipose or fat tissue that resides around the abdominal and the visceral organs. Being overweight is actually not all that unhealthy. But there are metabolic factors that people can be overweight, but actually quite fit and quite healthy. But people can be maybe not overweight, but they carry a lot of this kind of central fat that affects their metabolism; it makes them less sensitive to insulin, it leads to this chronic smoldering inflammatory state in the body. That leads to problems with cancer progression and that type of thing. So in this study, these guys lost a significant amount of that visceral adipose tissue. I wouldn't say it's necessarily surprising because they were exercising along with the caloric restriction. I was very pleased; the guys felt great about that outcome. And then some really obvious things changed: glucose-related biomarkers, so how the body handles blood sugar, that all improved significantly, which you would expect with that amount of weight loss and in the method in which we help them lose weight. And then some of the factors that are released from fat, we call them adipokines, they play a role in either helping cancer progress or holding cancer back, and the ratio changed in a way that was very favorable for reducing the likelihood of cancer progressing. One of the things that did not change was we looked at prostate tissue from the biopsy before the intervention began to prostate tissue after the intervention at surgery, so part of the prostatecomy, and of the markers we chose, we did not see any significant differences with the intervention. What's a little bit tricky about that is prostate cancer is multifocal. So there are lots of different places that it shows up in the prostate gland, and so we did not necessarily compare the same spot with the same spot. It's one of those things that I'm hoping that we get to do a larger trial, and there are new methods of collecting prostate tissue from the prostatectomy that can be mapped better to where the biopsy is so at least we're a lot closer. I hope we do get that chance, but that was probably the part that I was kind of like, "Oh man, I really thought we would see something," because in our feasibility study, we did see some favorable changes in the tissue.

This transcription was edited for clarity.