Einfluss von Mikronährstoffen und Ernährung auf das Erkrankungs- und Rezidivrisiko bei Prostatakrebs

Zusammenfassung

Mit 48 650 Neuerkrankungen im Jahr 2002 ist Prostatakrebs in Deutschland die häufigste Tumorerkrankung und die dritthäufigste tumorbedingte Todesursache des Mannes. Neben genetischen Faktoren spielen Ernährungsgewohnheiten und körperliche Aktivität eine bedeutende Rolle bei der Primärprävention. Adipositas, hohe Verzehrsmengen an Fett, gesättigten Fetten, Fleisch, Milchprodukten und Calcium sind mit einem erhöhten Erkrankungsrisiko assoziiert. Eine hohe Aufnahme an Tomaten- und Sojaprodukten, Lycopin, Selen, marinen Omega-3-Fettsäuren und bei Rauchern Vitamin E können dagegen das Risiko senken. Dies gilt insbesondere für fortgeschrittene und aggressive Formen von Prostatakrebs. Einen biochemischen (Anstieg des Prostata spezifischen Antigens) oder klinischen Progress der Erkrankung bzw. ein erhöhtes Rezidiv- oder Mortalitätsrisiko konnte durch eine Adipositas sowie eine hohe Fettzufuhr beobachtet werden. Hinweise auf eine Progressionsverzögerung liegen aus Supplementierungsstudien mit Tomatenprodukten und Selen vor. Experimentelle Studien deuten darüber hinaus darauf hin, dass die Toxizität einer Chemo- bzw. Radiotherapie durch die gleichzeitige Gabe von Natriumselenit verringert sowie die Wirkung der antitumoralen Standardtherapie verbessert wird.

Abschließend werden Empfehlungen für die Beratung von Prostatakrebserkrankten in der Arztpraxis gegeben, die auch das Bedürfnis von kompetenten Patienten nach Selbsthilfe und ihrem eigenen individuellen Weg im Umgang mit der Erkrankung berücksichtigen. Die Umstellung der Ernährung und zusätzlich die Einnahme von Nährstoffsupplementen sind dabei für viele Patienten essenzielle Bausteine eines Selbsthilfekonzepts, das Ärzte in der Betreuung von Krebspatienten respektieren sollten.

Summary

Prostate cancer is the most frequently occurring form of cancer in German men with an incidence rate of 48 650 in the year 2002. Evidence comes from epidemiological studies that apart from genetic susceptibility diet and physical activity may play major roles in both incidence and progression of the disease. Obesity may increase the primary risk. Among individual food groups/nutrients a high consumption of total fat, saturated fats, meat, dairy, and calcium are related to an increased risk. Tomato products, soy, lycopene, selenium, marine omega-3-fatty acids and vitamin E in smokers may inversely be associated with prostate cancer.

Obesity and a high intake of fat are also directly associated with biochemical (increase in prostate specific antigen) or clinical recurrence. Interventional studies with supplemental tomato products and selenium suggest a delay of progression. There is evidence from experimental studies that application of selenium during chemotherapy or radiotherapy may decrease therapy related toxicities and increases the effect of the standard therapy on cancer cells.

Expert patients aim to participate in managing their disease by developing individual self-help concepts. These often include both changing dietary habits and taking dietary supplements. Physicians should consider these needs when they counsel cancer patients.

Schlüsselwörter

Prostatakrebs - Prävention - Rezidive - Ernährung - Fett - Adipositas - Mikronährstoffe - Lycopin - Selen - Patientenkompetenz

Keywords

Prostatic Neoplasms - Prevention, primary - Neoplasm recurrence, local - Diet - Dietary Fats - Obesity - Micronutrients - Lycopene, Selenium - Expert patient

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