{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,18]],"date-time":"2026-08-18T05:01:24Z","timestamp":1787029284312,"version":"build-2736575974"},"reference-count":23,"publisher":"MDPI AG","issue":"21","license":[{"start":{"date-parts":[[2024,10,30]],"date-time":"2024-10-30T00:00:00Z","timestamp":1730246400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK)","award":["P30-DK072488"],"award-info":[{"award-number":["P30-DK072488"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Nutrients"],"abstract":"<jats:p>Background and Aims: Active Surveillance (AS) is a favored strategy for the management of indolent prostate cancers (PCs). Overweight and obese men harbor an increased risk of cancer progression during AS. We aim to prospectively evaluate the feasibility and outcomes of a ketogenic diet (KD) weight-loss intervention in overweight men with PC. Materials and Methods: Men with PC and a BMI &gt; 25 kg\/m2 undergoing AS were placed on an 8-week ad libitum KD program before a scheduled surveillance biopsy to assess the impact on clinical grade group (CGG). Blood ketone levels were tracked to ensure compliance. BMI, PSA, and inflammatory marker data (TNF-\u03b1, TNFR1, TNFR2, sICAM-1, sVCAM-1, IL-6, IL1-RA, CRP, and SAA) were collected before and after the KD intervention. A Shapiro\u2013Wilk test was performed to assess the normality of all continuous study variables. Paired t-tests and Wilcoxon rank sum tests were utilized to compare normally and non-normally distributed study outcomes, respectively. Results: Ten AS patients aged 62.1 (\u00b15.4) years were enrolled with an average BMI of 31.7 kg\/m2 (\u00b111.8). Post-KD intervention mean blood ketone levels were 0.32 (\u00b10.12) mmol\/L with a mean BMI reduction of 7.4% (p &lt; 0.0003). There were no meaningful changes in PSA or inflammatory biomarkers (p &gt; 0.05). Nine patients completed re-biopsy following a KD with four patients showing no evidence of cancer; one downgraded to a lower CGG; two had unchanged CGG scores; and two had higher CGG scores compared to baseline. Conclusions: Short-term KD interventions for BMI reduction are feasible in men undergoing AS for PC and may result in favorable pathological effects without inflammatory marker changes. Larger studies with longer follow-up are needed to explore whether KD-induced weight loss can improve clinical outcomes with AS in PC.<\/jats:p>","DOI":"10.3390\/nu16213716","type":"journal-article","created":{"date-parts":[[2024,10,31]],"date-time":"2024-10-31T09:57:36Z","timestamp":1730368656000},"page":"3716","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":10,"title":["Weight Loss, Pathological Changes, and Inflammatory Effects from a Short-Term Ketogenic Diet in Overweight and Obese Men with Untreated Prostate Cancer on Active Surveillance"],"prefix":"10.3390","volume":"16","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-1962-8351","authenticated-orcid":false,"given":"Adeel","family":"Kaiser","sequence":"first","affiliation":[{"name":"Department of Radiation Oncology, University of Maryland School of Medicine, Baltimore, MD 21201, USA"},{"name":"Department of Radiation Oncology, Miami Cancer Institute, Miami, FL 33176, USA"},{"name":"Herbert Wertheim College of Medicine, Florida International University, Miami, FL 33199, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mohummad M.","family":"Siddiqui","sequence":"additional","affiliation":[{"name":"Division of Urology, Department of Surgery, University of Maryland School of Medicine, Baltimore, MD 21201, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jason","family":"Bosley-Smith","sequence":"additional","affiliation":[{"name":"Center for Integrative Medicine, University of Maryland School of Medicine, Baltimore, MD 21201, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shu","family":"Wang","sequence":"additional","affiliation":[{"name":"Division of Urology, Department of Surgery, University of Maryland School of Medicine, Baltimore, MD 21201, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joseph","family":"Aryankalayil","sequence":"additional","affiliation":[{"name":"Department of Radiation Oncology, University of Maryland School of Medicine, Baltimore, MD 21201, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mark V.","family":"Mishra","sequence":"additional","affiliation":[{"name":"Department of Radiation Oncology, University of Maryland School of Medicine, Baltimore, MD 21201, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alice S.","family":"Ryan","sequence":"additional","affiliation":[{"name":"Department of Medicine, University of Maryland School of Medicine, Baltimore, MD 21201, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2415-8158","authenticated-orcid":false,"given":"Christopher R.","family":"D\u2019Adamo","sequence":"additional","affiliation":[{"name":"Department of Family and Community Medicine, University of Maryland School of Medicine, Baltimore, MD 21201, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2024,10,30]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"12","DOI":"10.3322\/caac.21820","article-title":"Cancer statistics, 2024","volume":"74","author":"Siegel","year":"2024","journal-title":"CA Cancer J. Clin."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"EVIDoa2300018","DOI":"10.1056\/EVIDoa2300018","article-title":"Patient-Reported Outcomes 12 Years after Localized Prostate Cancer Treatment","volume":"2","author":"Donovan","year":"2023","journal-title":"NEJM Evid."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"1547","DOI":"10.1056\/NEJMoa2214122","article-title":"Fifteen-Year Outcomes after Monitoring, Surgery, or Radiotherapy for Prostate Cancer","volume":"388","author":"Hamdy","year":"2023","journal-title":"N. Engl. J. Med."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"683","DOI":"10.1016\/j.juro.2017.11.095","article-title":"Clinically localized prostate cancer: AUA\/ASTRO\/SUO guideline. Part I: Risk stratification, shared decision making, and care options","volume":"199","author":"Sanda","year":"2018","journal-title":"J. Urol."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"19","DOI":"10.1097\/JU.0000000000002758","article-title":"Clinically Localized Prostate Cancer: AUA\/ASTRO Guideline, Part II: Principles of Active Surveillance, Principles of Surgery, and Follow-Up","volume":"208","author":"Eastham","year":"2022","journal-title":"J. Urol."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"272","DOI":"10.1200\/JCO.2014.55.1192","article-title":"Long-term follow-up of a large active surveillance cohort of patients with prostate cancer","volume":"33","author":"Klotz","year":"2015","journal-title":"J. Clin. Oncol."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"1415","DOI":"10.1056\/NEJMoa1606220","article-title":"10-Year Outcomes after Monitoring, Surgery, or Radiotherapy for Localized Prostate Cancer","volume":"375","author":"Hamdy","year":"2016","journal-title":"N. Engl. J. Med."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"841","DOI":"10.1016\/j.eururo.2014.06.005","article-title":"Obesity is associated with risk of progression for low-risk prostate cancers managed expectantly","volume":"66","author":"Bhindi","year":"2014","journal-title":"Eur. Urol."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"222","DOI":"10.1097\/CCO.0000000000000519","article-title":"The evolving role of diet in prostate cancer risk and progression","volume":"31","author":"Kaiser","year":"2019","journal-title":"Curr. Opin. Oncol."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"103543","DOI":"10.1016\/j.critrevonc.2021.103543","article-title":"Obesity and prostate cancer: A narrative review","volume":"169","author":"Wilson","year":"2022","journal-title":"Crit. Rev. Oncol. Hematol."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"1760","DOI":"10.1158\/1055-9965.EPI-22-0147","article-title":"Postdiagnostic Inflammatory, Hyperinsulinemic, and Insulin-Resistant Diets and Lifestyles and the Risk of Prostate Cancer Progression and Mortality","volume":"31","author":"Langlais","year":"2022","journal-title":"Cancer Epidemiol. Biomarkers Prev."},{"key":"ref_12","doi-asserted-by":"crossref","unstructured":"Fujita, K., Hayashi, T., Matsushita, M., Uemura, M., and Nonomura, N. (2019). Obesity, Inflammation, and Prostate Cancer. J. Clin. Med., 8.","DOI":"10.3390\/jcm8020201"},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"990","DOI":"10.1016\/j.juro.2018.01.002","article-title":"Clinically localized prostate cancer: AUA\/ASTRO\/SUO guideline. Part II: Recommended approaches and details of specific care options","volume":"199","author":"Sanda","year":"2018","journal-title":"J. Urol."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"44","DOI":"10.1093\/ajcn\/87.1.44","article-title":"Effects of a high-protein ketogenic diet on hunger, appetite, and weight loss in obese men feeding ad libitum","volume":"87","author":"Johnstone","year":"2008","journal-title":"Am. J. Clin. Nutr."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"e231439","DOI":"10.1001\/jamanetworkopen.2023.1439","article-title":"Time Trends and Variation in the Use of Active Surveillance for Management of Low-risk Prostate Cancer in the US","volume":"6","author":"Cooperberg","year":"2023","journal-title":"JAMA Netw. Open"},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"3035","DOI":"10.1158\/1078-0432.CCR-19-3873","article-title":"A Randomized Controlled Trial of a 6-Month Low-Carbohydrate Intervention on Disease Progression in Men with Recurrent Prostate Cancer: Carbohydrate and Prostate Study 2 (CAPS2)","volume":"26","author":"Freedland","year":"2020","journal-title":"Clin. Cancer Res."},{"key":"ref_17","first-page":"64","article-title":"HDAC inhibitors with potential to overcome drug resistance in castration-resistant prostate cancer","volume":"5","author":"Biersack","year":"2022","journal-title":"Cancer Drug Resist."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"770","DOI":"10.1038\/s41391-022-00525-6","article-title":"Serum metabolomic analysis of men on a low-carbohydrate diet for biochemically recurrent prostate cancer reveals the potential role of ketogenesis to slow tumor growth: A secondary analysis of the CAPS2 diet trial","volume":"25","author":"Chi","year":"2022","journal-title":"Prostate Cancer Prostatic Dis."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"323","DOI":"10.1007\/s00011-010-0163-y","article-title":"Association between serum amyloid A and obesity: A meta-analysis and systematic review","volume":"59","author":"Zhao","year":"2010","journal-title":"Inflamm. Res."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"31","DOI":"10.1001\/archinte.167.1.31","article-title":"The effect of weight loss on C-reactive protein: A systematic review","volume":"167","author":"Selvin","year":"2007","journal-title":"Arch. Intern. Med."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"804","DOI":"10.1161\/hc0702.104279","article-title":"Reduction of inflammatory cytokine concentrations and improvement of endothelial functions in obese women after weight loss over one year","volume":"105","author":"Ziccardi","year":"2002","journal-title":"Circulation"},{"key":"ref_22","doi-asserted-by":"crossref","unstructured":"Zhao, H., Jin, H., Xian, J., Zhang, Z., Shi, J., and Bai, X. (2022). Effect of Ketogenic Diets on Body Composition and Metabolic Parameters of Cancer Patients: A Systematic Review and Meta-Analysis. Nutrients, 14.","DOI":"10.3390\/nu14194192"},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"217","DOI":"10.1900\/RDS.2016.13.217","article-title":"Blood Ketones: Measurement, Interpretation, Limitations, and Utility in the Management of Diabetic Ketoacidosis","volume":"13","author":"Dhatariya","year":"2016","journal-title":"Rev. Diabet. Stud."}],"container-title":["Nutrients"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2072-6643\/16\/21\/3716\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T16:24:39Z","timestamp":1760113479000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2072-6643\/16\/21\/3716"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,10,30]]},"references-count":23,"journal-issue":{"issue":"21","published-online":{"date-parts":[[2024,11]]}},"alternative-id":["nu16213716"],"URL":"https:\/\/doi.org\/10.3390\/nu16213716","relation":{},"ISSN":["2072-6643"],"issn-type":[{"value":"2072-6643","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,10,30]]}}}