Does Lifestyle Affect Prostate Cancer Outcomes?

TOPLINE:

Healthier lifestyles were associated with improved overall survival but not prostate cancer–specific survival in a multiethnic cohort of patients with nonmetastatic prostate cancer.

METHODOLOGY:

• Behavioral scores combining multiple risk factors have been developed to examine associations with prostate cancer outcomes, with studies in White populations suggesting benefits from healthy lifestyle patterns. Researchers identified a need to evaluate whether findings from predominantly White populations generalize to other racial and ethnic groups.
• Researchers conducted a prospective cohort study among men aged 45-75 years enrolled between 1993 and 1996 in the multiethnic cohort study, with participants completing questionnaires after nonmetastatic prostate cancer diagnosis (2003-2008).
• Analysis included 2603 men with nonmetastatic prostate cancer (mean age, 69.6 ± 7.1 years), comprising African American (19.1%), Japanese American (29.0%), Latino (22.2%), Native Hawaiian (5.0%), and White (24.8%) participants.
• Investigators assessed lifestyle and dietary patterns after diagnosis using three prostate cancer behavior scores and 13 dietary indices, with four prioritized scores: The healthy eating index-2015, healthful plant-based diet index, dietary inflammatory index, and empirical dietary index for hyperinsulinemia.
• Participants were followed for a median of 10.9 years (interquartile range [IQR], 6.8-12.7) from questionnaire return and 14.5 years (IQR, 11.8-18.0) from diagnosis, with researchers documenting 1346 deaths.

TAKEAWAY:

• The 2021 prostate cancer (PCa) behavior score was associated with reduced risks for all-cause mortality (hazard ratio [HR], 0.69; 95% CI, 0.63-0.77) and cardiovascular disease (CVD)–related mortality (HR, 0.67; 95% CI, 0.56-0.79).
• Among African American men, the PCa behavior score showed a lower risk for PCa-specific mortality (HR, 0.46; 95% CI, 0.24-0.88), but this association was not observed in other racial and ethnic groups.
• The empirical dietary index for hyperinsulinemia was positively associated with all-cause mortality (HR, 1.37; 95% CI, 1.02-1.84) and CVD-related mortality (HR, 1.96; 95% CI, 1.15-3.33) when comparing highest vs lowest scores.
• The healthful plant-based diet index showed an inverse association with all-cause mortality (HR, 0.75; 95% CI, 0.58-0.97) for highest vs lowest scores.

IN PRACTICE:

“Notably, 85% of the observed deaths during follow-up were due to causes other than prostate cancer, highlighting the importance of managing comorbidities,” the authors of the study wrote.

SOURCE:

This study was led by Christopher A. Haiman, ScD, Department of Population and Public Health Sciences, Center for Genetic Epidemiology, Keck School of Medicine, University of Southern California in Los Angeles. It was published online in JAMA Network Open.

LIMITATIONS:

According to the authors, a significant limitation was the absence of information on prostate cancer progression or recurrence, which constrained their ability to assess the influence of postdiagnostic lifestyle and dietary patterns across the prostate cancer continuum. Additionally, the relatively small sample size of participants with prostate cancer reduced statistical power in analyses stratified by race and ethnicity.

DISCLOSURES:

Erin Van Blarigan, ScD, and Iona Cheng, PhD, disclosed receiving grants from the National Institutes of Health during the conduct of the study. June Chan, ScD, reported receiving nonfinancial support from Veracyte outside the submitted work, and disclosed that her husband is a full-time employee of Adela, Inc. Loic Le Marchand, MD, reported receiving grants to his institution from the National Cancer Institute during the conduct of the study. This study was supported by grants from the National Cancer Institute, the American Cancer Society, and the Helen Diller Family Chair in Population Science for Urologic Cancer at the University of California San Francisco.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.