Healthy lifestyle and dietary choices are associated with a reduction in the risk of all-cause death among patients with non-metastatic prostate cancer, but these choices are not associated with prostate cancer-specific survival, according to research published in JAMA Network Open.
Researchers evaluated the links between lifestyle and dietary index scores and risk of death in a prospective, multiethnic cohort of men diagnosed with non-metastatic prostate cancer. To evaluate lifestyle, the researchers used the 2021 Prostate Cancer Behavior Score, which incorporates body mass index, total physical activity, and smoking status. The researchers also conducted analyses incorporating this score along with dietary factors, including intake of saturated fat, whole milk, alcohol, and processed meat.
The analysis included 2603 patients. At diagnosis, 89.3% had localized prostate cancer, and 76.1% had a Gleason grade of at least 7. Treatments included surgery (32.8%), radiation (46.4%), and hormone therapy (30.2%).
Patients were followed for a median of 14.5 years from diagnosis and a median of 10.9 years from the return of questionnaires. There were a total of 1346 deaths during follow-up. Common causes of death included prostate cancer (14.6%), cardiovascular disease (26.4%), other cancers (20.9%), cerebrovascular disease (5.2%), and chronic pulmonary disease (3.4%).
In a fully adjusted model, each 1-point increase in the 2021 Prostate Cancer Behavior Score was significantly associated with a reduction in all-cause mortality (hazard ratio [HR] per point, 0.69; 95% CI, 0.63-0.77; P <.001). Results were similar when dietary factors were considered as well (HR per point, 0.70; 95% CI, 0.64-0.77; P <.001).
Higher 2021 Prostate Cancer Behavior Scores were also associated with a lower risk of cardiovascular-related morality (HR per point, 0.67; 95% CI 0.56-0.79; P <.001), and results were similar when dietary factors were included as well (HR per point, 0.68; 95% CI, 0.58-0.79; P <.001).
However, higher 2021 Prostate Cancer Behavior Scores were not associated with a decrease in the risk of prostate cancer-specific mortality when considered alone (HR per point, 0.90; 95% CI 0.69-1.18; P =.45) or in conjunction with dietary factors (HR per point, 0.96; 95% CI 0.75-1.21; P =.71).
Higher 2021 Prostate Cancer Behavior Scores were significantly associated with a lower risk of prostate cancer-specific mortality among Black patients (HR per point, 0.46, 95% CI 0.24-0.88) but not among other racial and ethnic groups. And results were no longer significant for Black patients when dietary factors were included as well (HR per point, 0.70; 95% CI, 0.42-1.16).
“The findings suggest improvements in overall and cardiovascular mortality, though the effect on prostate cancer-specific mortality does not reach statistical significance in all ethnic groups — largely due to limited statistical power,” said J. Ryan Mark, MD, of Fox Chase Cancer Center in Philadelphia, who was not involved in this study.
“Notably, the absence of recurrence and progression data presents a challenge in applying the study’s instruments to fully assess the influence of diet and lifestyle on prostate cancer outcomes,” he added. “Nevertheless, the trends identified in this research offer valuable insights for designing future studies that explore the role of healthy living in diverse populations. More immediately, they provide additional evidence to support the guidance we offer patients at a time when they may be most receptive to adopting healthier habits.”
Disclosures: This research was supported by various grants. Some study authors disclosed conflicts of interest, which can be found in the original reference. Dr Mark disclosed a relationship with Intuitive Surgical.
This article originally appeared on Cancer Therapy Advisor