ASPO Abstracts
Post-diagnostic Health Behavior Scores and the Risk of Prostate Cancer Progression and Mortality
Category: Lifestyles Behavior, Energy Balance & Chemoprevention
Conference Year: 2023
Abstract Body:
Purpose: Individual health behaviors are associated with prostate cancer progression. Behavioral scores, comprised of multiple risk factors, allow assessment of the combined impact of multiple behaviors. Methods: We examined the association between six health behavior scores and the risk of prostate cancer progression and death, in a cohort of 2,156 men with prostate cancer: two scores developed based on the prostate cancer survivorship literature ('2021 Score [+ Diet]'); a score developed based on pre-diagnostic prostate cancer literature ('2015 Score'); and three scores based on recommendations for cancer prevention (World Cancer Research Fund/American Institute for Cancer Research 'WCRF/AICR Score') and survival (American Cancer Society 'ACS Score [+ Alcohol]'). Hazard ratios (HRs) and 95% confidence intervals (CIs) were estimated for prostate cancer progression and prostate cancer death, using parametric survival models (interval censoring) and Cox models, respectively. Multivariable models were adjusted for diagnostic age, stage, grade, and prostate specific antigen level, treatment, time between diagnosis and survey, family history of prostate cancer, race, total caloric intake, and the following items (if not in the score) – whole milk, wine, total alcohol, red and processed meat, and dark meat fish intake, selenium supplement use, and smoking history. Results: Over a median (IQR) of 6.4 (1.3, 13.7) years, we observed 192 progression and 73 prostate cancer mortality events. Higher (i.e., healthier) 2021 Score + Diet and WCRF/AICR Score were inversely associated with risk of prostate cancer progression (2021 + Diet: HRcontinuous=0.76, 95% CI: 0.63-0.90; WCRF/AICR: HRcontinuous=0.83, 95% CI: 0.67-1.02) and mortality (2021 + Diet: HRcontinuous=0.65, 95% CI: 0.45-0.93; WCRF/AICR: HRcontinuous=0.71; 95% CI: 0.57-0.89). The ACS Score + Alcohol was only associated with progression (HRcontinuous=0.89, 95% CI: 0.81-0.98), while the 2021 Score was only associated with prostate cancer mortality (HRcontinuous=0.62, 95% CI: 0.45-0.85). The 2015 Score was not associated with prostate cancer progression or mortality. Conclusion: Findings strengthen the evidence that behavioral modifications following a prostate cancer diagnosis may improve clinical outcomes.
Keywords: prostate cancer progression, diet, physical activity, behavioral scores, prostate cancer death