2. UroToday Home
  3. Recent Abstracts
  4. Urologic Oncology
  5. Prostate Cancer

Post-Diagnostic Health Behaviour Scores in Relation to Fatal Prostate Cancer - Beyond the Abstract

Prostate cancer (PCa) is the second most common cancer among men worldwide, with nearly 1.5 million cases diagnosed each year.1 Though most men are diagnosed with local or regional disease,2 PCa becomes fatal for roughly 375,000 men annually.1 As such, a man diagnosed with PCa is likely to ask the question, “What can I do to reduce my risk of death from my disease?” Given that a cancer diagnosis is a “teachable moment”3-5 – a period during which an individual may be open to behavior change – providers should be equipped with evidence-based, disease-specific lifestyle recommendations.

But what combination of post-diagnostic behaviors should be recommended? We set out to evaluate the risk of fatal PCa in relation to four health behavior scores: 1) a novel, literature-based, three-factor score comprised of behaviors that have been associated with fatal outcomes (“2021 PCa Behavior Score”); 2) a six-factor score developed for the prevention of lethal PCa (“2015 PCa Behavior Score”);6 3) a score developed based on World Cancer Research Fund (WCRF)/​American Institute for Cancer Research (AICR) diet and exercise guidelines for cancer prevention (“WCRF/AICR Score”);7 and 4) a score developed based on American Cancer Society diet and exercise recommendations for cancer survivorship (“ACS Score”).8 The health behaviors contributing to each score are summarized in the following table:

PCa_Behavior_Score.png
Higher values of the scores corresponded to greater adherence to recommended behaviors.

Analyses of the 2021 PCa Behavior Score were based on 4362 men. The score was not associated with fatal PCa in models adjusted for clinical characteristics and pre-diagnostic behaviors (HR3 pts vs. 0-1 pts: 0.84, 95% CI: 0.46-1.52, Ptrend: 0.77). Analyses of the 2015 PCa Behavior Score were based on 4320 men. The score was significantly inversely associated with the risk of fatal PCa (HR5-6 pts vs. 0-1 pts: 0.68, 95% CI: 0.29-1.57, Ptrend: 0.02), wherein each one-point increase in the score was associated with a 19% reduced risk. Analyses of the WCRF/AICR Score were based on 4518 men, and those for the ACS Score were based on 4505 men. Neither score demonstrated evidence of an association with fatal PCa.

To summarize, each one-point increase toward not smoking, maintaining a healthy body size, engaging in regular physical activity, and consuming specific food items (2015 PCa Behavior Score) was associated with a 19% lower risk of dying from PCa. Other scores did not demonstrate convincing evidence of associations with fatal PCa. Further research is needed to understand our results in the context of prior associations between individual behavioral risk factors and fatal PCa and to inform tailored cancer survivorship recommendations.

Written by: Rebecca E. Graff, ScD, Assistant Professor, University of California, San Francisco, Department of Epidemiology & Biostatistics, San Francisco, CA

References:

  1. Ferlay J, Colombet M, Soerjomataram I, Parkin DM, Piñeros M, Znaor A, et al. Cancer statistics for the year 2020: An overview. Int J Cancer. 2021 10.1002/ijc.33588
  2. Siegel RL, Miller KD, Fuchs HE & Jemal A. Cancer statistics, 2022. CA Cancer J Clin. 2022;72:7-33.
  3. Bell K. Remaking the self: Trauma, teachable moments, and the biopolitics of cancer survivorship. Cult Med Psychiatry. 2012;36:584-600.
  4. Ganz PA. A teachable moment for oncologists: Cancer survivors, 10 million strong and growing! J Clin Oncol. 2005;23:5458-60.
  5. Karvinen K, Bruner B & Truant T. The teachable moment after cancer diagnosis: Perceptions from oncology nurses. Oncol Nurs Forum. 2015;42:602-9.
  6. Kenfield SA, Batista JL, Jahn JL, Downer MK, Van Blarigan EL, Sesso HD, et al. Development and application of a lifestyle score for prevention of lethal prostate cancer. J Natl Cancer Inst. 2016;108:djv329.
  7. World Cancer Research Fund/American Institute for Cancer Research. Diet, nutrition, physical activity and cancer: A global perspective. Continuous update project expert report 2018. (2018).
  8. Rock CL, Doyle C, Demark-Wahnefried W, Meyerhardt J, Courneya KS, Schwartz AL, et al. Nutrition and physical activity guidelines for cancer survivors. CA Cancer J Clin. 2012;62:243-74.

Read the Abstract