National Institute for Health Research Bristol Biomedical Research Centre, University Hospitals Bristol and Weston NHS Foundation Trust and the University of Bristol, Bristol, UK.
Translational Health Sciences, Bristol Medical School, Southmead Hospital, University of Bristol, Bristol, UK.
Eur J Clin Invest. 2021 Aug;51(8):e13545. doi: 10.1111/eci.13545. Epub 2021 Mar 25.
Cardiorespiratory fitness (CRF) has a strong inverse relationship with several chronic disease outcomes, including some cancers. The association between CRF and prostate cancer is controversial. We aimed to assess the prospective association of CRF with prostate cancer risk using a cohort study and review of the literature.
Cardiorespiratory fitness was assessed using a respiratory gas exchange analyser during exercise testing in 2204 cancer-free middle-aged men. Hazard ratios (HRs) with 95% confidence interval (CIs) were estimated. We corrected for within-person variability in CRF levels using repeat measurements.
During a median follow-up of 24.9 years, 216 prostate cancer cases occurred. The age-adjusted regression dilution ratio of CRF was 0.58 (95% CI: 0.53-0.64). The HR (95% CI) of prostate cancer per 1 standard deviation increase in CRF in age-adjusted analysis was 1.10 (0.95-1.27). The association remained consistent after further adjustment for several risk factors (HR 1.13; 95% CI 0.96-1.33). The corresponding adjusted HRs were 1.24 (95% CI: 0.87-1.77) and 1.28 (95% CI: 0.87-1.88), respectively, when comparing the extreme tertiles of CRF levels. Previous studies mostly reported no evidence of an association or an increased risk of prostate cancer in relation to high CRF. Studies reporting positive associations had short-term follow-up durations (<10 years).
Primary data and a review of previous studies suggest that elevated CRF is not associated with reduced prostate cancer risk. Previous findings of significant evidence of associations could be attributed to increased screening and detection as well as reverse causation bias.
心肺适能（CRF）与多种慢性疾病结局呈负相关，包括某些癌症。CRF 与前列腺癌之间的关联存在争议。我们旨在使用队列研究和文献综述评估 CRF 与前列腺癌风险的前瞻性关联。
在 2204 名无癌症的中年男性的运动测试中，使用呼吸气体交换分析仪评估心肺适能。使用重复测量校正 CRF 水平的个体内变异性。
在中位数为 24.9 年的随访期间，发生了 216 例前列腺癌病例。CRF 的年龄调整回归稀释比为 0.58（95%置信区间：0.53-0.64）。在年龄调整分析中，CRF 每增加 1 个标准差，前列腺癌的 HR（95%CI）为 1.10（0.95-1.27）。进一步调整了几个危险因素后，该关联仍然一致（HR 1.13；95%CI 0.96-1.33）。当比较 CRF 水平的极端三分位时，相应的调整 HR 分别为 1.24（95%CI：0.87-1.77）和 1.28（95%CI：0.87-1.88）。
原始数据和对以往研究的综述表明，CRF 升高与前列腺癌风险降低无关。先前发现的有意义的关联证据可能归因于筛查和检测增加以及反向因果关系偏差。
