Pagadala Meghana S, Lui Asona, Lynch Julie, Karunamuni Roshan, Lee Kyung Min, Plym Anna, Rose Brent S, Carter Hannah, Kibel Adam S, DuVall Scott L, Vassy Jason, Gaziano J Michael, Panizzon Matthew S, Hauger Richard L, Seibert Tyler M
Research Service, Veterans Affairs (VA) San Diego Healthcare System, San Diego, California, USA.
Medical Scientist Training Program, University of California San Diego, La Jolla, California, USA.
Cancer. 2024 Oct 15;130(20):3496-3505. doi: 10.1002/cncr.35434. Epub 2024 Jun 12.
This study aims to assess the impact of healthy lifestyle on prostate cancer (PCa) risk in a diverse population.
Data for 281,923 men from the Million Veteran Program (MVP), a nationwide, health system-based cohort study, were analyzed. Self-reported information at enrollment included smoking status, exercise, diet, family history of PCa, and race/ethnicity. Body mass index (BMI) was obtained from clinical records. Genetic risk was assessed via a validated polygenic score. Cox proportional hazards models were used to assess associations with PCa outcomes.
After accounting for ancestry, family history, and genetic risk, smoking was associated with an increased risk of metastatic PCa (hazard ratio [HR], 1.83; 95% confidence interval [CI], 1.64-2.02; p < 10) and fatal PCa (HR, 2.73; 95% CI, 2.36-3.25; p < 10). Exercise was associated with a reduced risk of fatal PCa (HR, 0.86; 95% CI, 0.76-0.98; p = .03). Higher BMI was associated with a slightly reduced risk of fatal PCa, and diet score was not independently associated with any end point. Association with exercise was strongest among those who had nonmetastatic PCa at MVP enrollment. Absolute reductions in the risk of fatal PCa via lifestyle factors were greatest among men of African ancestry (1.7% for nonsmokers vs. 6.1% for smokers) or high genetic risk (1.4% for nonsmokers vs. 4.3% for smokers).
Healthy lifestyle is minimally related to the overall risk of developing PCa but is associated with a substantially reduced risk of dying from PCa. In multivariable analyses, both exercise and not smoking remain independently associated with reduced metastatic and fatal PCa.
本研究旨在评估健康生活方式对不同人群前列腺癌（PCa）风险的影响。
对来自百万退伍军人计划（MVP）的281,923名男性的数据进行了分析，该计划是一项基于全国卫生系统的队列研究。入组时的自我报告信息包括吸烟状况、运动、饮食、PCa家族史和种族/族裔。体重指数（BMI）从临床记录中获取。通过经过验证的多基因评分评估遗传风险。使用Cox比例风险模型评估与PCa结局的关联。
在考虑了祖先、家族史和遗传风险后，吸烟与转移性PCa风险增加相关（风险比[HR]，1.83；95%置信区间[CI]，1.64 - 2.02；p < 0.001）以及致命性PCa风险增加相关（HR，2.73；95% CI，2.36 - 3.25；p < 0.001）。运动与致命性PCa风险降低相关（HR，0.86；95% CI，0.76 - 0.98；p = 0.03）。较高BMI与致命性PCa风险略有降低相关，且饮食评分与任何终点均无独立关联。在MVP入组时患有非转移性PCa的人群中，运动的关联最强。通过生活方式因素使致命性PCa风险绝对降低幅度在非洲裔男性（非吸烟者为1.7%，吸烟者为6.1%）或高遗传风险男性（非吸烟者为1.4%，吸烟者为4.3%）中最大。
健康生活方式与PCa总体发病风险的关联极小，但与PCa死亡风险大幅降低相关。在多变量分析中，运动和不吸烟均与转移性和致命性PCa风险降低独立相关。
