Background

Large prospective cohort studies need to confirm the associations between recreational physical activity (PA), including the most common type—walking, and prostate cancer–specific mortality (PCSM) among prostate cancer patients.

Objective

To investigate the associations of recreational PA, reported before and after diagnosis, with PCSM, overall and by tumor risk category.

Design, setting, and participants

In a prospective cohort study conducted in the USA, men diagnosed with nonmetastatic prostate cancer between 1992/1993 and June 2011 were followed for mortality until 2012. Patients were included in pre- (n = 7328) and/or postdiagnosis (n = 5319) analyses.

Outcome measurements and statistical analysis

Cox proportional hazards models were used to assess PCSM with recreational PA.

Results and limitations

A total of 454 and 261 prostate cancer deaths occurred during pre- and postdiagnosis follow-up, respectively. Prior to diagnosis, engaging in ≥17.5 metabolic equivalent hours per week (MET-h/wk) of recreational PA, compared with 3.5–<8.75 MET-h/wk, was associated with a significant 37% lower risk of PCSM (hazard ratio: 0.63, 95% confidence interval: 0.43–0.91, p trend = 0.03) only among men with lower-risk tumors (Gleason score 2–7 and T1–T2; p interaction = 0.02). A similar result was seen for walking but not for other recreational PA. After diagnosis, the same comparison (≥17.5 vs 3.5–<8.75 MET-h/wk) was associated with a significant 31% lower risk of overall PCSM (hazard ratio: 0.69, 95% confidence interval: 0.49–0.95, p trend = 0.006), which did not differ by tumor risk category. Postdiagnosis walking had a suggestive inverse association with PCSM (p trend = 0.07). These results were observational and may not be generalized to patients with metastatic prostate cancer. Residual confounding due to a higher screening rate among men with lower-risk tumors cannot be ruled out.

Conclusions

The findings provide additional evidence for prostate cancer survivors to adhere to PA recommendations, and support clinical trials of exercise among prostate cancer survivors with progression or mortality as outcomes.

Patient summary

In a large follow-up study of men diagnosed with nonmetastatic prostate cancer, those who exercise more after diagnosis had a lower risk of dying from prostate cancer.

中文翻译：

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非转移性前列腺癌男性的娱乐性体育活动与前列腺癌特定死亡率的关系

背景

大规模的前瞻性队列研究需要证实娱乐性体育活动（PA）之间的关联，包括前列腺癌患者中最常见的步行型和前列腺癌特异性死亡率（PCSM）。

客观的

调查在诊断之前和之后报告的娱乐性PA与PCSM的整体和肿瘤风险类别之间的关系。

设计，设置和参与者

在美国进行的一项前瞻性队列研究中，追踪了1992/1993年至2011年6月之间诊断为非转移性前列腺癌的男性的死亡率，直到2012年。患者被纳入诊断前（n  = 7328）和/或诊断后（n  = 5319）分析。

成果测量和统计分析

使用Cox比例风险模型评估休闲PA的PCSM。

结果与局限性

在诊断前后，分别有454和261例前列腺癌死亡。在诊断之前，每周进行≥17.5代谢当量小时（MET-h / wk）的休闲性PA，而3.5- <8.75 MET-h / wk与PCSM的风险显着降低37％（危险比） ：0.63，95％置信区间：0.43-0.91，p趋势= 0.03）仅存在于低危肿瘤患者中（格里森评分2-7和T1-T2；p相互作用= 0.02）。步行时看到了类似的结果，但其他休闲PA则没有。诊断后，相同的比较（≥17.5 vs 3.5- <8.75 MET-h / wk）与整体PCSM的风险显着降低31％（危险比：0.69，95％置信区间：0.49-0.95，p趋势= 0.006），这在肿瘤风险类别上没有差异。诊断后行走与PCSM呈暗示性负相关（p趋势= 0.07）。这些结果是观察性的，可能无法推广到转移性前列腺癌患者。不能排除因低筛查率的男性筛查率较高而造成的残留混杂。

结论

该发现为前列腺癌幸存者遵守PA建议提供了更多证据，并支持以进展或死亡为结果的前列腺癌幸存者进行运动的临床试验。

病人总结

在一项针对被诊断患有非转移性前列腺癌的男性的大型随访研究中，诊断后运动更多的人死于前列腺癌的风险较低。