Lifestyle factors before and after a cancer diagnosis have been linked to survival, but evidence specifically for prostate cancer has been limited. A new analysis from the Cancer Prevention Study-II (CPS-II) Nutrition Cohort provides important insights into how adherence to healthy lifestyle guidelines influences long-term survival outcomes in men diagnosed with nonmetastatic prostate cancer.
Study Design
This prospective cohort study, published in JAMA Network Open, included 4,232 men with confirmed nonmetastatic prostate cancer, followed for a median of 14.1 years (interquartile range, 8.4–17.5 years). Researchers assessed concordance with the American Cancer Society (ACS) guidelines — encompassing four domains: diet quality, body mass index (BMI), physical activity, and alcohol intake.
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During follow-up, there were:
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3,101 all-cause deaths (73%)
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912 cardiovascular deaths (22%)
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453 prostate cancer–specific deaths (11%)
Key Findings
1. Baseline Concordance and Survival Outcomes
Men with high baseline lifestyle concordance scores (ACS score 6–8) had significantly improved survival compared to those with low concordance (score 0–3):
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All-cause mortality (ACM): HR 0.77 (95% CI, 0.69–0.85)
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Cardiovascular mortality (CVDM): HR 0.75 (0.63–0.91)
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Prostate cancer–specific mortality (PCSM): HR 0.79 (0.60–1.03; trend toward benefit)
2. Physical Activity and Other Components
Physical activity (>15 MET·hours/week) was the strongest individual factor, associated with a 33% reduction in PCSM (HR 0.67; 95% CI, 0.54–0.84). BMI in the “healthy” range (18.5–<30) was associated with lower ACM (HR 0.84) and CVDM (HR 0.81). Diet quality showed weaker, though positive, associations, while alcohol abstinence alone was not consistently protective.
3. Lifestyle Changes After Diagnosis
Changes in lifestyle behaviours after diagnosis also mattered:
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Improved concordance (low → high) was linked to reduced ACM (HR 0.83; 95% CI, 0.73–0.94) and CVDM (HR 0.72; 0.56–0.92).
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Decreased concordance (high → low) still showed benefits for ACM (HR 0.86; 0.76–0.98) and notably PCSM (HR 0.61; 0.43–0.86), although no statistically significant benefit for CVDM was seen.
These findings suggest that maintaining or improving healthy lifestyle behaviours after prostate cancer diagnosis can confer substantial survival benefits — particularly regarding cardiovascular health and overall longevity.
Implications for Survivorship Care
This research reinforces the importance of lifestyle interventions as part of survivorship care for prostate cancer patients. While diet quality and BMI are important, physical activity emerges as a central modifiable factor. Even postdiagnosis lifestyle improvements can translate into meaningful survival gains, highlighting the value of ongoing lifestyle support for men living with prostate cancer.
Paper: Elahy, V, et al. Adherence to American Cancer Society Guidelines and Mortality in Men With Non-metastatic Prostate Cancer. JAMA Network Open. September 2025. Access online here.
