{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,27]],"date-time":"2026-09-27T22:44:43Z","timestamp":1790549083727,"version":"4.1.0"},"reference-count":34,"publisher":"American Medical Association (AMA)","issue":"2","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JAMA Netw Open"],"abstract":"Importance<\/jats:title>Prostate cancer (PCa) remains a leading cause of cancer-related death among men in the US.<\/jats:p><\/jats:sec>Objective<\/jats:title>To evaluate the association of healthy lifestyle and dietary behaviors with survival after a nonmetastatic PCa diagnosis in a multiethnic population.<\/jats:p><\/jats:sec>Design, Setting, and Participants<\/jats:title>This prospective cohort study was conducted among men aged 45 to 75 years enrolled between 1993 and 1996 in the Multiethnic Cohort study. Participants with nonmetastatic PCa completed a questionnaire after diagnosis (2003-2008) and were followed up until death or loss to follow-up. Data were analyzed from January 10, 2023, to May 20, 2024.<\/jats:p><\/jats:sec>Exposures<\/jats:title>Lifestyle and dietary patterns were assessed after diagnosis using 3 PCa behavior scores and 13 dietary indices (4 prioritized scores: the Healthy Eating Index\u20132015, Healthful Plant-Based Diet Index, Dietary Inflammatory Index, and Empirical Dietary Index for Hyperinsulinemia).<\/jats:p><\/jats:sec>Main Outcomes and Measures<\/jats:title>Cox proportional hazards models were used to evaluate multivariable-adjusted associations of each PCa behavior score with all-cause, cardiovascular disease (CVD), and PCa-specific mortality.<\/jats:p><\/jats:sec>Results<\/jats:title>A total of 2603 men with nonmetastatic PCa (mean [SD] age, 69.6 [7.1] years) were followed up, and 1346 deaths were documented, including 356 (24.6%) from CVD and 197 (14.6%) from PCa. The median (IQR) follow-up was 10.9 (IQR, 6.8-12.7) years from questionnaire return and 14.5 (IQR, 11.8-18.0) years from diagnosis. The 2021 PCa Behavior Score was associated with reduced risks of all-cause (hazard ratio [HR] per point,\u20090.69; 95% CI, 0.63-0.77) and CVD-related (HR,\u20090.67; 95% CI, 0.56-0.79) mortality. This score was also associated with a lower risk of PCa-specific mortality among African American men (HR,\u20090.46; 95% CI, 0.24-0.88) but not in the other racial and ethnic groups. Comparing quintile 5 (highest score) with 1 (lowest score), the Empirical Dietary Index for Hyperinsulinemia was positively associated with all-cause (HR,\u20091.37; 95% CI, 1.02-1.84) and CVD-related (HR,\u20091.96; 95% CI, 1.15-3.33) mortality, whereas the Healthful Plant-Based Diet Index was associated with a reduced risk of all-cause (HR,\u20090.75; 95% CI, 0.58-0.97); findings for CVD-related mortality were not statistically significant (HR, 0.67; 95% CI, 0.44-1.03). No associations were found between lifestyle or dietary patterns and PCa mortality.<\/jats:p><\/jats:sec>Conclusions and Relevance<\/jats:title>In this multiethnic cohort of patients with nonmetastatic PCa, healthier lifestyles were associated with improved overall survival but not with PCa-specific survival. Given the predominance of non\u2013PCa-specific deaths, these findings support the need for health behavior counseling to treat comorbidities in men with PCa.<\/jats:p><\/jats:sec>","DOI":"10.1001\/jamanetworkopen.2024.60785","type":"journal-article","created":{"date-parts":[[2025,2,26]],"date-time":"2025-02-26T16:32:41Z","timestamp":1740587561000},"page":"e2460785","source":"Crossref","is-referenced-by-count":10,"title":["Race and Ethnicity, Lifestyle, Diet, and Survival in Patients With Prostate Cancer"],"prefix":"10.1001","volume":"8","author":[{"given":"Anqi","family":"Wang","sequence":"first","affiliation":[{"name":"Center for Genetic Epidemiology, Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles"},{"name":"Department of Epidemiology, Harvard T.H. 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