{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,3]],"date-time":"2026-09-03T02:42:57Z","timestamp":1788403377792,"version":"build-2803163510"},"reference-count":40,"publisher":"American Medical Association (AMA)","issue":"9","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JAMA Netw Open"],"abstract":"Importance<\/jats:title>Among men with nonmetastatic prostate cancer, prostate cancer\u2013specific mortality (PCSM) is the leading cancer-related cause of death, and cardiovascular disease mortality (CVDM) is the most common non\u2013cancer-related cause. The American Cancer Society (ACS) guideline for cancer survivors recommends avoiding obesity, engaging in regular physical activity, and following a healthy diet. While physical activity and body weight have been associated individually with lower mortality in patients with prostate cancer, the combined effect of all ACS guideline components remains unclear.<\/jats:p><\/jats:sec>Objective<\/jats:title>To examine the association between postdiagnosis ACS guideline concordance and mortality in nonmetastatic prostate cancer survivors.<\/jats:p><\/jats:sec>Design, Setting, and Participants<\/jats:title>This cohort study used data from the Cancer Prevention Study-II Nutrition Cohort and included men diagnosed with nonmetastatic prostate cancer between 1992 and 2003 and followed up from postdiagnosis survey completion until death or December 31, 2020. Analyses were conducted from March 2024 to February 2025.<\/jats:p><\/jats:sec>Exposure<\/jats:title>Prediagnosis and postdiagnosis ACS guideline concordance was scored from 0 to 8, with higher scores indicating greater adherence.<\/jats:p><\/jats:sec>Main Outcomes and Measures<\/jats:title>Mortality outcomes, including all-cause mortality (ACM), CVDM, and PCSM, were ascertained via National Death Index linkage. Cox proportional hazards regressions were used to estimate multivariable-adjusted hazard ratios (HRs) and 95% CIs across score categories (categorized as 0-3, 4, 5, and 6-8).<\/jats:p><\/jats:sec>Results<\/jats:title>Among 4232 prostate cancer survivors (median [IQR] age at diagnosis, 69 [65.0-73.0] years) followed for a median (IQR) of 14.1 (8.4-17.5) years, there were 3101 ACM outcomes (73.3%), 912 CVDM outcomes (21.6%), and 453 PCSM outcomes (10.7%). Higher postdiagnosis ACS score (ie, 6 to 8 vs 0 to 3) was associated with lower risk of ACM (HR, 0.77; 95% CI, 0.69-0.85; per 1-point increase: HR, 0.94; 95% CI, 0.91-0.96; P<\/jats:italic>\u2009&amp;lt;\u2009.001) and CVDM (HR, 0.75; 95% CI, 0.63-0.91; per 1-point increase: HR, 0.93; 95% CI, 0.89-0.97; P<\/jats:italic>\u2009=\u2009.001), while results for PCSM were not statistically significant. Results were similar when stratified by tumor aggressiveness. Patients who improved their guideline concordance after diagnosis (ie, a score of &amp;lt;5 to \u22655) or maintained high concordance (ie, a score of \u22655 to \u22655) had lower mortality risk compared with those who maintained low scores.<\/jats:p><\/jats:sec>Conclusions and Relevance<\/jats:title>In this cohort study of men with nonmetastatic prostate cancer, higher postdiagnosis ACS guideline concordance and improvements in concordance were associated with lower ACM and CVDM, highlighting the importance of lifestyle modifications in prostate cancer survivorship.<\/jats:p><\/jats:sec>","DOI":"10.1001\/jamanetworkopen.2025.33922","type":"journal-article","created":{"date-parts":[[2025,9,26]],"date-time":"2025-09-26T15:30:31Z","timestamp":1758900631000},"page":"e2533922","source":"Crossref","is-referenced-by-count":2,"title":["Adherence to American Cancer Society Guideline and Mortality in Men With Nonmetastatic Prostate Cancer"],"prefix":"10.1001","volume":"8","author":[{"given":"Valeria","family":"Elahy","sequence":"first","affiliation":[{"name":"Department of Population Science, American Cancer Society, Atlanta, Georgia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christina C.","family":"Newton","sequence":"additional","affiliation":[{"name":"Department of Population Science, American Cancer Society, Atlanta, Georgia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marjorie L.","family":"McCullough","sequence":"additional","affiliation":[{"name":"Department of Population Science, American Cancer Society, Atlanta, Georgia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lauren R.","family":"Teras","sequence":"additional","affiliation":[{"name":"Department of Population Science, American Cancer Society, Atlanta, Georgia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Clara","family":"Bodelon","sequence":"additional","affiliation":[{"name":"Department of Population Science, American Cancer Society, Atlanta, Georgia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Erika","family":"Rees-Punia","sequence":"additional","affiliation":[{"name":"Department of Population Science, American Cancer Society, Atlanta, Georgia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Caroline Y.","family":"Um","sequence":"additional","affiliation":[{"name":"Department of Population Science, American Cancer Society, Atlanta, Georgia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Laura","family":"Makaroff","sequence":"additional","affiliation":[{"name":"Department of Cancer Prevention and Survivorship, American Cancer Society, Atlanta, Georgia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alpa V.","family":"Patel","sequence":"additional","affiliation":[{"name":"Department of Population Science, American Cancer Society, Atlanta, Georgia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ying","family":"Wang","sequence":"additional","affiliation":[{"name":"Department of Population Science, American Cancer Society, Atlanta, Georgia"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"10","published-online":{"date-parts":[[2025,9,26]]},"reference":[{"issue":"1","key":"zoi250952r1","doi-asserted-by":"publisher","first-page":"12","DOI":"10.3322\/caac.21820","article-title":"Cancer statistics, 2024.","volume":"74","author":"Siegel","year":"2024","journal-title":"CA Cancer J Clin"},{"issue":"16","key":"zoi250952r2","doi-asserted-by":"publisher","first-page":"2895","DOI":"10.1002\/cncr.33584","article-title":"Cause of death during prostate cancer survivorship: a contemporary, US population-based analysis.","volume":"127","author":"Weiner","year":"2021","journal-title":"Cancer"},{"issue":"7","key":"zoi250952r3","doi-asserted-by":"publisher","DOI":"10.1001\/jamanetworkopen.2024.20034","article-title":"Early prostate cancer deaths among men with higher vs lower genetic risk.","volume":"7","author":"Plym","year":"2024","journal-title":"JAMA Netw Open"},{"issue":"2","key":"zoi250952r4","doi-asserted-by":"publisher","first-page":"253","DOI":"10.1007\/s11764-013-0267-9","article-title":"Cardiovascular risk factors among long-term survivors of breast, prostate, colorectal, and gynecologic cancers: a gap in survivorship care?","volume":"7","author":"Weaver","year":"2013","journal-title":"J Cancer Surviv"},{"issue":"3","key":"zoi250952r5","doi-asserted-by":"publisher","first-page":"230","DOI":"10.3322\/caac.21719","article-title":"American Cancer Society nutrition and physical activity guideline for cancer survivors.","volume":"72","author":"Rock","year":"2022","journal-title":"CA Cancer J Clin"},{"issue":"4","key":"zoi250952r6","doi-asserted-by":"publisher","first-page":"245","DOI":"10.3322\/caac.21591","article-title":"American Cancer Society guideline for diet and physical activity for cancer prevention.","volume":"70","author":"Rock","year":"2020","journal-title":"CA Cancer J Clin"},{"issue":"1","key":"zoi250952r7","doi-asserted-by":"publisher","DOI":"10.1093\/jncics\/pkz080","article-title":"Physical activity and mortality in cancer survivors: a systematic review and meta-analysis.","volume":"4","author":"Friedenreich","year":"2019","journal-title":"J Natl Cancer Inst Cancer Spectr"},{"issue":"6","key":"zoi250952r8","doi-asserted-by":"publisher","first-page":"931","DOI":"10.1016\/j.eururo.2017.06.037","article-title":"Recreational physical activity in relation to prostate cancer\u2013specific mortality among men with nonmetastatic prostate cancer.","volume":"72","author":"Wang","year":"2017","journal-title":"Eur Urol"},{"issue":"18","key":"zoi250952r9","doi-asserted-by":"publisher","first-page":"2018","DOI":"10.1200\/JCO.19.02185","article-title":"Postdiagnosis body mass index, weight change, and mortality from prostate cancer, cardiovascular disease, and all causes among survivors of nonmetastatic prostate cancer.","volume":"38","author":"Troeschel","year":"2020","journal-title":"J Clin Oncol"},{"issue":"9","key":"zoi250952r10","doi-asserted-by":"publisher","first-page":"1670","DOI":"10.1038\/s41416-022-01948-7","article-title":"Postdiagnostic health behaviour scores in relation to fatal prostate cancer.","volume":"127","author":"Graff","year":"2022","journal-title":"Br J Cancer"},{"issue":"2","key":"zoi250952r11","doi-asserted-by":"publisher","first-page":"346","DOI":"10.1038\/s41416-023-02283-1","article-title":"Postdiagnostic health behaviour scores and risk of prostate cancer progression and mortality.","volume":"129","author":"Langlais","year":"2023","journal-title":"Br J Cancer"},{"issue":"3","key":"zoi250952r12","doi-asserted-by":"publisher","first-page":"579","DOI":"10.1093\/aje\/kwy261","article-title":"Guideline-based physical activity and survival Among US men with nonmetastatic prostate cancer.","volume":"188","author":"Dickerman","year":"2019","journal-title":"Am J Epidemiol"},{"key":"zoi250952r13","doi-asserted-by":"publisher","DOI":"10.3389\/fonc.2022.914875","article-title":"Causes of death among prostate cancer patients aged 40 years and older in the United States.","volume":"12","author":"Ye","year":"2022","journal-title":"Frontiers Oncology"},{"issue":"2","key":"zoi250952r14","doi-asserted-by":"publisher","first-page":"162","DOI":"10.6004\/jnccn.2010.0012","article-title":"NCCN clinical practice guidelines in oncology: prostate cancer.","volume":"8","author":"Mohler","year":"2010","journal-title":"J Natl Compr Canc Netw"},{"issue":"9","key":"zoi250952r15","first-page":"861","article-title":"Epidemiological research at the American cancer society.","volume":"9","author":"Thun","year":"2000","journal-title":"Cancer Epidemiol Biomarkers Prev"},{"issue":"2","key":"zoi250952r16","doi-asserted-by":"publisher","first-page":"500","DOI":"10.1002\/cncr.10197","article-title":"The American Cancer Society Cancer Prevention Study II Nutrition Cohort: rationale, study design, and baseline characteristics.","volume":"94","author":"Calle","year":"2002","journal-title":"Cancer"},{"issue":"6","key":"zoi250952r17","doi-asserted-by":"publisher","first-page":"1089","DOI":"10.1158\/1055-9965.EPI-10-1173","article-title":"Following cancer prevention guidelines reduces risk of cancer, cardiovascular disease, and all-cause mortality.","volume":"20","author":"McCullough","year":"2011","journal-title":"Cancer Epidemiol Biomarkers Prev"},{"issue":"11","key":"zoi250952r18","doi-asserted-by":"publisher","first-page":"1129","DOI":"10.1002\/pros.23001","article-title":"Body mass index and mortality in men with prostate cancer.","volume":"75","author":"Cantarutti","year":"2015","journal-title":"Prostate"},{"issue":"5","key":"zoi250952r19","doi-asserted-by":"publisher","first-page":"405","DOI":"10.3322\/caac.21858","article-title":"Proportion and number of cancer cases and deaths attributable to potentially modifiable risk factors in the United States, 2019.","volume":"74","author":"Islami","year":"2024","journal-title":"CA Cancer J Clin"},{"issue":"8","key":"zoi250952r20","doi-asserted-by":"publisher","first-page":"1233","DOI":"10.1038\/bjc.2017.280","article-title":"Cardiovascular disease risk and androgen deprivation therapy in patients with localised prostate cancer: a prospective cohort study.","volume":"117","author":"Haque","year":"2017","journal-title":"Br J Cancer"},{"issue":"446","key":"zoi250952r21","doi-asserted-by":"publisher","first-page":"496","DOI":"10.1080\/01621459.1999.10474144","article-title":"A proportional hazards model for the subdistribution of a competing risk.","volume":"94","author":"Fine","year":"1999","journal-title":"J Am Stat Assoc"},{"issue":"3","key":"zoi250952r22","doi-asserted-by":"publisher","DOI":"10.1056\/EVIDoa2300272","article-title":"Smoking cessation and short- and longer-term mortality.","volume":"3","author":"Cho","year":"2024","journal-title":"NEJM Evid"},{"issue":"12","key":"zoi250952r23","doi-asserted-by":"publisher","first-page":"2485","DOI":"10.1002\/oby.21239","article-title":"Smoking and reverse causation create an obesity paradox in cardiovascular disease.","volume":"23","author":"Stokes","year":"2015","journal-title":"Obesity (Silver Spring)"},{"issue":"4","key":"zoi250952r24","doi-asserted-by":"publisher","first-page":"755","DOI":"10.1002\/oby.23114","article-title":"Shape of BMI-mortality risk associations: reverse causality and heterogeneity in a representative cohort of US adults.","volume":"29","author":"Garcia","year":"2021","journal-title":"Obesity (Silver Spring)"},{"issue":"1","key":"zoi250952r25","doi-asserted-by":"publisher","first-page":"138","DOI":"10.1001\/jamaoncol.2020.5874","article-title":"Possible reverse causation and confounding in study of the association of sedentary behavior with cancer mortality.","volume":"7","author":"Rezende","year":"2021","journal-title":"JAMA Oncol"},{"issue":"2","key":"zoi250952r26","doi-asserted-by":"publisher","first-page":"189","DOI":"10.1093\/aje\/kwh195","article-title":"Relative risk of mortality in the physically inactive is underestimated because of real changes in exposure level during follow-up.","volume":"160","author":"Andersen","year":"2004","journal-title":"Am J Epidemiol"},{"issue":"5","key":"zoi250952r29","doi-asserted-by":"publisher","first-page":"615","DOI":"10.1097\/01.ede.0000135174.63482.43","article-title":"A structural approach to selection bias.","volume":"15","author":"Hern\u00e1n","year":"2004","journal-title":"Epidemiology"},{"issue":"5","key":"zoi250952r30","doi-asserted-by":"publisher","first-page":"1714","DOI":"10.1093\/ije\/dyy138","article-title":"Reflection on modern methods: selection bias-a review of recent developments.","volume":"47","author":"Infante-Rivard","year":"2018","journal-title":"Int J Epidemiol"},{"issue":"3","key":"zoi250952r31","doi-asserted-by":"publisher","first-page":"37","DOI":"10.1007\/s11912-021-01017-x","article-title":"Postdiagnostic dietary and lifestyle factors and prostate cancer recurrence, progression, and mortality.","volume":"23","author":"Langlais","year":"2021","journal-title":"Curr Oncol Rep"},{"issue":"11","key":"zoi250952r32","doi-asserted-by":"publisher","first-page":"3889","DOI":"10.1158\/0008-5472.CAN-10-3932","article-title":"Physical activity after diagnosis and risk of prostate cancer progression: data from the cancer of the prostate strategic urologic research endeavor.","volume":"71","author":"Richman","year":"2011","journal-title":"Cancer Res"},{"issue":"6","key":"zoi250952r33","doi-asserted-by":"publisher","first-page":"726","DOI":"10.1200\/JCO.2010.31.5226","article-title":"Physical activity and survival after prostate cancer diagnosis in the health professionals follow-up study.","volume":"29","author":"Kenfield","year":"2011","journal-title":"J Clin Oncol"},{"issue":"11","key":"zoi250952r34","doi-asserted-by":"publisher","first-page":"2375","DOI":"10.1249\/MSS.0000000000002116","article-title":"Exercise guidelines for cancer survivors: consensus statement from international multidisciplinary roundtable.","volume":"51","author":"Campbell","year":"2019","journal-title":"Med Sci Sports Exercise"},{"issue":"1","key":"zoi250952r35","doi-asserted-by":"publisher","first-page":"493","DOI":"10.1186\/s12885-024-12260-3","article-title":"Creatine supplementation and resistance training to preserve muscle mass and attenuate cancer progression (CREATINE-52): a protocol for a double-blind randomized controlled trial.","volume":"24","author":"Coletta","year":"2024","journal-title":"BMC Cancer"},{"issue":"5","key":"zoi250952r36","doi-asserted-by":"publisher","first-page":"887","DOI":"10.1016\/j.eururo.2013.08.009","article-title":"Mediterranean diet and prostate cancer risk and mortality in the health professionals follow-up study.","volume":"65","author":"Kenfield","year":"2014","journal-title":"Eur Urol"},{"issue":"2","key":"zoi250952r37","doi-asserted-by":"publisher","first-page":"253","DOI":"10.1002\/ijc.31307","article-title":"Postdiagnosis alcohol intake and prostate cancer survival: a population-based cohort study.","volume":"143","author":"Farris","year":"2018","journal-title":"Int J Cancer"},{"issue":"10","key":"zoi250952r38","doi-asserted-by":"publisher","first-page":"2073","DOI":"10.1007\/s00198-019-05048-w","article-title":"Assessing risk factors of nonfatal outcomes amid a competing risk of mortality: the example of hip fracture.","volume":"30","author":"Buzkova","year":"2019","journal-title":"Osteoporos Int"},{"key":"zoi250952r39","doi-asserted-by":"publisher","DOI":"10.1007\/s11764-024-01625-z","article-title":"Associations of role, area deprivation index, and race with health behaviors and body mass index among localized prostate cancer patients and their partners.","author":"Xu","journal-title":"J Cancer Survivorship"},{"issue":"27","key":"zoi250952r40","doi-asserted-by":"publisher","first-page":"3110","DOI":"10.1200\/JCO.22.00123","article-title":"Low-grade prostate cancer: time to stop calling it cancer.","volume":"40","author":"Eggener","year":"2022","journal-title":"J Clin Onc"},{"key":"zoi250952r27","doi-asserted-by":"crossref","DOI":"10.1002\/9780470316696","volume-title":"Multiple Imputation for Nonresponse in Surveys","author":"Rubin","year":"1987"},{"key":"zoi250952r28","volume-title":"Multiple Imputation for Nonresponse in Surveys","author":"Rubin","year":"2004"}],"container-title":["JAMA Network Open"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/jamanetwork.com\/journals\/jamanetworkopen\/articlepdf\/2839379\/elahy_2025_oi_250952_1758301020.08197.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,9,26]],"date-time":"2025-09-26T15:30:32Z","timestamp":1758900632000},"score":1,"resource":{"primary":{"URL":"https:\/\/jamanetwork.com\/journals\/jamanetworkopen\/fullarticle\/2839379"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,9,26]]},"references-count":40,"journal-issue":{"issue":"9","published-print":{"date-parts":[[2025,9,2]]}},"URL":"https:\/\/doi.org\/10.1001\/jamanetworkopen.2025.33922","relation":{},"ISSN":["2574-3805"],"issn-type":[{"value":"2574-3805","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,9,26]]}}}