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Self\u2010reported 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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      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\u20132.02;\n                      <jats:italic>p<\/jats:italic>\n                      \u00a0&lt;\u00a010\n                      <jats:sup>\u221216<\/jats:sup>\n                      ) and fatal PCa (HR, 2.73; 95% CI, 2.36\u20133.25;\n                      <jats:italic>p<\/jats:italic>\n                      \u00a0&lt;\u00a010\n                      <jats:sup>\u221216<\/jats:sup>\n                      ). Exercise was associated with a reduced risk of fatal PCa (HR, 0.86; 95% CI, 0.76\u20130.98;\n                      <jats:italic>p<\/jats:italic>\n                      \u00a0=\u00a0.03). 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).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>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.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/cncr.35434","type":"journal-article","created":{"date-parts":[[2024,6,12]],"date-time":"2024-06-12T13:41:19Z","timestamp":1718199679000},"page":"3496-3505","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":8,"title":["Healthy lifestyle and prostate cancer risk in the Million Veteran Program"],"prefix":"10.1002","volume":"130","author":[{"given":"Meghana S.","family":"Pagadala","sequence":"first","affiliation":[{"name":"Research Service Veterans Affairs (VA) San Diego Healthcare System  San Diego California USA"},{"name":"Medical Scientist Training Program University of California San Diego  La Jolla California USA"},{"name":"Biomedical Science Program University of California San Diego  La Jolla California USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Asona","family":"Lui","sequence":"additional","affiliation":[{"name":"Department of Radiation Medicine and Applied Sciences University of California San Diego  La Jolla California USA"},{"name":"Cancer Center The Salk Institute for Biological Studies  La Jolla California USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0108-2127","authenticated-orcid":false,"given":"Julie","family":"Lynch","sequence":"additional","affiliation":[{"name":"VA Informatics and Computing Infrastructure VA Salt Lake City Healthcare System  Salt Lake City Utah USA"},{"name":"Division of Epidemiology Department of Internal Medicine University of Utah School of Medicine  Salt Lake City Utah USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Roshan","family":"Karunamuni","sequence":"additional","affiliation":[{"name":"Department of Radiation Medicine and Applied Sciences University of California San Diego  La Jolla California USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8995-0448","authenticated-orcid":false,"given":"Kyung Min","family":"Lee","sequence":"additional","affiliation":[{"name":"VA Informatics and Computing Infrastructure VA Salt Lake City Healthcare System  Salt Lake City Utah USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anna","family":"Plym","sequence":"additional","affiliation":[{"name":"Department of Urology Brigham and Women\u2019s Hospital  Boston Massachusetts USA"},{"name":"Epidemiology T.H. Chan School of Public Health Harvard University  Boston Massachusetts USA"},{"name":"Department of Medical Epidemiology and Biostatistics Karolinska Institutet  Stockholm Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Brent S.","family":"Rose","sequence":"additional","affiliation":[{"name":"Research Service Veterans Affairs (VA) San Diego Healthcare System  San Diego California USA"},{"name":"Department of Radiation Medicine and Applied Sciences University of California San Diego  La Jolla California USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hannah","family":"Carter","sequence":"additional","affiliation":[{"name":"Department of Medicine University of California San Diego  La Jolla California USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Adam S.","family":"Kibel","sequence":"additional","affiliation":[{"name":"Department of Urology Brigham and Women\u2019s Hospital  Boston Massachusetts USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Scott L.","family":"DuVall","sequence":"additional","affiliation":[{"name":"VA Informatics and Computing Infrastructure VA Salt Lake City Healthcare System  Salt Lake City Utah USA"},{"name":"Division of Epidemiology Department of Internal Medicine University of Utah School of Medicine  Salt Lake City Utah USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jason","family":"Vassy","sequence":"additional","affiliation":[{"name":"VA Boston Healthcare System  Boston Massachusetts USA"},{"name":"Department of Medicine Harvard Medical School  Boston Massachusetts USA"},{"name":"Department of Medicine Brigham and Women\u2019s Hospital  Boston Massachusetts USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"J. 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