Health Behaviors and Mortality in Prostate Cancer Survivors in the Multiethnic Cohort Study

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PROJECT ABSTRACT: Large racial/ethnic disparities exist for prostate cancer (PC) incidence and mortality. Between 2001-2017, the 5-year relative survival for Black, Asian American/Pacific Islander, and Latinx groups was lower compared to non-Latinx White men. Progressing to advanced disease is a pivotal concern among patients with non- metastatic PC, their family, caregivers, and physicians. A major gap in current knowledge is the lack of research studies focused on post-diagnostic modifiable factors from racially/ethnically diverse populations. Preliminary data suggest that a Healthful Plant-based Diet Index may be associated with a ~60% lower risk of incident fatal PC among healthy men. In addition, our team recently developed a post-diagnostic Prostate Health Behavior Score (focused on physical activity, weight, and diet) with higher scores associated with a ~55% lower risk of PC-specific mortality among men with PC. Even so, 92% of participants in these two analyses identified as non-Latinx White; thus, the findings may not be generalizable to the racially/ethnically diverse populations of people living with PC. In this R03, we propose to examine whether a Healthful Plant- based Diet Index or composite Prostate Health Behavior Score is associated with survival among men with PC in the population-based Multiethnic Cohort Study (MEC). The MEC is a diverse cohort of over 215,000 adults living predominately in southern California and Hawai’i when enrolled between 1993-1996. For these analyses, we will use data from 2,652 men with PC who have measures of health behaviors before and after diagnosis; 19% identified as African American, 25% identified as non-Latino White, 23% identified as Latino, 28% identified as Asian American, and 5% identified as Native Hawaiian. A comprehensive self-administered questionnaire captured demographics, body size, medical and family histories, medication use, smoking history, and physical activity at enrollment; and a quantitative food frequency questionnaire (FFQ) was also administered. Follow-up surveys have been administered every 4-6 years. Data from the baseline survey will be used to adjust for pre-diagnosis health behaviors and body weight. Using these data, we aim to 1) examine whether the Healthful Plant-based Diet Index, a Prostate Health Behavior Score, and their components, measured after PC diagnosis, are associated with lower risk of all-cause and PC-specific mortality; and 2) explore whether associations between these modifiable risk factors and mortality vary across racial/ethnic groups and the degree to which health behaviors contribute to observed racial/ethnic disparities in PC mortality. This work will be completed in the largest prospective study of racially/ethnically diverse men with PC in the U.S., ensuring the generalizability of our results and directly informing clinical and public health recommendations. In addition, this proposal will strengthen the evidence on the impact of health behaviors on outcomes in cancer survivors and could help reduce racial/ethnic disparities in PC outcomes, and guide interventions to ultimately help people with PC lower their risk of cancer progression and death.