Fitness and prostate cancer screening, incidence, and mortality: Results from the Henry Ford Exercise Testing (FIT) Project

Abstract

Background The relation between cardiorespiratory fitness (CRF) and prostate cancer is not well established. The objective of this study was to determine whether CRF is associated with prostate cancer screening, incidence, or mortality. Methods The Henry Ford Exercise Testing Project is a retrospective cohort study of men aged 40 to 70 years without cancer who underwent physician‐referred exercise stress testing from 1995 to 2009. CRF was quantified in metabolic equivalents of task (METs) (<6 [reference], 6‐9, 10‐11, and ≥12 METs), estimated from the peak workload achieved during a symptom‐limited, maximal exercise stress test. Prostate‐specific antigen (PSA) testing, incident prostate cancer, and all‐cause mortality were analyzed with multivariable adjusted Poisson regression and Cox proportional hazard models. Results In total, 22,827 men were included, of whom 739 developed prostate cancer, with a median follow‐up of 7.5 years. Men who had high fitness (≥12 METs) had an 28% higher risk of PSA screening (95% CI, 1.2‐1.3) compared with those who had low fitness (<6 METs. After adjusting for PSA screening, fitness was associated with higher prostate cancer incidence (men aged <55 years, P = .02; men aged >55 years, P ≤ .01), but not with advanced prostate cancer. Among the men who were diagnosed with prostate cancer, high fitness was associated with a 60% lower risk of all‐cause mortality (95% CI, 0.2‐0.9). Conclusions Although men with high fitness are more likely to undergo PSA screening, this does not fully account for the increased incidence of prostate cancer seen among these individuals. However, men with high fitness have a lower risk of death after a prostate cancer diagnosis, suggesting that the cancers identified may be low‐risk with little impact on long‐term outcomes.

Healthy Lifestyle Benefits Both Cancer and Cardiovascular Disease

“…Another perhaps surprising finding was that a healthy lifestyle was associated with an increased risk for prostate cancer (HR: 1.04 per 1-point increment in HLI; 95% CI: 1.01-1.06) and melanoma (HR: 1.09; 95% CI: 1.04-1.15), the former perhaps due to screening practices, as has been suggested previously ( 10 ), and the latter perhaps due to ultraviolet exposure from outdoor physical activity. Although this certainly does not negate the overwhelming benefits of a healthy lifestyle overall, this finding does point out that there is significant heterogeneity between lifestyle factors and certain cancers.…”

Association Between Cardiorespiratory Fitness and Cancer Incidence and Cancer-Specific Mortality of Colon, Lung, and Prostate Cancer Among Swedish Men

“…24 The influence of potentially higher prostate cancer screening rates in those with higher CRF has been put forward as an explanation for the counterintuitive association between CRF and prostate cancer incidence found in this study and others. 8 Reiter-Brennan et al 11 reported that men with high CRF had a 28% higher risk of completing prostate cancer screening in comparison with men with low CRF. It is important to also consider that prostate cancer is the most heritable cancer, with a reported 58% of the variability in risk attributable to inherited risk factors, 25 meaning that lifestyle factors may be less likely to influence prostate cancer incidence rates than other cancers prone to lifestyle-related cancer-causing agents.…”

“…Of these studies, analysis of the association between CRF and both cancer incidence and mortality in the same study, reported by cancer type, and conducted in large population samples are lacking in existing studies. [8][9][10][11] Moreover, previous studies have typically only examined main effects, thereby ignoring important interaction analyses of, for example, when in adulthood associations between CRF and cancer outcomes are particularly strong or weak. As increasing age is one of the strongest risk factors for several cancer forms 12 and CRF levels tend to decrease with older age, 13 the associations between CRF and cancer incidence and mortality risk may vary depending on when in life CRF is assessed.…”

“…Regular PA has been associated with a lower risk of several cancer types, yet few studies have investigated the influence of CRF on cancer incidence or mortality. Of these studies, analysis of the association between CRF and both cancer incidence and mortality in the same study, reported by cancer type, and conducted in large population samples are lacking in existing studies . Moreover, previous studies have typically only examined main effects, thereby ignoring important interaction analyses of, for example, when in adulthood associations between CRF and cancer outcomes are particularly strong or weak.…”

Prostate Cancer Incidence and Mortality: Global Status and Temporal Trends in 89 Countries From 2000 to 2019

“…Advancing age, black race, and family history are well-established risk factors for prostate cancer ( 3 ). Meanwhile, more lifestyle and dietary risk factors that might increase the risk of prostate cancer have been consecutively put forward, like obesity ( 4 ), fitness ( 5 ), diabetes mellitus ( 6 ), dietary patterns ( 7 ), and supplementation with vitamin E ( 8 ). Moreover, human development index (HDI), a summary measure of average achievement in key dimensions of human development for each country including life expectancy at birth, education index, and gross national income per capita ( 9 ), has demonstrated an impact on the incidence and mortality of prostate cancer ( 1 – 3 ).…”