The survival impact of adhering to current physical activity guidelines after prostate cancer diagnosis is unknown. We therefore emulated a target trial of guideline-based physical activity interventions and 10-year survival among US men with nonmetastatic prostate cancer. We used observational data on 2,299 men in the Health Professionals Follow-up Study diagnosed with nonmetastatic prostate cancer from 1998-2010 and free of conditions that might preclude participation at baseline (first post-diagnostic questionnaire). We estimated their survival under several guideline-based physical activity interventions starting at baseline and ending at the development of conditions limiting physical ability. We adjusted for baseline and time-varying risk factors for death using the parametric g-formula. Compared with the observed 15.4% mortality risk, the estimated 10-year risk (95% confidence interval, CI) of mortality was 13.0% (10.9, 15.4) and 11.1% (8.7, 14.1) for ≥1.25 and ≥2.5 hours/week of vigorous activity, and 13.9% (12.0, 16.0) and 12.6% (10.6, 14.7) for ≥2.5 and ≥5 hours/week of moderate activity, respectively. We estimated that these men would have experienced clinically meaningful reductions in mortality had they followed current physical activity recommendations until the development of conditions limiting physical ability. These findings may help guide clinical recommendations for prostate cancer patients and future trial design.
American journal of epidemiology. 2018 Nov 29 [Epub ahead of print]
Barbra A Dickerman, Edward Giovannucci, Claire H Pernar, Lorelei A Mucci, Miguel A Hernán
Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts.