Healthy dietary patterns and survival among men with prostate cancer

Prostate cancer is the second leading cause of cancer death in US men, yet most patients die from other causes. We examined whether adherence to healthy dietary patterns after diagnosis is associated with overall and cause-specific survival.

We analyzed 6085 men with prostate cancer (1986-2016) in the Health Professionals Follow-up Study. Five dietary patterns-Alternative Healthy Eating Index (AHEI), Mediterranean diet (AMED), Dietary Approaches to Stop Hypertension, anti-insulinemic, and anti-inflammatory diets-were derived from validated food frequency questionnaires every 4 years. Postdiagnosis scores were cumulatively averaged, and changes from pre- to postdiagnosis were calculated. Multivariable Cox models estimated hazard ratios (HRs) and 95% confidence intervals (CIs) for mortality through 2024.

Over 71 760 person-years, 3710 deaths occurred (592 prostate cancer, 971 cardiovascular disease, 2147 other). Greater postdiagnosis adherence to AHEI (quintile 5 vs quintile 1, HR = 0.75, 95% CI = 0.66 to 0.86) and AMED (HR = 0.80, 95% CI = 0.70 to 0.92) was associated with lower all-cause mortality. Increased adherence after diagnosis also predicted better survival, particularly for AHEI. Survival benefits were stronger among men with less aggressive disease. Increased AHEI adherence was associated with lower cardiovascular disease mortality (HR = 0.82, 95% CI = 0.66 to 1.03), but no associations were observed for prostate cancer-specific survival. Limitations include the observational design and potential residual confounding.

Adherence to healthy dietary patterns, especially AHEI and AMED, after prostate cancer diagnosis was associated with improved survival, particularly in less aggressive disease. These findings support dietary improvement as a part of survivorship care.