title: Development and Application of a Lifestyle Score for Prevention of Lethal Prostate Cancer.
abstract: BACKGROUND
  Several lifestyle factors have been associated with risk of lethal prostate cancer, but little is known about their combined effect. Our objective was to develop and apply a lifestyle score for prevention of lethal prostate cancer.
  
  
  METHODS
  We developed a lifestyle score among 42 701 men in the Health Professionals Follow-up Study (HPFS) followed from 1986 to 2010 and applied it among 20 324 men in the Physicians' Health Study (PHS) followed from 1982 to 2010. One point was given for each of: not currently smoking or quit 10 or more years ago, body mass index under 30 kg/m(2), high vigorous physical activity, high intake of tomatoes and fatty fish, and low intake of processed meat. Diet-only scores (range = 0-3) and total scores (range = 0-6) were calculated. We used multivariable Cox proportional hazards regression to estimate the risk of lethal prostate cancer, adjusting for potential risk factors of lethal prostate cancer. All statistical tests were two-sided.
  
  
  RESULTS
  We observed 576 lethal prostate cancer events in HPFS and 337 in PHS. Men with 5-6 vs 0-1 points had a 68% decreased risk of lethal prostate cancer (hazard ratio [HR] = 0.32, 95% confidence interval [CI] = 0.19 to 0.52) in HPFS and a non-statistically significant 38% decreased risk (HR = 0.62, 95% CI = 0.30 to 1.26) in PHS. For dietary factors only, men with 3 vs 0 points had a 46% decreased risk (HR = 0.54, 95% CI = 0.30 to 0.96) in the HPFS and a non-statistically significant 30% decreased risk (HR = 0.70, 95% CI = 0.40 to 1.23) in PHS.
  
  
  CONCLUSIONS
  Adhering to a healthy lifestyle, defined by not smoking, normal body weight, high physical activity, and a healthy diet, may lower risk of lethal prostate cancer.
authors.affiliation: Department of Urology, University of California, San Francisco, San Francisco, CA (SAK, ELVB, JMC); Departments of Epidemiology (SAK, JLB, MKD, ELG, MJS), Nutrition (ELG, MJS), and Social and Behavioral Sciences (JLJ), Harvard School of Public Health, Boston, MA; Channing Division of Network Medicine (JLB, JLJ, MKD, MJS) and Division of Preventive Medicine (HDS), Brigham and Women's Hospital, Boston, MA; Department of Epidemiology and Biostatistics, University of California, San Francisco, CA (ELVB, JMC).
authors.forename: Stacey A
authors.initials: SA
authors.lastname: Kenfield
authors.affiliation: Department of Urology, University of California, San Francisco, San Francisco, CA (SAK, ELVB, JMC); Departments of Epidemiology (SAK, JLB, MKD, ELG, MJS), Nutrition (ELG, MJS), and Social and Behavioral Sciences (JLJ), Harvard School of Public Health, Boston, MA; Channing Division of Network Medicine (JLB, JLJ, MKD, MJS) and Division of Preventive Medicine (HDS), Brigham and Women's Hospital, Boston, MA; Department of Epidemiology and Biostatistics, University of California, San Francisco, CA (ELVB, JMC).
authors.forename: Julie L
authors.initials: JL
authors.lastname: Batista
authors.affiliation: Department of Urology, University of California, San Francisco, San Francisco, CA (SAK, ELVB, JMC); Departments of Epidemiology (SAK, JLB, MKD, ELG, MJS), Nutrition (ELG, MJS), and Social and Behavioral Sciences (JLJ), Harvard School of Public Health, Boston, MA; Channing Division of Network Medicine (JLB, JLJ, MKD, MJS) and Division of Preventive Medicine (HDS), Brigham and Women's Hospital, Boston, MA; Department of Epidemiology and Biostatistics, University of California, San Francisco, CA (ELVB, JMC).
authors.forename: Jaquelyn L
authors.initials: JL
authors.lastname: Jahn
authors.affiliation: Department of Urology, University of California, San Francisco, San Francisco, CA (SAK, ELVB, JMC); Departments of Epidemiology (SAK, JLB, MKD, ELG, MJS), Nutrition (ELG, MJS), and Social and Behavioral Sciences (JLJ), Harvard School of Public Health, Boston, MA; Channing Division of Network Medicine (JLB, JLJ, MKD, MJS) and Division of Preventive Medicine (HDS), Brigham and Women's Hospital, Boston, MA; Department of Epidemiology and Biostatistics, University of California, San Francisco, CA (ELVB, JMC).
authors.forename: Mary Kathryn
authors.initials: MK
authors.lastname: Downer
authors.affiliation: Department of Urology, University of California, San Francisco, San Francisco, CA (SAK, ELVB, JMC); Departments of Epidemiology (SAK, JLB, MKD, ELG, MJS), Nutrition (ELG, MJS), and Social and Behavioral Sciences (JLJ), Harvard School of Public Health, Boston, MA; Channing Division of Network Medicine (JLB, JLJ, MKD, MJS) and Division of Preventive Medicine (HDS), Brigham and Women's Hospital, Boston, MA; Department of Epidemiology and Biostatistics, University of California, San Francisco, CA (ELVB, JMC).
authors.forename: Erin L
authors.initials: EL
authors.lastname: Van Blarigan
authors.affiliation: Department of Urology, University of California, San Francisco, San Francisco, CA (SAK, ELVB, JMC); Departments of Epidemiology (SAK, JLB, MKD, ELG, MJS), Nutrition (ELG, MJS), and Social and Behavioral Sciences (JLJ), Harvard School of Public Health, Boston, MA; Channing Division of Network Medicine (JLB, JLJ, MKD, MJS) and Division of Preventive Medicine (HDS), Brigham and Women's Hospital, Boston, MA; Department of Epidemiology and Biostatistics, University of California, San Francisco, CA (ELVB, JMC).
authors.forename: Howard D
authors.initials: HD
authors.lastname: Sesso
authors.affiliation: Department of Urology, University of California, San Francisco, San Francisco, CA (SAK, ELVB, JMC); Departments of Epidemiology (SAK, JLB, MKD, ELG, MJS), Nutrition (ELG, MJS), and Social and Behavioral Sciences (JLJ), Harvard School of Public Health, Boston, MA; Channing Division of Network Medicine (JLB, JLJ, MKD, MJS) and Division of Preventive Medicine (HDS), Brigham and Women's Hospital, Boston, MA; Department of Epidemiology and Biostatistics, University of California, San Francisco, CA (ELVB, JMC).
authors.forename: Edward L
authors.initials: EL
authors.lastname: Giovannucci
authors.affiliation: Department of Urology, University of California, San Francisco, San Francisco, CA (SAK, ELVB, JMC); Departments of Epidemiology (SAK, JLB, MKD, ELG, MJS), Nutrition (ELG, MJS), and Social and Behavioral Sciences (JLJ), Harvard School of Public Health, Boston, MA; Channing Division of Network Medicine (JLB, JLJ, MKD, MJS) and Division of Preventive Medicine (HDS), Brigham and Women's Hospital, Boston, MA; Department of Epidemiology and Biostatistics, University of California, San Francisco, CA (ELVB, JMC).
authors.forename: Meir J
authors.initials: MJ
authors.lastname: Stampfer
authors.affiliation: Department of Urology, University of California, San Francisco, San Francisco, CA (SAK, ELVB, JMC); Departments of Epidemiology (SAK, JLB, MKD, ELG, MJS), Nutrition (ELG, MJS), and Social and Behavioral Sciences (JLJ), Harvard School of Public Health, Boston, MA; Channing Division of Network Medicine (JLB, JLJ, MKD, MJS) and Division of Preventive Medicine (HDS), Brigham and Women's Hospital, Boston, MA; Department of Epidemiology and Biostatistics, University of California, San Francisco, CA (ELVB, JMC).
authors.forename: June M
authors.initials: JM
authors.lastname: Chan
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000818:Animals; D015992:Body Mass Index; D005247:Feeding Behavior; D005399:Fishes; D006801:Humans; D015994:Incidence; D008019:Life Style; D018551:Solanum lycopersicum; D008297:Male; D008461:Meat Products; D008875:Middle Aged; D009043:Motor Activity; D016017:Odds Ratio; D016016:Proportional Hazards Models; D011471:Prostatic Neoplasms / Q000453:epidemiology* / Q000401:mortality / Q000517:prevention & control*; D018570:Risk Assessment; D012307:Risk Factors; D040242:Risk Reduction Behavior; D057566:Self Report; D012907:Smoking / Q000453:epidemiology; D014481:United States / Q000453:epidemiology