What is the clinical evidence from this study?

Study design: Cohort. Population: High-risk prostate cancer (n=2713). Intervention: Clinical and lifestyle factors (COPD, hypertension, diabetes, smoking, obesity). Primary outcome: All-cause mortality (HR 1.98, 95% CI 1.13-3.50).

What question did this study set out to answer?

To examine the impact of clinical and lifestyle factors on all-cause mortality among high-risk prostate cancer patients.

April 5, 2026

Abstract 5057: Clinical and lifestyle determinants of all-cause mortality among high-risk prostate cancer patients: Findings from a multicenter longitudinal cohort, 1990-2024

Key Result

Chronic obstructive pulmonary disease strongly predicted increased all-cause mortality among high-risk prostate cancer patients undergoing radical prostatectomy (HR 1.98; 95% CI 1.13-3.50).

Key Points

To examine the impact of clinical and lifestyle factors on all-cause mortality among high-risk prostate cancer patients.
Conducted a longitudinal cohort study involving 2,713 patients from 1990-2024.
Included clinical factors (like comorbidities) and lifestyle factors (such as obesity and smoking).
Used multivariable Cox regression analyses to assess associations with mortality across treatment groups.
45% of patients died during follow-up.
Chronic obstructive pulmonary disease was a strong predictor of increased mortality in all treatment groups.
Hypertension and diabetes showed marginal associations with higher mortality, especially among ever smokers.
Coronary artery disease significantly predicted mortality among patients receiving external beam radiation therapy.
Renal insufficiency was linked to increased mortality in certain treatment groups.

Study Design

Type

Cohort (n=2,713)

Multicenter

Yes

Structured PICO

Do clinical and lifestyle factors influence all-cause mortality in high-risk prostate cancer patients?

Population

n=2,713 male patients with newly diagnosed National Comprehensive Cancer Network-defined high-risk prostate cancer who underwent radical prostatectomy (RP), external beam radiation therapy (EBRT), and androgen deprivation therapy (ADT) from the Center for Prostate Disease Research Multicenter National Database (1990-2024). Median age 68 years, 66% White, 26% African American.

Intervention

Clinical and lifestyle factors (obesity, smoking, comorbidities including COPD, hypertension, diabetes, coronary artery disease, renal insufficiency)

Outcome

All-cause mortalityhard clinical

Comorbidities such as COPD, hypertension, and diabetes are consistently associated with increased all-cause mortality in high-risk prostate cancer patients, highlighting the need for integrated management.

Main Result

Effect estimate: HR 1.98 (95% CI 1.13-3.50)

Abstract

Abstract Patients with high-risk prostate cancer (PCa) have substantially elevated risks of disease progression and mortality, yet outcomes remain highly variable. Emerging evidence suggests that comorbidities, obesity, and smoking contribute to PCa progression and overall survival through metabolic and inflammatory pathways. However, few studies have evaluated how these factors interact to influence mortality in high-risk PCa patients. We examined individual and combined effects of clinical and lifestyle factors on all-cause mortality in a large, longitudinal cohort of high-risk patients treated within military treatment facilities. Male patients with newly diagnosed National Comprehensive Cancer Network-defined high-risk PCa who underwent radical prostatectomy (RP), external beam radiation therapy (EBRT), and androgen deprivation therapy (ADT) were included from the Center for Prostate Disease Research Multicenter National Database (1990-2024; n=2,713). Multivariable Cox regression analyses were conducted to evaluate associations between lifestyle factors (obesity, smoking) and self-reported comorbidity conditions at enrollment and all-cause mortality across treatment groups. Median age at diagnosis was 68 years; 66% self-identified as White and 26% as African American. Overall, 44% underwent EBRT, 34% RP, and 14% ADT. During follow-up, 45% of patients died. Chronic obstructive pulmonary disease (COPD) was a strong predictor of increased all-cause mortality across all treatment groups RP, Hazard Ratio (HR)=1.98 (1.13, 3.50); EBRT, HR=1.52 (1.09, 2.16); ADT, HR=1.65 (0.98, 2.75). The association was more apparent among ever smokers in RP group HR=2.58 vs. never, HR=0.58 and among non-obese patients in RP HR=2.21 vs. obese, HR=1.27 and EBRT HR=1.80 vs. 1.01 groups. Hypertension and diabetes were also marginally associated with higher mortality across treatment groups, with stronger associations among ever smokers in RP hypertension, HR=1.58 vs. 0.77; diabetes HR=1.6 vs. 0.49. Coronary artery disease was a significant predictor of mortality among EBRT patients HR=1.34 (1.03, 1.74) but not in other groups. Renal insufficiency was associated with increased mortality in EBRT HR=1.84 (1.16, 2.93) and ADT HR=1.38 (0.70, 2.73), with a stronger association never smokers EBRT, HR=8.45 vs. ever, HR=1.29. COPD, hypertension, and diabethes were consistently associated with increased all-cause mortality in high-risk PCa patients, with modest effect modification by smoking and obesity status. These findings highlight the importance of integrated management of comorbidities and lifestyle risk factors to improve survivorship in this high-risk patients. Citation Format: Cynthia R. Robbins, Jiji Jiang, Sally Elsamanoudi, Paul Campbell, Sean P. Stroup, Jennifer Cullen, Gregory Chesnut, Jongeun Rhee. Clinical and lifestyle determinants of all-cause mortality among high-risk prostate cancer patients: Findings from a multicenter longitudinal cohort, 1990-2024 abstract. In: Proceedings of the American Association for Cancer Research Annual Meeting 2026; Part 1 (Regular Abstracts); 2026 Apr 17-22; San Diego, CA. Philadelphia (PA): AACR; Cancer Res 2026;86(7 Suppl):Abstract nr 5057.

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