Prostate cancer survivorship: Physical activity, social integration, and neighborhood greenness

Abstract

The population of prostate cancer survivors is substantial and growing. It is estimated that 3.6 million are living in the United States as of 2022 and this population is projected to exceed 5 million by 2030. While non-metastatic prostate cancer survivors may have increasingly prolonged survival, living long is not necessarily living well. Prostate cancer and its treatment can have a substantial impact on health-related quality of life. However, data on the role of modifiable individual behaviors, interpersonal relationships, and the built environment on long-term quality of life among individuals with non-metastatic prostate cancer are limited. In Chapter 1, we emulated a target trial of the effect of physical activity strategies on 6-year quality of life among individuals with non-metastatic prostate cancer. Our findings showed that adhering to current physical activity recommendations may help to improve 6-year symptoms in the sexual domain, with little expected influence on symptoms in the bowel, urinary, and vitality/hormonal domains. Our study informed clinically realistic physical activity recommendations that may benefit prostate cancer survivor’s long-term quality of life. In Chapter 2, we examined the association between social integration (measured by marital status and the Berkman-Syme Social Network Index) and quality of life among individuals with non-metastatic prostate cancer. Being socially integrated was associated with fewer depressive signs and better psychosocial wellbeing. Married prostate cancer survivors had fewer urinary symptoms. Our study highlighted aspects of long-term physical and psychosocial quality of life that are more favorable among prostate cancer survivors with a supportive social environment. In Chapter 3, we examined the association between neighborhood greenness and quality of life among individuals with non-metastatic prostate cancer. Cumulative average 1230m greenness since diagnosis was associated with fewer vitality/hormonal symptoms. Other domains of physical quality of life and psychosocial quality of life did not differ by greenness overall. Our study generated hypothesis for future interventions to leverage greenness as an environmental, contextual modifiable factor that could promote long-term physical and psychosocial quality of life of prostate cancer survivors on a broad scale. In conclusion, to achieve meaningful health promotion and better address the needs of this ever-growing population of individuals with prostate cancer, it is important to holistically examine the quality of the cancer survivorship experience.