Associations of Outdoor Air Pollution With Cause-specific Mortality in Metastatic Prostate Cancer: A cohort study
Year: 2026
Type: preprint
Study design: Observational Study
Abstract: Background: Cardiovascular disease is an important competing cause of death in men with metastatic prostate cancer, and ambient air pollution may increase cardiovascular vulnerability. We evaluated associations of fine particulate matter (PM2.5) and nitrogen dioxide (NO2) with all-cause, cardiovascular, and prostate cancer-specific mortality, including joint associations with androgen deprivation therapy (ADT). Methods: We analyzed 33,384 men from 11 US state registries diagnosed with metastatic prostate cancer during 2000-2015 and followed through 2018. Residential PM2.5 and NO2 concentrations at diagnosis were assigned using 1-km exposure models. Multivariable Cox models estimated all-cause mortality, and inverse-probability-weighted Cox models assessed cause-specific mortality. Results: Each interquartile-range increase in PM2.5 was associated with higher cardiovascular mortality (HR 1.04, 95% CI 1.02-1.07; p-trend=0.008). Cardiovascular mortality was also higher in the fourth and fifth PM2.5 quintiles versus the first (HR 1.18 and 1.21, respectively). Higher NO2 was associated with prostate cancer-specific mortality in the highest quintile (HR 1.07, 95% CI 1.01-1.13). In joint analyses, ADT-treated men with high versus low PM2.5 exposure had higher cardiovascular mortality (HR 1.19, 95% CI 1.05-1.34), without clear evidence of effect modification (p-interaction=0.051). Conclusions: In men with metastatic prostate cancer, higher PM2.5 exposure was associated with cardiovascular mortality, particularly among ADT-treated patients, supporting further study of environmental exposures and systemic therapy in cardiooncology. What this study adds: Men with metastatic prostate cancer receiving androgen deprivation therapy may be particularly vulnerable to cardiovascular complications. In this large population-based cohort, higher residential PM2.5 exposure was associated with increased cardiovascular mortality, including among men receiving ADT. Although we found no clear evidence that ADT modified the effect of PM2.5, the joint exposure pattern suggests that environmental air pollution may contribute to cardiovascular vulnerability in patients already exposed to cardiometabolic effects of systemic therapy. These findings extend environmental epidemiology to a clinically high-risk cancer population.
Source: medRxiv
Institutions: Vita-Salute San Raffaele University, IRCCS Ospedale San Raffaele, University of Pittsburgh Medical Center, IRCCS San Raffaele Roma, University of Toronto, Brigham and Women's Hospital, Harvard University, IRCCS Humanitas Research Hospital, UPMC Hillman Cancer Center, Rutgers Cancer Institute
Language: English
Subfield: Health, Toxicology and Mutagenesis
Field: Environmental Science
Domain: Physical Sciences
Open Access status: green
Funders: U.S. Department of Defense, Pfizer, Pennsylvania Department of Health, California Department of Public Health, University of Southern California, Wayne State University, Rutgers Cancer Institute of New Jersey, Huntsman Cancer Foundation, Barbara Ann Karmanos Cancer Institute, Centers for Disease Control and Prevention, University of California, San Francisco, National Cancer Institute, National Institute of Environmental Health Sciences
Awards: CANCER PREVENTION AND CONTROL PROGRAMS FOR STATE, TERRITORIAL AND TRIBAL ORGANIZATIONS, G1278770830, G1352184354, G1395202410, G203338226, G2133803159, G222668952, G2337224928, G2612351997, G2781186375, G2995161194, G3384295147, G3448447748, G3509688676, G3559905640, G3632360174, G4223207080, G4332884407, G4428815567, G4595388861, G4732173760, G4827249719, G4830823076, G4854421162, G503567923, G504639888, G5160342360, G5234832500, G5631299761, G5792419742, G5810215049, G5821893214, G5877590089, G6167219248, CANCER PREVENTION AND CONTROL PROGRAM 3: NATIONAL PROGRAM OF CANCER REGISTRIES - THE MISSION OF THE UTAH CANCER REGISTRY (UCR), AS AUTHORIZED BY THE UTAH CANCER REPORTING RULE, IS TO PROMOTE PUBLIC HEALTH BY COLLECTING AND MANAGING CANCER INCIDENCE AND MORTALITY DATA FOR THE STATE OF UTAH. UCR HAS OPERATED AS A STATEWIDE, POPULATION-BASED REGISTRY IN UTAH SINCE 1966. UCR JOINED THE NATIONAL PROGRAM OF CANCER REGISTRIES (NPCR) IN 2017. UCR DATA SUBMITTED TO CDC HAVE MET THE NATIONAL DATA QUALITY STANDARD FOR EACH YEAR OF OUR NPCR PARTICIPATION, AND THE REGISTRY HAS RECEIVED MULTIPLE ANNUAL AWARDS RECOGNIZING HIGHEST DATA QUALITY AS ASSESSED BY THE SURVEILLANCE, EPIDEMIOLOGY, AND END RESULTS PROGRAM (SEER) OF THE NATIONAL CANCER INSTITUTE AND BY THE NORTH AMERICAN ASSOCIATION OF CENTRAL CANCER REGISTRIES (NAACCR). IN THIS APPLICATION, THE UNIVERSITY OF UTAH REQUESTS SUPPORT FOR UCR UNDER CDC-RFA-DP22-2202 PROGRAM 3, NPCR. WE REQUEST THIS SUPPORT TO ENHANCE OUR SURVEILLANCE QUALITY, PERFORM PROGRAM MONITORING AND EVALUATION, AND COLLABORATE WITH PARTNERS IN CANCER CONTROL AND PREVENTION THROUGH DISSEMINATION OF DATA TO IMPROVE HEALTH EQUITY AND CANCER OUTCOMES. IN THIS APPLICATION, WE PRESENT A COMPREHENSIVE WORK PLAN THAT ENCOMPASSES ACTIVITIES TO ADDRESS THE FOUR APPLICABLE STRATEGIES OF THE NOTICE OF FUNDING OPPORTUNITY. A COMPREHENSIVE AND COORDINATED APPROACH IS VITAL TO DEVELOPING AND IMPLEMENTING STRATEGIES AND ACTIVITIES TO CONTROL AND PREVENT CANCER. UCR COLLABORATES CLOSELY WITH UTAH DEPARTMENT OF HEALTH (UDOH) CANCER PROGRAMS TO SUPPORT AND ADVANCE CANCER CONTROL AND PREVENTION IN UTAH THROUGH DISSEMINATION OF DATA AND PARTICIPATION IN JOINT PROJECTS AND INITIATIVES. IN THIS APPLICATION, WE PROPOSE ACTIVITIES THAT SUPPORT OUR COLLABORATORS’ PROGRAM PLANNING AND IMPLEMENTATION BY MAINTAINING OUR STRONG SURVEILLANCE INFRASTRUCTURE AND DISSEMINATING HIGH QUALITY DATA. WE ALSO PROPOSE TO COLLABORATE WITH OUR PARTNERS AT UDOH TO IMPLEMENT A POPULATION-BASED SURVEY OF CANCER SURVIVORS FOR SURVEILLANCE OF HEALTH IN THIS POPULATION AND IMPROVE HEALTH EQUITY. THROUGH THE PROPOSED ACTIVITIES, UCR WILL IMPROVE THE TIMELINESS, QUALITY, COMPLETENESS, AND CONFIDENTIALITY OF NPCR SURVEILLANCE DATA THROUGH RIGOROUS PROGRAM MONITORING AND INCREASED ADOPTION OF DATA MODERNIZATION STRATEGIES. WE WILL ALSO INCREASE COLLABORATION WITH OUR PUBLIC HEALTH PARTNERS AND THE DISSEMINATION OF USE OF SURVEILLANCE DATA., G6951404960, G6986264563, G7290139498, G7382510057, G7705257630, G8083727551, G8509442309, G9000055636, Exposure to Per- and Polyfluoroalkyl Substances and Prostate Cancer: Opportunities for Prevention and Early Detection, CANCER CENTER SUPPORT GRANT, G946791773, G985308953
OpenAlex ID: W7214993175