Purpose
To determine whether postdiagnosis dietary patterns, lifestyle scores, and related indices are associated with prostate cancer (PCa) clinical outcomes, with the goal of informing evidence-based strategies for survivorship and secondary prevention.
Participants
Adult men (≥18 years) diagnosed with PCa.
Outcome Measures
Clinical trials and cohort studies reporting on PCa progression, recurrence, PCa-specific mortality (PCSM), and PSA kinetics. All-cause mortality (ACM) was considered only when accompanied by PCa-specific endpoints.
Information Sources
PubMed, Embase, and the Cochrane Library were searched from January 1, 2005, to May 3, 2025. Eligible studies assessed individual-level postdiagnosis diet or lifestyle exposures using diet or composite indices. Titles and abstracts were screened by 2 independent reviewers, with full texts of eligible studies assessed in duplicate.
Results
A total of 21 studies were included. Although not all studies agree, several studies suggest that eating plant foods, adopting healthful diets and lifestyle patterns (as defined herein), and minimizing consumption of inflammatory foods and those with higher insulinemic potential may potentially lower the risk of PCa progression and PCSM. The data also indicate that following Mediterranean, Healthy Eating Index, and Prudent dietary patterns, healthy behaviors, and World Cancer Research Fund/American Institute of Cancer Research recommendations are associated with lower risk of ACM, while the Western dietary pattern and eating foods with higher insulinemic potential are associated with increased risk of ACM.
Conclusions
Current evidence suggests that healthy dietary practices combined with healthy lifestyle behaviors (not smoking, regular physical activity, maintaining a healthy weight) may reduce PCa progression and ACM, with some evidence reported for PCSM. Additional robust cohort and interventional studies with longer follow-up and a greater number of PCSM events are needed. Consideration should be given to incorporating principles of healthy diet and lifestyle as part of PCa survivorship care. A summary table with diet and lifestyle recommendations is provided for healthcare providers.