@ezupcic Great question, and I think the systematic review is really valuable — but I'd read it slightly differently.

You're right that exercise has the strongest evidence. The ERASE trial showed HIIT decreased PSA, PSA velocity, and inhibited cancer cell growth in men on active surveillance. If you only do one thing, make it exercise.

Diet is a step behind but moving in the right direction. The CAPFISH-3 trial (high omega-3, low omega-6 with fish oil) just showed a significant reduction in Ki-67 — a cancer proliferation marker — in AS patients. Published in the Journal of Clinical Oncology. That's not conclusive proof it prevents progression, but it's more than a hunch.

Supplements are the most mixed bag, and the review is right to be cautious about the category overall. But there are some results worth knowing about. Professor Robert Thomas's research group in the UK has now run two double-blind, placebo-controlled RCTs. The original Pomi-T trial (2014, 199 men) showed a polyphenol blend of pomegranate, green tea, broccoli, and turmeric reduced PSA rise by 63.8% compared to placebo. His latest trial, published in European Urology Oncology in 2025, went further — an upgraded phytochemical supplement (YourPhyto) combined with a probiotic (YourGutPlus) slowed PSA progression by 44%, and MRI disease stabilised or shrunk in 91% of patients. It also improved urinary symptoms, erectile function, and grip strength. That's published in one of the top journals in the field and was presented at ASCO GU.

The Belgian PRAEMUNE trial also showed fermented soy with equol modulated PSA in 61% of AS patients and led to fewer biopsies.

So I think the key takeaway isn't that diet and supplements don't work — it's that we don't yet have the very large, long-term trials to say definitively that they prevent progression. That's a different statement. And given that most of these interventions are low-cost, low-risk, and likely to improve overall health regardless, the question for most of us on AS isn't really "is the evidence conclusive?" — it's "is there enough evidence to justify doing this while we wait for bigger trials?" For exercise, clearly yes. For an omega-3 rich diet, I'd say yes. For specific tested supplements like YourPhyto, the evidence is now quite compelling.

I've been pulling together all of this research at evidence.zone — every intervention rated by the quality of the published evidence, with full study citations and limitations. It's free to use. Might be useful if you want to dig into any of these individual findings.

Paul