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Active Surveillance- Systematic Review of Interventions
Prostate Cancer | Last Active: May 26 7:21am | Replies (36)Comment receiving replies
@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
Replies to "@ezupcic Great question, and I think the systematic review is really valuable — but I'd read..."
Your analysis of the evidence discussed in this review is spot on!
However, I think the review's conclusion comes across as overly negative and somewhat unwarranted:
"...With moderate certainty, exercise programs improve cardiorespiratory fitness and some patient-reported outcomes (quality of life, fatigue, cancer-related worry), supporting lifestyle change as structured supportive care during surveillance. With low to very low certainty, evidence does not show a consistent, reproducible reduction in key oncologic outcomes such as biopsy upgrading, MRI progression or durable deferral of definitive treatment....For men undergoing active surveillance, lifestyle interventions may be beneficial as supportive measures to improve physical well-being, selected patient-reported outcomes, and cardiometabolic health. However, current evidence remains insufficient to demonstrate a consistent effect on biopsy upgrading, MRI progression, or durable deferral of definitive treatment."
IMHO if I was just diagnosed with low or favorable risk PCa, this review's conclusion is probably going to dampen my resolve to implement any of the cited evidence based interventions. Why am I not surprised?
I think it's important to put these evidence based interventions alongside the alternative...active treatment.
For example, if one goes with the "gold standard" RALP treatment there's an 8 year biochemical reoccurrence (BCR) risk of 21% for Low Risk, 25% for Favorable Intermediate Risk, 41% for Unfavorable Intermediate Risk and 60% for High Risk PCa, in the post-2010 era.
https://www.sciencedirect.com/science/article/abs/pii/S1078143924003442
That doesn't sound anything like "certainty". It sounds more like RALP is quite likely to put my PCa into a "durable deferral of (additional) definitive treatment(s)"....not to mention the absolute certainty of short term, high likelihood of intermediate term and possibility of long term side effects.
In my case, I considered my FIR diagnosis a "draft card" into evidence based intervention "boot camp" and, in my opinion, it needs to be considered as such.
I fully understand why many looking at the ERASE protocol have a million reasons why they can't or won't participate...maybe even receiving medical advise not to even try...but at the end of the day these folks shouldn't kid themselves that going the active treatment route is going to definitively resolve anything...the evidence indicates they are simply trading off to a different set of likely issues.
I am not against active treatment; but the evidence is clear that this also provides "low to very low certainty" (using the conclusion criteria of this review’s authors) that it will be the last time one has to deal with the aftermath of their PCa.
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@paulsweeney, I appreciate the response and the evidence zone site. It is really helpful and I'm trying many of the things that are recommended there. There is a great deal of uncertainty with prostate cancer but I would agree that changes to exercise, diet and supplements are worth trying even if large evidence based studies to support their efficacy do not yet exist.