Can vegan diet and HIIT workouts move the needle?

@sulatnasteve You need to ask your doctors for more information on your biopsy. 40% of core means that if it was a 10mm then 4mm was cancerous. A 3+4 means over 50% was 3 but they usually give the percent of 4. A percentage of 45% type 4 is much worse than 5% type 4. Also want to know if there was large Cribriform or other condition noted in the biopsy. Both play into the AS vs. focal now (Nanoknife, Tulsa Pro, laser are most common; there is also an Aquablation trial active) if a good candidate. All of these can be followed by either surgery or radiation if there is a recurrence a few years down the line. You can get a second opinion on your biopsy if required.

Don't make the same mistake I made. When first diagnosed with Pca I went into stress mode trying to figure what the right things to do were. Like many here, I read everything I could find on the topic and of course found that a mostly vegetarian diet and exercise has some documented validity for slowing progression. I quickly transitioned to the vegetarian mindset eating beans, nuts, fruits, whole grains, and vegetables of all sorts, lots of tomatoes. Long story short, it was terrible! Felt constantly hungry. The weight flew off me. Within just a few months I had lost 30 lbs. From 180 down to 150. Too much for me. I'm 6'-1" and not only did everyone say I looked terrible, I felt like crap. I just could not continue this regimen. Anyhow, I started adding back in lean animal protien from fish, turkey, and chicken. I've managed to gain 20 lbs. back now at 170 lbs. feel much better. I believe the reduction in stress as I've become more comfortable with my journey has also helped. Oh yeah, I gave up a case of beer a week habit too. I now drink some zero alcohol beers occasionally. Not the same, but fills the void. As far as high intensity workouts, that's great if you can keep it up. At my age I choose a brisk 3 mile walk daily and some calisthenics. I'm convinced these measures are beneficial not only for Pca but for other maladies as we age.

@jim18 I live in Fairbanks so the biopsy and pathology were done here. We don't always have the latest and greatest here and I am wondering if I shouldn't travel to a place taht specializes in prostate cancer and see what they determine. I totally understand your question and will see if my doctor can give me an answer, Sure appreciate you taking the time to respond!

Don't make the same mistake I made. When first diagnosed with Pca I went into stress mode trying to figure what the right things to do were. Like many here, I read everything I could find on the topic and of course found that a mostly vegetarian diet and exercise has some documented validity for slowing progression. I quickly transitioned to the vegetarian mindset eating beans, nuts, fruits, whole grains, and vegetables of all sorts, lots of tomatoes. Long story short, it was terrible! Felt constantly hungry. The weight flew off me. Within just a few months I had lost 30 lbs. From 180 down to 150. Too much for me. I'm 6'-1" and not only did everyone say I looked terrible, I felt like crap. I just could not continue this regimen. Anyhow, I started adding back in lean animal protien from fish, turkey, and chicken. I've managed to gain 20 lbs. back now at 170 lbs. feel much better. I believe the reduction in stress as I've become more comfortable with my journey has also helped. Oh yeah, I gave up a case of beer a week habit too. I now drink some zero alcohol beers occasionally. Not the same, but fills the void. As far as high intensity workouts, that's great if you can keep it up. At my age I choose a brisk 3 mile walk daily and some calisthenics. I'm convinced these measures are beneficial not only for Pca but for other maladies as we age.

@sulatnasteve You do not have to travel to get a second pathology opinion. jeffmarc (posted video) can give you details. Cost is $500. Primarily want to confirm the percentage of type 4 in your biopsy (I take it this was targeted at the PIRAD4 lesion). The assignment of a score is part art, part science so 2 pathologists do not always agree. Want someone with lots of experience in prostate cancer. Also to make sure there are no aggressive features in the cells. All of this is to make sure that there is a low probability of progression on AS for the next few years.

If you decide on surgery than you should travel since the skill of the surgeon becomes your destiny to minimize ED and incontinence. Should go to center of excellence. Fred Hutch in Seattle (UW) is probably the closest but also in SF & LA areas on west coast. Same may go for focal treatments although there the risk is more poor execution leading to a recurrence requiring radiation or surgery. Even with radiation they are now doing SBRT (5 treatments over 10-12 days) so not as long as traditional IMRT of 4-7 weeks.

As far as direct cancer control goes, it's highly speculative.

However, a healthy diet and regular exercise will definitely help counteract the metabolic side-effects of cancer treatment. When the metabolic side effects are more mild, your immune system is stronger and you can continue aggressive treatment for longer, so they can definitely help indirectly.

Note that it doesn't have to be vegan per se, just a healthy, well-balanced diet low in processed foods; likewise, staying active at all is more important than whether it's high intensity.

tl;dr: Eat well, move often 🙂

Sorry you have been drafted into our club!

My situation is somewhat similar to yours, although there are differences. Let me say upfront, I am not a physician, but as a retired chemical engineer I tend (sometimes to my chagrin) to quantify everything.

At 66 years old my PSA was 7.8 and after a MRI-guided fusion biopsy, including 21 cores, I was diagnosed in October 2023 with low volume Gleason 3+4 (GG2).

Two 3+4 cores were found and they had 10-20% pattern 4. As others have indicated, it's important to determine the percentage of pattern 4, and the type of pattern 4, if possible. My original mpMRI found three lesions (PIRADS 3, 4 and 5) and my original PSA density was 0.179. I also had a Decipher score of 0.22 and the clinical-genomic risk model, in my Decipher GRID report, placed me in the Low Risk group and indicated AS was the preferred treatment.

I spent many hours researching and it soon became apparent that a man diagnosed with GG2 has probably the greatest number of treatment or AS options of any PCa diagnosis...it can be confusing and daunting to make a decision for a specific path forward....

As you have already done, and are asking, I also sought out information regarding diet and exercise.

Early on I found a small randomized clinic trial (ERASE) that was reported in 2021 JAMA article https://jamanetwork.com/journals/jamaoncology/fullarticle/2783273). ERASE tested the effectiveness of a 12 week HIIT program for men on AS and came to this conclusion:

"The ERASE trial demonstrated that HIIT increased cardiorespiratory fitness levels and decreased PSA levels, PSA velocity, and prostate cancer cell growth in men with localized prostate cancer who were under active surveillance. Larger trials are warranted to determine whether such improvement translates to better longer-term clinical outcomes in this setting."

I've modified the ERASE "HIIT protocol" to fit my own needs, BUT I've been implementing it now for 144 weeks. IMHO CONSISTENCY and SAFETY are the most important features for anyone wanting to implement a HIIT program. At our age especially, less is more, and safety is paramount.

I won't go into all the details, but my protocol (I call it my "proactive surveillance" program) can be summarized as: three sets of push-ups (strength exercising) followed by a Zone 2 5K run (70% of your max heart rate) and two 0.25 mile HIIT runs. I do this three times a week, always taking at least one day of recovery between outings, use super cushioning Hoka Bondi 8 running shoes and run on a rubberized 400m oval track.

In my case, the greatest benefit is measured in my overall fitness, as shown in the attachments. The plot averages many VO2 Max readings between each point, over the last four years, which smooths the curve and shows the trend. To give you an idea, I could barely slow jog one lap around the track when I first started at 66 years old....so I was in no way a fit individual when I started.

As it relates to my PCa diagnosis, my third mpMRI (after 28 months in February) indicated the three original lesions were no longer visible, my urologist believes they were actually just inflammation which resolved. My latest PSA was 6.4, I test every three month. That is still elevated, but my PSA velocity has always been negative since my pre diagnosis 7.8 level, but my PSA density has dropped to 0.145.

I should say a couple things about diet...I went on a vegan diet for the first 4 months and lost 30 lbs...but only to reach my objective of a BMI of 22.5 - 23.0. Once accomplished I maintained the things I liked from the vegan diet (Matcha tea, broccoli sprouts, dark berry smoothies and a veggie chili, which I have since modified) and added back chicken, salmon and even the occasional steak.

My primary "cheat" includes spicy cheese, whole wheat crackers and a glass of red wine every late afternoon; which I add to my carrots, red peppers and hummus. I've been able to maintain my BMI between 22.5 - 23.0 ever since I quit the strict vegan diet.

A "one-stop" website that rates various evidence based interventions, for PCa folks on AS, can be found here https://evidence.zone. "What's proven, what's promising, and what's noise", by Paul Sweeney.

As I'm sure you are already finding out, PCa treatment is virtually the opposite of "one size fits all". Therefore, each PCa man will decide upon an active treatment or an active surveillance program for which they are comfortable implementing.

All the best as you put together your plan, whatever it may include, and may it be super successful!