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Latest Evidence on Active Surveillance Interventions
Evidence.zone is a free resource for men on active surveillance for prostate cancer. Every intervention rated by the strength of the published research — so you know what's proven, what's promising, and what's noise.
Three new interventions this week — and the most important one costs nothing.
Relationship & Intimacy (Connection) — Tier 2, Start. This card is based on research from PC-PEP (Prostate Cancer Patient Empowerment Program) — a comprehensive 6-month home-based programme developed at Dalhousie University that combines relationship and intimacy coaching, stress management, diet, exercise, and pelvic floor training for prostate cancer patients.
Their RCT, published in European Urology, showed the programme significantly reduces psychological distress in men undergoing prostate cancer treatment. PC-PEP is now being implemented internationally across Canada, New Zealand, South Africa, and Romania.
For men on AS, where anxiety is the single biggest reason men abandon surveillance for treatment they may not need, the connection component deserves its own card. Thanks to Rob Rutledge at PCPEP for the suggestion.
Also added: Berberine (Tier 3) — the most coherent preclinical story of any supplement in the library, with a proven bioavailability hack using silymarin.
Fenbendazole (Tier 3) — the veterinary dewormer with genuine lab data but zero human evidence and real safety concerns.
All cards include full study citations, limitations, and an overview.
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Interesting. I take Berberine (1,000 mg/day) for its purported benefit in managing blood sugar. Had no idea of other potential benefits.
@brianjarvis consider combing it with silymarin to increase the bioavailability.
Thought this was worth sharing — a new systematic review published last month looked at all the evidence on lifestyle interventions for men on active surveillance. It reviewed studies from 2000 to 2025 across diet, exercise, weight management, and supplements.The headline findings:— Exercise came out on top. Consistently improved cardiorespiratory fitness, reduced fatigue, and lowered anxiety. The ERASE trial (HIIT, 3x/week) showed decreased PSA, decreased PSA velocity, and inhibited cancer cell growth in AS patients.— Diet improved metabolic health markers but didn't consistently prevent biopsy upgrading or MRI progression. The CAPFISH-3 trial (low omega-6, high omega-3 with fish oil) was a standout — reduced Ki-67 proliferation marker vs controls. Published in JCO.— Supplements showed only minor, short-term effects on PSA without reproducible oncologic protection.The hierarchy that emerged — exercise first, diet second, supplements third — is probably not what most of us want to hear, especially those of us with a cupboard full of pills. But it's where the evidence currently points.The full paper is: "Lifestyle Interventions in Patients in Active Surveillance for Prostate Cancer: A Systematic Review" (Journal of Clinical Medicine, April 2026). https://www.mdpi.com/2077-0383/15/9/3369I& been building a free resource called evidence.zone that tries to rate every AS intervention by the quality of the published research. This review largely confirms the tier system we've been using. Happy to discuss any of the findings.Paul
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13 ReactionsI can’t prove what their findings show, I can just show what my results are.
For cardio, I walk a mile twice a day on the track as fast as I can go and I go to the gym three days a week and exercise the whole time I’m there, with weights.
I eat very carefully, Lots of fruit, vegetables, nuts, brown rice, chicken or fish very seldom do I have red meat.
Even though I have BRCA2 and I’ve had prostate cancer for 16 years I’ve been undetectable for the last 30 months. Is my exercise and eating making a difference I don’t know, I do know the cancer is not progressing, yet.
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6 ReactionsThat’s inspiring, you’ve made me want to up my game with the protocol I’ve developed.
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1 ReactionSo in other words other than HIIT exercise, the evidence to support dietary changes and the use of supplements (although they might improve overall health) to keep PSA scores stable/low and prevent cancer progression is inconclusive?
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1 Reaction@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
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5 Reactions@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.
@ezupcic so glad you found it helpful. And I completely agree on things that are worth trying, many of them are good for general health also.
@paulsweeney
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.