Active Surveillance- Systematic Review of Interventions

Posted by Paul Sweeney @paulsweeney, May 17 10:23am

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).

I've 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

Interested in more discussions like this? Go to the Prostate Cancer Support Group.

heavyphil | @heavyphil | 6 hours ago

In reply to @jeffmarc "@heavyphil Here is the explanation from the ancan.org weekly newsletter? It was part of the discussion..." + (show)

@jeffmarc

@heavyphil
Here is the explanation from the ancan.org weekly newsletter? It was part of the discussion this week. One reason to just sign up with them to get the newsletter, even if you don’t go to the meetings. Written by Rick Davis.

Is Grade Group 1, Gleason 3+3 Prostate Cancer really malignant? If not, should we call it something else?
Long time AnCan AS participants recognize this old debate. AnCan has long supported one of its prime advocates, Howard Wolinsky and The Active Surveillor, in the campaign to rename. This week the topic resurfaces like an untethered buoy popping up from the from the depths. Prostate Cancer Mortality After Relabeling Low-Grade Prostate Cancer as Precancerous, JAMA Oncology May 21, 2026 authored by Andrew Vickers alongside the usual suspects, AnCan friendly uros... Drs. Cooperberg, Carroll, Pavlovich and Eggener. They have developed a model that predicts by dropping the 'C' word from GG1/G3+3 , it will save lives.
This new study reveals a model - plug in variables and it spits out a result. So this is not reality so much as principle. It suggests that 6 lives will be saved for every life lost to prostate cancer.
The argument is that calling GG1/G3+3 something other than cancer will promote prostate cancer screening with more men PSA tested. That will result in identifying aggressive cancers earlier and reduce prostate cancer specific mortality. The downside is that men with 3+3 not called cancer will won't comply with AS protocols to monitor their condition. That may lead to progression and ultimately death.
AnCan's survey back in 2023 and included below, suggested that only 5% of the 462 surveyed would not comply.
If you want to dig deeper, Howard addresses this far better than I ever could in his comprehensive commentary in The Active Surveillor last Thursday.

There was a link provided, but it didn’t work. If you’re interested, you can go to the Active Surveillor website. I could post this later if people show interest, I will get a fixed link.

Bottom line Gents (& Carers) ... PSA testing saves lives. It is about information not treatment - it's the Providers that cause overtreatment, not us patients. AnCan strongly supports testing.

An interesting slide

Jump to this post

@jeffmarc YES, Jeff - the contrarian views of this ‘plug and play’ scenario echo my thoughts completely.
I do not believe this for one second. Only like 22 men of 462 won’t continue rigorous AS?? To me, that’s laughable. NOT in the ‘real’ world…
I won’t belabor the point ( as I did with poor @handera, who probably is making a voodoo doll of me at this moment) but thank you for the nutshell opinion from AnCan.
I will adhere to my own, not that it matters one bit…Best,
Phil

handera | @handera | 5 hours ago

In reply to @heavyphil "@jeffmarc YES, Jeff - the contrarian views of this ‘plug and play’ scenario echo my thoughts..." + (show)

@heavyphil

If 25 years of working for and with Germans (and being descended from one myself) has taught me anything it’s that “iron sharpens iron”….even if sparks fly…in fact that’s the only way true progress is made…I’d want it no other way!

I greatly appreciate your comments and opinions, even when I remain unconvinced of a particular POV…I’m a better and more thoughtful person for having had the interaction!

Thanks Phil!

Alan

jimbo12 | @jimbo12 | 5 hours ago

1. I am an outlier.
2. Based on my experience, I hope that people will carefully consider the options.
3. I now wish that I had chosen "watchful waiting."
4. Four years ago (I am now 89), I rushed into hormone treatment.
5. The side effects differ among patients.
6. In my case, draining my testosterone resulted in losing my muscle mass.
7. I have not been able to walk safely down the sidewalk ever since.

heavyphil | @heavyphil | 3 hours ago

In reply to @handera "@heavyphil If 25 years of working for and with Germans (and being descended from one myself)..." + (show)

@handera Alan, thank you and likewise! Always a pleasure debating with someone whose opinions I respect. Best,
Phil