Prostate Cancer Prevention and Recovery, The Role of Diet and Exercise in the Latest Research
- Alastair Hunt
- May 1
- 8 min read
Updated: May 3
Prostate cancer risk increases significantly with age, especially after 50. In Singapore, Chinese men face double the risk compared to Malay or Indian men. Family history is a strong risk factor - particularly if a brother or multiple relatives were diagnosed, especially at a young age. Diets high in animal fat, including red meat and dairy, also raise the risk.
During the period from 2018-2022 in Singapore, the three most frequent incident cancers reported for males were: prostate (17.4%), colorectal (16.2%; learn more here) and lung (13.4%). In the UK prostate cancer is the most common cancer, accounting for 28% of all new cancer cases in males (2017-2019).
For men concerned about prostate cancer, what is a health promoting, anti-cancer lifestyle? For those diagnosed with prostate cancer, the path forward can feel uncertain - especially if the disease re-emerges after treatment. The good news is that a growing body of research is shedding light on how diet, physical activity and lifestyle choices may influence not only general well-being but also the course of prostate cancer itself.
Four significant studies - two systematic reviews from Cancer Causes & Control (2015) and BJU International (2016), a genetics-based investigation published in European Urology (2022) and a 2024 cohort analysis from JAMA Network Open can support our health decision making and are the subject of this article.
As ever, please talk to your doctor or medical practitioner most familiar with your medical history before implementing any changes in diet, exercise or lifestyle, especially if you are under treatment. Links to all studies at bottom of page.
Risk Factors
Prostate cancer is among the most common cancers in Singaporean men. Age is the strongest risk factor, with most cases occurring after 65.
Ethnicity plays a role. While global data shows African men at highest risk, in Singapore, Chinese men have the highest rates, followed by Malays and Indians. This may reflect differences in genetics, diet, and screening habits.
Family history and inherited genes also raise risk. Having a first-degree relative with prostate cancer increases your chances.
Obesity is linked to more aggressive prostate cancers. As overweight rates rise in Singapore, maintaining a healthy weight through diet and exercise may reduce risk.
Emerging evidence suggests high IGF-1 levels and pesticide exposure may also increase risk, but these links are still being studied.
Diet also stands out as a modifiable risk factor. Western-style diets - high in fat, sugar, and processed meat - were consistently linked with higher risk, particularly of advanced or aggressive prostate cancer. In contrast, a Mediterranean (or traditional style Asian) diet rich in vegetables, legumes, fish and healthy fats was associated with lower incidence. For a region like Singapore, where dietary habits are increasingly Westernised, this shift is worth watching.
What Early Studies Have Shown
The 2015 systematic review examined 44 randomised controlled trials (RCTs) covering over 3,400 men with prostate cancer. It assessed the impact of dietary changes, supplements, and physical activity. Unfortunately, the majority of these studies were small, short-term, or poorly reported, and often relied on prostate-specific antigen (PSA) levels as a marker—an indicator of progression that does not always correlate with long-term outcomes like metastasis or survival.
A more focused 2016 review looked at five well-designed RCTs of plant-based supplements- such as pomegranate extract, soy and sulphoraphane. These trials provided early evidence that some supplements might slow PSA doubling time (PSA-DT) or stabilise PSA levels, particularly in men on active surveillance. Notably, the supplement Pomi-T (containing pomegranate, green tea, turmeric and broccoli) showed a significant effect in reducing PSA progression over six months compared to placebo.
But both reviews emphasised a key limitation: the absence of long-term clinical endpoints, such as prostate cancer-specific mortality or metastasis. Despite some promise, more robust research was clearly needed.
A Whole-Diet Approaches Work Better Than Supplements Alone
In 2024, a major observational study brought welcome clarity. Researchers followed over 2,000 men with nonmetastatic prostate cancer for a median of 6.5 years after diagnosis. The findings were striking: those who ate the most plant-based foods - measured using the Plant-Based Diet Index (PDI) - had a 47% lower risk of disease progression than those who consumed the least.
Interestingly, the more selective “healthful” plant-based index (hPDI) - which excludes refined grains and sugary plant foods—did not show a clear benefit across the board. However, among men with more aggressive disease (Gleason score 7 or higher), the hPDI was protective, associated with a 55% lower risk of progression. This suggests that even within plant-based diets, the context and severity of disease may affect outcomes.
These findings reinforce the notion that focusing on whole dietary patterns - rather than isolated nutrients - is more meaningful. Diets rich in vegetables, fruits, whole grains, legumes, nuts, and seeds seem to support slower disease progression and may contribute to improved long-term health.
The Role of Genes: Lifestyle Still Matters for Those at High Risk
Some of the most compelling recent evidence comes from a 2022 study in European Urology that examined whether a healthy lifestyle could mitigate the genetic risk of prostate cancer. Researchers followed over 12,000 men using a polygenic risk score (PRS) that estimates genetic predisposition to the disease.
Men in the highest PRS quartile had a fourfold increased risk of lethal prostate cancer compared to those in the lowest. However, among these high-risk individuals, those who maintained a healthy lifestyle - defined by not smoking, maintaining a healthy weight, exercising regularly and eating well - saw a 45% reduction in the risk of dying from prostate cancer.
This is a particularly encouraging finding: even with inherited risk, lifestyle choices can make a tangible difference. A healthy lifestyle reduced the lifetime risk of lethal prostate cancer from 5.3% to 1.6% among men at highest genetic risk.
What Does a “Healthy Lifestyle” for Prostate Health Look Like?
Based on findings from these studies, men with or at risk of prostate cancer may consider the following strategies:
Prioritise a plant-rich diet: Aim for at least 5–7 servings of vegetables and fruits daily, including cruciferous vegetables (like broccoli, kale, cabbage), cooked tomatoes (a source of lycopene), whole grains, legumes and nuts.
Reduce intake of red and processed meat: High consumption has been linked to worse outcomes in prostate cancer and other diseases.
Include fatty fish: Omega-3 fatty acids found in salmon, sardines, and mackerel may offer anti-inflammatory benefits and support heart and prostate health.
Maintain a healthy weight: Obesity was one of the strongest predictors of lethal prostate cancer in the genetic risk study. Aim for a BMI under 30 if possible.
Engage in regular vigorous exercise: This could be brisk walking, cycling, or strength training. Even moderate activity is better than none, but vigorous activity appears especially protective.
Avoid smoking: Never smoking, or quitting more than 10 years ago, was consistently associated with reduced risk of lethal prostate cancer.
Limit dairy and high-calcium supplements: While more evidence is needed, high dairy intake - especially whole milk - has been associated with increased prostate cancer risk in some studies.
Moderate alcohol intake: While not all studies focus on alcohol, general health guidelines recommend limiting consumption to one drink per day or less.
Achieve and maintain a healthy bodyweight.
Realistic Expectations and Open Conversations
It’s important to emphasise that lifestyle changes are not a substitute for the clinical treatment of prostate cancer or regular follow-up. But they can be part of a proactive, holistic approach to health. Importantly, none of the reviewed interventions showed harm, and many conferred additional benefits, such as lower cholesterol, improved glucose control and better cardiovascular health.
Men with prostate cancer are living longer than ever, and many are looking to take an active role in their care. For those on active surveillance, concerned about recurrence, or simply hoping to reduce future risk, lifestyle changes offer a safe and potentially effective strategy.
Final Thoughts
So, can diet and exercise make a real difference for men avoiding or with prostate cancer? The answer is a qualified and hopeful “yes”. While the scientific jury is still out on many specifics, a consistent theme is emerging: whole-food, plant-forward diets, physical activity and maintaining a healthy weight not only benefit general health but may also slow the progression of prostate cancer - especially in those at highest genetic risk. For many men, it offers a practical and empowering path to take control of their health and potentially alter the trajectory of their disease should they have it.
Changing health for the better is about progress, not perfection, and even small changes can have a powerful and positive effect on health. For most people, improving health is about finding motivation and prioritising self-care - with an ultimate goal of taking action. If you want to take effective and targeted steps that fit into your unique lifestyle and circumstances, The Whole Health Practice is here to help.
Whether your interest is healthspan and longevity, to beat chronic illness or to enhance your mental health and well-being, our consultations and programs deliver results that are tailored to your needs.
Our foundational Whole Health Consult identifies and prioritises the key factors - known and unknown - that affect health and wellbeing. It provides targeted recommendations tailored to you, the individual, and your unique lifestyle.
Stay Healthy,
Alastair
See our articles on colorectal and breast cancer.
Join us, or scroll down to contact us and learn more about our services:
Achieve your Health Goals
Our health, physical – mental – social - is complex and affected by multiple factors within and outside of your control. Our consults and programmes address the whole person, the root causes of ill health and maximising your health, performance & vitality.
Take the first step. Contact us to arrange an introductory call, to discuss how we can support your journey to health. We are based in Singapore and work with clients globally.
Book a Whole Health Consult to assess, identify and prioritise key factors (known and unknown) that affect your health. And receive personalised recommendations on how to address them.
Want to put recommendations into action? Learn more about our programmes for individuals or teams.
Related Studies
Cui H, Zhang W, Zhang L, Qu Y, Xu Z, Tan Z, Yan P, Tang M, Yang C, Wang Y, Chen L, Xiao C, Zou Y, Liu Y, Zhang L, Yang Y, Yao Y, Li J, Liu Z, Yang C, Jiang X, Zhang B. Risk factors for prostate cancer: An umbrella review of prospective observational studies and mendelian randomization analyses. PLoS Med. 2024 Mar 15;21(3):e1004362. doi: 10.1371/journal.pmed.1004362. PMID: 38489391; PMCID: PMC10980219.
Bossio S, Urlandini L, Perri A, Conforti F, Aversa A, Di Agostino S, Rago V. Prostate Cancer: Emerging Modifiable Risk Factors and Therapeutic Strategies in the Management of Advanced Cancer. Life (Basel). 2024 Aug 30;14(9):1094. doi: 10.3390/life14091094. PMID: 39337878; PMCID: PMC11433263.
Plym A, Zhang Y, Stopsack KH, Delcoigne B, Wiklund F, Haiman C, Kenfield SA, Kibel AS, Giovannucci E, Penney KL, Mucci LA. A Healthy Lifestyle in Men at Increased Genetic Risk for Prostate Cancer. Eur Urol. 2023 Apr;83(4):343-351. doi: 10.1016/j.eururo.2022.05.008. Epub 2022 May 28. PMID: 35637041; PMCID: PMC10279925.
Berenguer CV, Pereira F, Câmara JS, Pereira JAM. Underlying Features of Prostate Cancer-Statistics, Risk Factors, and Emerging Methods for Its Diagnosis. Curr Oncol. 2023 Feb 15;30(2):2300-2321. doi: 10.3390/curroncol30020178. PMID: 36826139; PMCID: PMC9955741.
Loeb S, Fu BC, Bauer SR, Pernar CH, Chan JM, Van Blarigan EL, Giovannucci EL, Kenfield SA, Mucci LA. Association of plant-based diet index with prostate cancer risk. Am J Clin Nutr. 2022 Mar 4;115(3):662-670. doi: 10.1093/ajcn/nqab365. PMID: 34791008; PMCID: PMC8895206.
Oczkowski M, Dziendzikowska K, Pasternak-Winiarska A, Włodarek D, Gromadzka-Ostrowska J. Dietary Factors and Prostate Cancer Development, Progression, and Reduction. Nutrients. 2021 Feb 3;13(2):496. doi: 10.3390/nu13020496. PMID: 33546190; PMCID: PMC7913227.
Zuniga KB, Chan JM, Ryan CJ, Kenfield SA. Diet and lifestyle considerations for patients with prostate cancer. Urol Oncol. 2020 Mar;38(3):105-117. doi: 10.1016/j.urolonc.2019.06.018. Epub 2019 Jul 18. PMID: 31327752; PMCID: PMC7293879.
Wilson KM, Mucci LA. Diet and Lifestyle in Prostate Cancer. Adv Exp Med Biol. 2019;1210:1-27. doi: 10.1007/978-3-030-32656-2_1. PMID: 31900902.
van Die MD, Bone KM, Emery J, Williams SG, Pirotta MV, Paller CJ. Phytotherapeutic interventions in the management of biochemically recurrent prostate cancer: a systematic review of randomised trials. BJU Int. 2016 Apr;117 Suppl 4(Suppl 4):17-34. doi: 10.1111/bju.13361. Epub 2016 Feb 22. PMID: 26898239; PMCID: PMC8631186.
Hackshaw-McGeagh LE, Perry RE, Leach VA, Qandil S, Jeffreys M, Martin RM, Lane JA. A systematic review of dietary, nutritional, and physical activity interventions for the prevention of prostate cancer progression and mortality. Cancer Causes Control. 2015 Nov;26(11):1521-50. doi: 10.1007/s10552-015-0659-4. Epub 2015 Sep 9. PMID: 26354897; PMCID: PMC4596907.
Chen C, Naidoo N, Yang Q, Hartman M, Verkooijen HM, Loy EY, Bouchardy C, Chia KS, Chia SE. A comparative population-based study of prostate cancer incidence and mortality rates in Singapore, Sweden and Geneva, Switzerland from 1973 to 2006. BMC Cancer. 2012 Jun 6;12:222. doi: 10.1186/1471-2407-12-222. PMID: 22673095; PMCID: PMC3507696.
تعليقات