Healthy lifestyle, diet linked to longer survival for men with prostate cancer
April 22, 2025
3 min read
Key takeaways:
- Maintaining a healthy lifestyle after prostate cancer diagnosis could lower overall risk for mortality.
- Researchers recommend lifestyle counseling as part of survivorship care.
Healthy lifestyle and dietary behaviors appeared associated with reduced all-cause and cardiovascular mortality among men with nonmetastatic prostate cancer, according to results of a prospective cohort study.
However, researchers reported no associations between lifestyle or dietary habits and prostate cancer-specific mortality.
“Clinically, our findings emphasize the need for oncologists and primary care providers to integrate lifestyle counseling into routine survivorship care,” Anqi Wang, MBBS, PhD, ScM, postdoctoral research fellow in genitourinary cancer epidemiology at Harvard T.H. Chan School of Public Health, and Christopher A. Haiman, ScD, professor of population and public health services and director of the Center for Genetic Epidemiology at Keck School of Medicine of USC, told Healio via email.
Previous studies have suggested that lifestyle factors — such as diet, exercise, smoking cessation and healthy BMI — may delay progression and improve survival for men with prostate cancer. However, most of this research has been conducted in predominantly white populations, the researchers noted.
“By examining a more diverse cohort, we aimed to determine whether race and ethnicity could alter the effects of healthy behaviors on survival outcomes,” Wang and Haiman said. “This is critical for developing equitable, evidence-based recommendations that can improve survival and quality of life for all patients.”
Healio has reported findings from various studies about the effect of diet on prostate cancer.
In one study, researchers found that a high-quality diet that adheres to American dietary guideline recommendations may reduce the likelihood of grade reclassification for men with prostate cancer undergoing active surveillance.
Another study showed that men who consumed diets rich in plant-based foods had lower risk for prostate cancer progression than those who did not.
To examine the association of healthy lifestyle and diet on survival outcomes in a diverse racial and ethnic group, Wang, Haiman and colleagues conducted a prospective cohort study of men aged 45 to 75 years with nonmetastatic prostate cancer enrolled in the Multiethnic Cohort study between 1993 and 1996.
The analysis included 2,603 men who self-reported race and ethnicity upon study enrollment (mean age, 69.6 years; 29% Japanese American; 24.8% white; 22.2% Latino; 19.1% African American; 5% Native Hawaiian).
Participants completed questionnaires at baseline and after prostate cancer diagnosis. The questionnaires used three prostate cancer behavior scores and 13 dietary indices to assess lifestyle and dietary patterns.
Median follow-up reached 10.9 years from questionnaire return and 14.5 years from diagnosis.
Results showed that each 1-point increase in 2021 PCa Behavior Score — which assesses the relationship between fatal prostate cancer and BMI, smoking status, physical activity and other lifestyle factors — was associated with reduced risk for all-cause mortality (HR = 0.69; 95% CI, 0.63-0.77) and cardiovascular-related mortality (HR = 0.67; 95% CI, 0.56-0.79).
The score also appeared associated with lower risk for prostate cancer-specific mortality among African American men (HR = 0.46; 95% CI, 0.24-0.88). Researchers observed no associations for other racial and ethnic groups.
Comparing the highest and lowest scores, the Empirical Dietary Index for Hyperinsulinemia appeared positively associated with all-cause mortality (HR = 1.37; 95% CI, 1.02-1.84) and cardiovascular-related mortality (HR = 1.96; 95% CI, 1.15-3.33).
The Healthful Plant-Based Diet Index also appeared associated with a reduced risk of all-cause mortality (HR = 0.75; 95% CI, 0.58-0.97), but the association with cardiovascular-related mortality did not reach statistical significance (HR = 0.67; 95% CI, 0.44-1.03).
The most common causes of death in the cohort included cardiovascular disease (26.4%), other cancer (20.9%), cerebrovascular disease (5.2%) and chronic pulmonary disease (3.4%).
The researchers did not observe associations between lifestyle or dietary patterns and prostate cancer mortality.
The researchers acknowledged study limitations, including the study’s small sample size and lack of information related to prostate cancer progression or recurrence.
“We were somewhat surprised to find that while results trended in a protective direction, the effect on prostate cancer-specific survival was not statistically significant,” Wang and Haiman told Healio. “We have discussed several possible explanations for this in the paper. Nonetheless, the profound impact of post-diagnostic lifestyle on longevity and [cardiovascular disease] — a leading cause of death in these patients — remains clinically meaningful.
“Next steps should prioritize intervention trials testing whether structured lifestyle programs — targeting diet, exercise, maintaining a healthy BMI and smoking cessation — directly improve survival and comorbidity management [for men with] low- to intermediate-risk prostate cancer,” they added.
Perspective
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James Ryan Mark, MD, FACS
Receiving a prostate cancer diagnosis is often a pivotal moment in a patient’s life. Nearly all my patients, after discussing treatment options, either ask what dietary or lifestyle changes they can make to improve their outcomes or later share the changes they have already implemented, seeking my input. My common response is, “What’s good for your heart is good for your prostate.”
This study contributes to the growing body of literature examining the impact of diet and lifestyle on men with prostate cancer across different ethnic groups. The findings suggest improvements in overall and cardiovascular mortality, though the effect on prostate cancer-specific mortality does not reach statistical significance in all ethnic groups, largely due to limited statistical power.
Notably, the absence of recurrence and progression data presents a challenge in applying the study’s instruments to fully assess the influence of diet and lifestyle on prostate cancer outcomes.
Nevertheless, the trends identified in this research offer valuable insights for designing future studies that explore the role of healthy living in diverse populations. More immediately, they provide additional evidence to support the guidance we offer patients at a time when they may be most receptive to adopting healthier habits.
James Ryan Mark, MD, FACS
Fox Chase Cancer Center
Disclosures: Mark reports no relevant financial disclosures.
Sources/Disclosures
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Disclosures:
NCI and American Cancer Society supported this research. Wang and Haiman report no financial disclosures. Please see the study for all other authors’ relevant financial disclosures.
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