At the 31st Annual Prostate Cancer Foundation (PCF) Scientific Retreat, a session was devoted to metabolic effects in the biology of survivorship. In one of the presentations from this session, Stacey Kenfield, ScD, from the University of California, San Francisco (UCSF), highlighted the benefits of lifestyle management on prostate cancer outcomes.

Following this presentation, featured expert Peter R. Carroll, MD, MPH, was interviewed by Conference Reporter Editor-in-Chief Tom Iarocci, MD. Dr Carroll’s clinical perspectives on this topic are presented here.

Increasingly, patients and their loved ones want to play a role in treatment, and this was true even dating back to early work that we did with Dean Ornish, MD, on lifestyle changes and prostate cancer progression. At that time, the question was: Might it be possible to delay progression or even cure some cases of prostate cancer through lifestyle management? The study included 93 volunteers with low-risk prostate cancer (ie, prostate-specific antigen [PSA] levels of 4-10 ng/mL and Gleason scores of <7) who had chosen active surveillance. Patients were randomly assigned to an experimental group, where they were asked to make comprehensive lifestyle changes, or a control group. No one in the experimental group underwent treatment, whereas 6 patients in the control group were treated, due to an increase in PSA and/or progression of disease on imaging. The lack of treatment needed in the experimental group could be due to the subtle biologic effects of the interventions or because those who engage in lifestyle changes are more likely to be compliant with surveillance.

Today, metabolic health is of great interest in patients with prostate cancer, and nutritionists, for example, can engage with patients in important ways. I think that, to patients, the concept of “I am doing something about my cancer and my health” can be a powerful motivator. And, in the setting of active surveillance, data suggest that those who are working to improve their lifestyle may also be more adherent to monitoring, so there may be many benefits for active surveillance itself. Further, the number one killer of men with prostate cancer is cardiovascular disease, and lifestyle changes that may lower the risk of prostate cancer progression can also benefit cardiovascular health. Moreover, we have seen an improvement in quality of life with lifestyle management.

What I tell people is: (1) you do not need a diagnosis of cancer to improve your lifestyle, as you should be doing that already; and (2) as you improve your lifestyle, you decrease your risk of other diseases and enjoy life more. Additionally, lifestyle management may ameliorate the side effects of treatment, including hormonal therapy, that has metabolic side effects.

Wellness and lifestyle management have been a major focus of the PCF and of work here at UCSF. For example, June Chan, ScD, has been involved in the development of very nice downloadable resources on wellness, diet, and exercise for patients with prostate cancer that are available on the PCF website. With respect to diet, a point that we try to convey is that you should avoid thinking in terms of a single item or supplement (ie, avoid buying expensive supplements). Presently, I think that some of the key questions relate to: What is the best diet? Vegan only? Plant based? I tell patients, “Your life has got to be worth living, but limit your calories and avoid refined sugars and saturated fat.” And, with respect to exercise (both aerobic and resistance training), an important point to emphasize is that you do not need to run a marathon to benefit (ie, the threshold for benefit is rather low).

At the 31st Annual PCF Scientific Retreat, Dr Kenfield outlined some of the benefits of diet and exercise that have been shown over the years during her presentation, “Exercise and Dietary Impacts on Prostate Cancer Outcomes.” Specifically, she noted that evidence of a favorable impact of physical activity on prostate cancer progression, death from prostate cancer, and overall death in men with prostate cancer has been consistent. She also highlighted the diet and exercise interventions that are currently being studied at UCSF in randomized clinical trials. These include the phase 2 Prostate 8-II trial to determine the effect of 2-year digital health behavioral interventions on clinical, patient-reported, and biological outcomes in men with prostate cancer. The study is recruiting approximately 200 men with prostate cancer who expect to have radical prostatectomy as their primary treatment, and patients are randomized to usual care, exercise only, diet only, or diet and exercise groups. The trial is expected to report outcomes within the next year or so.

There is much research in this space, not only on prostate cancer but also on many other cancers. The relationship between lifestyle and cancer induction and progression is a very important field of study.