<p>Lifestyle management can increase a patient’s quality of life while also reducing their risk of prostate cancer recurrence and overall all-cause mortality. Peter R. Carroll, MD, MPH, discusses the current role of diet and exercise programs in treating patients with prostate cancer.</p>

Over the years, we have seen an increasing interest in lifestyle management among both patients with prostate cancer and their families. Initially, lifestyle management referred to diet and/or nutrition; more recently, exercise became part of that paradigm. As clinicians, we get so many questions about diet and exercise. In fact, at the University of California, San Francisco, much of the discussion is often done by nutritionists because of the number of questions we get from patients about this topic. This allows us to spend more time focused on other issues with our patients.

<br>

Sometimes, lifestyle management may be the only form of treatment, specifically for those on active surveillance and for those with very low-risk and low-risk localized disease. Yet, for other patients, it is complementary. For example, I would not use lifestyle management as the only form of treatment for men with unfavorable intermediate- and high-risk disease.

<br>

Recent data have shown that diet (particularly a plant-based diet) and exercise may decrease prostate cancer recurrence rates and improve overall quality of life. Another recent study found that multivitamin use after prostate cancer diagnosis was associated with a lower risk of disease recurrence. Additionally, clinical trials have shown that patients who have a structured approach to diet seem to do better in many domains than those without this approach—but what we do not know is how much better.

<br>

Even in metastatic disease, many men implement lifestyle management successfully. Of course, nowadays we have improved therapies, including augmented hormone therapy, PARP inhibition, and theranostics, among others. Additionally, we are able to detect metastatic disease earlier on, so the outcomes for patients with metastatic disease may be better overall. However, I do think that when you institute lifestyle management with diet and exercise early on—so, in a newly diagnosed patient with metastatic disease—the benefits will likely be better. If you have a patient with hormone-refractory disease who has gone through 2 to 3 rounds of treatment, for example, it could be a tougher hill to climb.

<br>

I also think that men with prostate cancer and their families like the fact that they are participating in their care. It is important for people to be part of their health outcomes. So, rather than being passive recipients of their health care, they can be active participants in deciding what they get treated with and what they do to improve their health.

<br>

You can develop programs that are tailored to each patient. For example, we also use diet and exercise to mitigate the effects of hormone therapy on weight gain, cognitive issues, and depression. And the bar that a patient needs to reach to experience a benefit is not high. I always tell my patients, “Let’s find an exercise and nutrition program that works for you and that you can feel good about.”