Diet and Physical Activity For many years it has been known that a lifestyle program that includes a combination of diet and physical activity is beneficial in the prevention and treatment of chronic diseases including heart disease (commonly referred to as “cardiac rehab”programs) and diabetes. In 2005 a similar lifestyle program was studied in men with prostate cancer who had selected to undergo active surveillance. This study evaluated the effect of a vegan diet that was in low fat with added soy, as well as a variety of dietary supplements, combined with moderate aerobic activity and stress management (Ornish et al, 2005). After 1 year men following the lifestyle program had a modest decrease in PSA and there was an increase in PSA in men in the control group (receiving standard care). This study suggests that combined lifestyle factors may slow prostate cancer progression in men with early stage prostate cancer on active surveillance. After 2 years of follow up fewer men in the lifestyle program compared to the controls required prostate cancer treatment (Frattaroli et al, 2008). Lastly, men following this program had modest weight loss and improvements in their blood cholesterol and therefore the potential for important health benefits beyond prostate cancer. Since that time two additional randomized controlled trials have evaluated lifestyle programs in men with prostate cancer. The studies included men with rising PSA after treatment (Hebert et al, 2012) and men with more advanced cancer (Bourke et al, 2011). While these studies did not show the same improvements in PSA as a marker of cancer progression they resulted in significant improvements in eating and exercise habits of men with prostate cancer as well as improvements in muscle strength and fatigue (Bourke et al, 2011). Lifestyle programs therefore have the potential for important benefits to overall health in men with prostate cancer. It is important to note that in the above studies there were several differences in the diet and physical activity programs, their duration and in how the intervention was delivered and therefore it is difficult to make direct comparisons between the studies. Recommendation Choose a healthy lifestyle which includes eating a plant-based diet, regular physical activity and achieving a healthy body weight. These are modifiable factors that have the greatest effect on overall health and well being and on reducing the risk of common chronic diseases including heart disease and Type 2 (adult onset) diabetes. Studies show that these lifestyle factors may have a modest effect on PSA and lower the risk of cancer recurrence or progression and are also likely to have additional health benefits for men with prostate cancer and help to manage side effects of treatment. Early evidence suggests that combined healthy lifestyle habits offer greater benefit to men with prostate cancer than each approach by itself but more research is needed in this area. Even small improvements in diet and physical activity habits and weight management are likely to have positive effects on health. Plant-based diets Other studies in men with prostate cancer have included a plant-based diet, without including physical activity or stress management. In these studies the plant-based diet was typically rich in fruits, vegetables, whole grains and legumes (beans) and was often lower in total fat. The findings showed some improvement in PSA that was not large enough to be statistically significant (Carmody et al, 2008) or a decrease in other markers associated with cancer progression (Li et al, 2008), or had no effect on PSA (Parsons et al, 2008). While the results of plant-based diet studies did vary, overall they have shown some benefits to cancer progression and improvements in eating habits and overall health. At least one study also showed improvements in cholesterol and body composition (Li et al, 2008).