Dietary Patterns in Prostate Cancer Prevention and Management: A Systematic Review of Prospective Cohort Studies and Randomized Clinical Trials

Pao-Hwa Lin; Alanna D Burwell; Edward L Giovannucci; Stacy Loeb; June M Chan; Brandi Tuttle; Cosimo De Nunzio; Anders Bjartell; William Aronson; Stephen J Freedland

doi:10.1016/j.eururo.2025.07.017

Dietary Patterns in Prostate Cancer Prevention and Management: A Systematic Review of Prospective Cohort Studies and Randomized Clinical Trials

Eur Urol. 2025 Dec;88(6):571-588. doi: 10.1016/j.eururo.2025.07.017. Epub 2025 Aug 19.

Authors

Affiliations

¹ Department of Medicine, Duke University School of Medicine, Durham, NC, USA. Electronic address: pao.hwa.lin@dm.duke.edu.
² Institute for Medical Research, Durham Veterans Affairs Health Care System, Durham, NC, USA.
³ Departments of Nutrition and Epidemiology, Harvard T.H. Chan School of Public Health, Harvard Medical School, Boston, MA, USA.
⁴ NYU Grossman School of Medicine and Manhattan Veterans Affairs Medical Center, New York, NY, USA.
⁵ Departments of Epidemiology and Biostatistics and Urology, University of California-San Francisco, San Francisco, CA, USA.
⁶ Medical Center Library and Archives, Duke University, Durham, NC, USA.
⁷ Sapienza University of Rome and Sant'Andrea Hospital, Rome, Italy.
⁸ Lund University and Skåne University Hospital, Malmö, Sweden.
⁹ Department of Urology, David Geffen School of Medicine, University of California-Los Angeles, VA Medical Center Greater Los Angeles Healthcare System, Los Angeles, CA, USA.
¹⁰ Institute for Medical Research, Durham Veterans Affairs Health Care System, Durham, NC, USA; Cedars-Sinai Medical Center, Samuel Oschin Comprehensive Cancer Institute, Los Angeles, CA, USA; Durham VA Medical Center, Durham, NC, USA.

PMID: 40835500
DOI: 10.1016/j.eururo.2025.07.017

Abstract

Background and objective: Prostate cancer (PC) is the second most common cancer and a leading cause of death among males. In this systematic review we evaluated cohort studies and randomized controlled trials (RCTs) on the relationship between dietary patterns and PC risk, progression, mortality, and biomarkers.

Methods: A systematic search of MEDLINE, Embase, and Cochrane Central was conducted through June 2024 according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. A total of 63 studies (49 cohort studies, 14 RCTs reports) examining dietary patterns and PC outcomes were included. Study quality was assessed using Critical Appraisal Skills Programme checklists.

Key findings and limitations: Among males without PC at baseline, plant-based and healthy dietary patterns (eg, higher Healthy Eating Index, lower dietary inflammatory and hyperinsulinemic scores) were generally associated with lower total PC risk. Among patients with PC, Mediterranean, plant-based, and low-inflammatory diets were more consistently linked to lower risk of progression and PC-specific mortality. RCTs testing various diet patterns showed mixed effects on prostate-specific antigen or tumor markers. Limitations include variations in diet definitions, outcomes, and follow-up duration, and residual confounding.

Conclusions and clinical implications: Healthy dietary patterns that support cardiometabolic health may also benefit PC prevention and management. While evidence appears stronger for diet in slowing PC progression after diagnosis, the impact of diet on reducing the risk of other PC outcomes should not be overlooked (eg, risk of developing PC or risk of PC death). Integrated strategies are needed to promote healthy eating, particularly for patients at risk of PC progression, as this population often has higher risk of cardiovascular disease and metabolic disorders such as diabetes.

Keywords: Cancer prevention; Cancer progression; Dietary pattern; Prospective studies; Prostate cancer; Randomized controlled trial.

Publication types

Systematic Review

MeSH terms

Cohort Studies
Diet*
Diet, Healthy*
Humans
Male
Prospective Studies
Prostatic Neoplasms* / diet therapy
Prostatic Neoplasms* / prevention & control
Randomized Controlled Trials as Topic