Prostate cancer (PCa) remains a significant health burden, but lifestyle medicine continues to play a crucial role in improving outcomes. A new study by Wang et al. (2025) provides compelling evidence that dietary patterns and lifestyle choices significantly impact all-cause and cardiovascular disease (CVD)-related mortality in men with nonmetastatic PCa, regardless of racial and ethnic differences.

Let’s Dive Into the Key Findings of the Study

Study Overview

• Population: 2,603 men diagnosed with nonmetastatic PCa
• Follow-up: Median of 10.9 years post-questionnaire, 14.5 years post-diagnosis
• Mean Age at Diagnosis: 69.6 years
• Racial/Ethnic Breakdown:

• 19.1% African American
• 29.0% Japanese American
• 22.2% Latino
• 5.0% Native Hawaiian
• 24.8% White
• PCa Characteristics at Diagnosis:

• 89.3% had localized disease
• 76.1% had a Gleason score ≥7
• Treatment: 32.8% surgery, 46.4% radiation therapy, 30.2% hormone therapy

Mortality Outcomes

Of the 1,346 total deaths:

• 14.6% (197) were from PCa
• 26.4% from CVD
• 20.9% from other cancers
• 5.2% from cerebrovascular disease

Clinical Takeaway: 85% of deaths were due to causes other than PCa, reinforcing the importance of managing CVD and other comorbidities in survivorship care.

Lifestyle & Dietary Associations with Mortality

• Japanese American men had the healthiest lifestyle scores, while African American men had the lowest.
• Post-diagnosis dietary patterns were healthier than pre-diagnosis.
• Proinflammatory and proinsulinemic diets (E-DII & EDIH scores) were more prevalent in African American and Native Hawaiian men and were linked to higher CVD mortality.

Side note: The E-DII (Empirical Dietary Inflammatory Index) measures how pro-inflammatory or anti-inflammatory a diet is based on food intake patterns, with higher scores indicating a more inflammatory diet. The EDIH (Empirical Dietary Index for Hyperinsulinemia) assesses a diet’s potential to raise insulin levels, where higher scores suggest a greater insulin-stimulating effect.

Clinical Takeaway: Dietary interventions targeting inflammation and insulin resistance could help reduce CVD-related mortality, particularly in high-risk racial/ethnic groups.

Key Findings on Lifestyle & Mortality

Higher lifestyle scores significantly reduced mortality:

• Each 1-point increase in the 2021 Lifestyle Score was associated with a
  • 31% lower all-cause mortality 
  • 33% lower CVD-related mortality 
• No significant association was found between lifestyle scores and PCa-specific mortality.
• Healthier dietary patterns were linked to lower all-cause mortality
• Higher inflammatory and insulinemic dietary scores (E-DII, EDIH) increased mortality risk:
• Particularly in Japanese American and Latino men, suggesting a need for dietary modification strategies in these populations.

Racial/Ethnic Variations in PCa-Specific Mortality

• African American men with higher 2021 Lifestyle Scores had a 54% lower risk of PCa-specific mortality
• No significant associations were found in other racial/ethnic groups.

Clinical Implications: How Can We Apply These Findings?

• Lifestyle modifications should be emphasized as part of PCa survivorship care.
• Focus on reducing CVD risk factors (hypertension, diabetes, obesity) to enhance longevity.
• Advocate for an anti-inflammatory diet rich in plant-based foods, omega-3s, and minimal processed meat.
• Encourage African American men, in particular, to adopt healthy lifestyle habits for both PCa-specific and overall mortality risk reduction.
• Monitor high-risk patients (e.g., those with proinflammatory dietary patterns or metabolic syndrome) more closely for CVD-related complications.

Final Thoughts 

Despite some limitations—such as the lack of data on PCa recurrence or progression, its observational design (which cannot establish causation), and, perhaps most importantly, the absence of exercise as a factor—this study suggests a positive impact of diet on prostate cancer prognosis at least in African American males.

This research highlights the importance of lifestyle interventions beyond cancer treatment. While lifestyle changes did not significantly reduce PCa-specific mortality, they played a crucial role in improving cardiovascular health and overall longevity—an important consideration given that CVD is a leading cause of death among PCa patients. 

However, for lifestyle interventions to be most effective, exercise must be included to likely have serious anti-cancer benefits. Evidence suggests that even modest physical activity—such as ≥20 minutes/day of walking or bicycling, ≥1 hour/week of exercise, or ≥1 hour/day of household work—lowers both PCa-specific and overall mortality (Leitão et al., 2022).

For our patients, this means:

• Diet and exercise should be a routine part of “thrivership” discussions.
• Managing metabolic health is crucial for long-term survival.
• African American men, in particular, may benefit from proactive lifestyle counseling.

References:

Wang A, Van Blarigan EL, Cheng I, et al. Race and Ethnicity, Lifestyle, Diet, and Survival in Patients with Prostate Cancer. JAMA Netw Open. 2025;8(2):e2460785. doi:10.1001/jamanetworkopen.2024.60785.

Leitão C, Matos B, Roque F, Herdeiro MT, Fardilha M. The Impact of Lifestyle on Prostate Cancer: A Road to the Discovery of New Biomarkers. J Clin Med. 2022 May 22;11(10):2925. doi: 10.3390/jcm11102925. PMID: 35629050; PMCID: PMC9148038.