What is Active Surveillance for low-risk prostate cancer?

Active Surveillance (AS) is a management strategy for low-risk prostate cancer that does not need immediate treatment. Low-risk cancer is defined as

• Gleason score of 6 or less (Grade Group 1)
• PSA (prostate-specific antigen) level of 10 or less
• Cancer is localized (confined to the prostate gland)

AS is a way for patients to hold off on whole-gland treatments with side effect risks. AS is considered safe for Gleason 6 disease, which is generally grows slowly.

However, AS requires close monitoring using PSA blood tests at intervals prescribed by the doctor, and multiparametric MRI scans if there is a suspicious rise in PSA. Many patients on AS experience anxiety and worry that cancer is growing in their body.

Can healthy habits help slow cancer growth?

There are a number of health habits that are theorized to slow prostate cancer growth during AS. The British Journal of Urology International carried an October, 2025 review of published studies from 2011 onward.^[i] The authors selected randomized controlled studies and cohort studies relevant to non-surgical interventions during AS.

Their review included findings on “minimally toxic non-surgical strategies to delay or prevent disease progression…” according to the following non-hormonal treatment categories:

• Metabolic/anti-inflammatory agents
• Supplements/nutraceuticals
• Diet
• Exercise

Are there metabolic/anti-inflammatory agents that slow prostate cancer growth?

There have been some studies on metabolic or anti-inflammatory agents during AS. For example, metformin (a drug developed for use with diabetes) is a metabolic agent that regulates blood sugar. In a high-level research study comparing two groups of low-risk patients on AS (one group on metformin, the other on placebo) there was no difference in in cancer activity.^[ii]

Regarding vitamin D and aspirin as anti-inflammatory agents, the authors report that evidence of effect is scant and therefore inconclusive. Large randomized, controlled trials are needed.

Are there supplements or nutraceuticals that slow prostate cancer growth?

The authors reported on plant-based substances called polyphenols, alone or in combination, that are thought to have chemo-preventive effects against prostate cancer. These include polyphenols derived from pomegranate, green tea, broccoli, and turmeric. Some biological effects that may have anti-cancer properties were observed, such as reduced oxidative stress. Also, reduced PSA blood test results were reported. However, more research is needed.

Folic acid, one of the B vitamins, has also been linked to folate blood levels, thought a relation between blood levels and prostate cancer grade has not been definitely established.

Can dietary changes influence prostate cancer growth?

On balance, the review did not find a solid association between dietary changes involving increased intake of vegetables or omega-3 fatty acids from supplements or fatty fish. Nonetheless, the authors state that given other health benefits (cardiovascular, metabolic, etc.) such changes would be prudent for patients on AS.

Does exercise have a positive effect against prostate cancer growth?

The authors cite a small comparison study of AS patients on an exercise protocol vs those on regular care. No significant difference was observed regarding prostate cancer, but those who exercised benefitted in other ways.

The authors wrote that the above interventions “shown signals of benefit in small studies, such as improvements in biomarkers, PSA kinetics, and quality-of-life measures.”^[iii] The evidence not compelling, constrained by small sample sizes, and varied study designs. More high-level randomized, controlled, double-blind studies are needed.

What did the authors conclude?

In conclusion, the authors summarized their findings that nutraceuticals, diet changes, and exercise are well-tolerated by patients on AS, but there is a lack of evidence in the form of large-scale high-level research to support a significant cancer control effect.

Focal therapy: cancer control as an alternative to AS

The Sperling Prostate Center offers focal therapy for localized low-risk prostate cancer as an alternative to AS. Candidates must be accurately diagnosed by multiparametric MRI and in-bore MRI-guided targeted biopsy. Key advantages include

• Minimally invasive
• Outpatient
• Destroys the tumor
• Spares healthy prostate function
• Minimal risk of urinary/sexual side effects
• Quality of life as high as AS but without the anxiety/uncertainty

In addition, Dr. Sperling supports health habits that have direct cardiovascular, metabolic, and anti-inflammatory benefits. There are many small studies that support lifestyle practices with chemo-preventive effects against prostate cancer. For example, the 2008 work of Ornish, et al. demonstrated anti-cancer genomic changes for AS patients on a short-term program involving diet, exercise, stress management, group support, and supplements.^[iv]

While the world must wait for large, randomized and controlled research on ways to control prostate cancer growth, focal therapy presents a safe and effective way to avoid whole gland treatment yet destroy the cancer. The Sperling Prostate Center provides expert Focal Laser Ablation and TULSA, for qualified low-risk patients who want to hold off on treatment and don’t want the anxiety of Active Surveillance.

NOTE: This content is solely for purposes of information and does not substitute for diagnostic or medical advice. Talk to your doctor if you are experiencing pelvic pain, or have any other health concerns or questions of a personal medical nature.

References

[i] Gill S, Chen R, Lamb BW, Moore CM et al. Interventions for patients with prostate cancer on active surveillance: a narrative review. BJU Int. 2025 Oct 6.
[ii] Fleshner NE, Bernardino RM, Lajkosz K et al. A randomized, double-blind, placebo-controlled trial of metformin in reducing progression among men on expectant management for low-risk prostate cancer: the MAST (metformin active surveillance trial) study. J Clin Oncol 2024; 42(17_suppl): LBA5002
[iii] Gill et al., ibid.
[iv] Ornish D, Magbanua MJ, Weidner G et al. Changes in prostate gene expression in men undergoing an intensive nutrition and lifestyle intervention. Proc Natl Acad Sci U S A. 2008 Jun 17;105(24):8369-74.