Doctors are finding new ways to help men with early prostate cancer who choose to watch and wait instead of having surgery right away. Researchers looked at studies about different treatments—from exercise and vitamins to special medications—that might slow down cancer growth. Some medications showed promise in delaying serious cancer, but they can cause side effects. Healthier eating, exercise, and supplements seem safe but need more testing. The challenge is figuring out which men really need treatment and which can safely wait. Doctors are hoping new blood tests and imaging scans will help them make better decisions about who needs what treatment.

The Quick Take

  • What they studied: What non-surgical treatments might help slow down early prostate cancer in men who choose active surveillance (watching and waiting instead of immediate treatment)
  • Who participated: This was a review of many different studies published since 2011 that tested various treatments in men with early prostate cancer on active surveillance
  • Key finding: Certain medications called ARPIs showed the strongest ability to delay cancer progression, but concerns exist about side effects and long-term safety. Lifestyle changes like exercise and diet appear safe but need larger studies to prove they work
  • What it means for you: If you have early prostate cancer and are watching it, talk with your doctor about whether medication, lifestyle changes, or a combination might be right for you. The best choice depends on your specific situation and risk level

The Research Details

This was a narrative review, meaning researchers searched through medical databases to find and summarize all the important studies about treating early prostate cancer without surgery. They looked at studies published from 2011 to January 2024, focusing on randomized controlled trials (where some patients get treatment and others don’t, chosen randomly) and cohort studies (where researchers follow groups of patients over time). The researchers examined many different types of treatments: medications that block cancer-growth signals, vitamins and supplements, dietary changes, and exercise programs. By reviewing all this research together, they could see which treatments had the strongest evidence and which ones needed more study.

This approach is important because many men with early prostate cancer don’t need immediate surgery—their cancer grows very slowly or not at all. Finding safe treatments that can slow progression without surgery’s risks and side effects could help thousands of men. However, doctors need clear evidence about what actually works before recommending treatments to patients.

This review summarizes existing research rather than conducting a new study. The strength of the conclusions depends on the quality of the studies reviewed. The researchers noted that most evidence comes from smaller studies or early-stage trials, not large, rigorous tests. This means we should be cautious about the findings until larger, more definitive studies are completed. The review is thorough and published in a respected medical journal, which adds credibility.

What the Results Show

The largest and most rigorous studies tested medications called androgen receptor pathway inhibitors (ARPIs), which block signals that help cancer grow. These medications showed the strongest effect in delaying progression to more aggressive cancer. However, researchers expressed concerns about side effects, potential long-term safety issues, and whether these drugs actually help people live longer. The evidence suggests ARPIs might be most useful for men at higher risk of their cancer becoming more serious. For men at lower risk, the benefits may not outweigh the potential harms. Doctors are exploring using these medications for shorter periods rather than long-term, which might reduce side effects while still providing benefit.

Vitamins, supplements, dietary changes (like eating more plants and less red meat), and exercise programs all appear to be safe and well-tolerated by patients. Some studies suggest these lifestyle approaches might help, but the evidence isn’t strong enough yet. Most studies testing these approaches were small or didn’t have the rigorous design needed to prove they work. These lifestyle changes have other health benefits beyond prostate cancer, so they may still be worth doing. Researchers noted that new blood tests and imaging scans (like MRI) might help doctors better understand which patients truly need treatment and which can safely continue watching.

This review updates and expands on previous research by including studies through early 2024. It confirms that active surveillance is a reasonable option for many men with early prostate cancer, rather than rushing into surgery. The findings align with growing medical consensus that not all prostate cancers need immediate aggressive treatment. However, this review highlights that we still lack clear answers about which non-surgical treatments work best, which is why more research is needed.

The main limitation is that most studies reviewed were relatively small or didn’t have the strongest research design. Few large, rigorous trials have tested these treatments over long periods. There’s no agreement yet on which patients should start active surveillance or when they should switch to other treatments. The review also notes that newer imaging techniques (like MRI before biopsy) are changing how doctors diagnose prostate cancer, which makes it harder to compare older and newer studies. Finally, most studies haven’t clearly shown whether these treatments help people live longer—they only show whether they slow cancer growth.

The Bottom Line

For men with early, low-risk prostate cancer on active surveillance: (1) Discuss with your doctor whether lifestyle changes like regular exercise, healthy diet, and weight management make sense for you—these are safe and have other health benefits (moderate confidence); (2) If you’re at higher risk of progression, ask your doctor about short-term medication options like ARPIs, weighing benefits against side effects (moderate confidence); (3) Ask about new blood tests or imaging that might help guide your care (emerging evidence). Do not make treatment decisions based on this review alone—work with your cancer doctor who knows your specific situation.

This research matters most for men diagnosed with early prostate cancer who are considering active surveillance. It’s also relevant for their families, primary care doctors, and urologists. Men with advanced prostate cancer or those already undergoing treatment should follow their oncologist’s recommendations. Women and men without prostate cancer don’t need to apply these findings directly, though some lifestyle recommendations apply broadly.

If you choose lifestyle changes, give them at least 3-6 months to see if they help you feel better, though cancer-specific benefits take longer to measure. If you start medication, your doctor will monitor you regularly (usually every few months) with blood tests and imaging to see if it’s working. Some men may need to switch approaches if their cancer shows signs of progressing. This is a long-term process—active surveillance typically involves monitoring for years.

Want to Apply This Research?

  • Track PSA blood test results every 3-6 months (as recommended by your doctor) and note the date and value. Also track any symptoms like urinary changes or pain. This creates a clear record to discuss with your doctor at appointments.
  • Set reminders for: (1) Regular exercise—aim for 150 minutes of moderate activity per week; (2) Dietary goals—increase vegetables and whole grains, reduce red meat; (3) Appointment scheduling—don’t miss monitoring visits with your cancer doctor; (4) Medication adherence—if prescribed, take medications exactly as directed.
  • Create a health dashboard showing: PSA trends over time (with dates), appointment dates and results, any side effects from medications, exercise frequency, and dietary goals. Share this with your doctor to help guide treatment decisions. Set annual reminders to review progress with your healthcare team.

This summary is for educational purposes only and does not replace professional medical advice. Prostate cancer treatment decisions are highly individual and depend on your specific diagnosis, age, overall health, and personal preferences. Do not start, stop, or change any cancer treatment based on this information. Always consult with your oncologist or urologist before making any treatment decisions. This review summarizes existing research but does not provide definitive clinical guidance. If you have prostate cancer or are at risk, work with your healthcare team to develop a personalized care plan.