Interventions for prostate cancer patients on active surveillance: what our patients should know

A major new review published in BJU International explores additional treatments and lifestyle measures for men with early prostate cancer who are managed with active surveillance, as well as monitoring tools that may help guide care.

From left, Professor Caroline Moore, Professor Prabhakar Rajan and Mr Benjamin Lamb, review authors from UCLH.

Prostate cancer is the most commonly diagnosed cancer in men in the UK, with more than 55,000 new cases each year. For many men with early disease, active surveillance (careful monitoring with regular PSA tests, scans and biopsies) is now the preferred approach, helping to avoid or delay the side effects of treatment.

The authors of the review, three of whom are UCLH consultants, advise that the three key steps for men are:

• Maintaining a healthy lifestyle
• Having regular PSA tests and MRI when advised
• Talking through any additional treatments they are considering with their specialist team

While some additional interventions look promising, none are yet routinely recommended for everyone.

Hormone therapies: effective in some settings but not without cost
The review highlights newer hormone treatments, including Enzalutamide and Apalutamide, which can reduce the risk of disease progression by around 50 per cent in some instances.

However, the benefits must be weighed against side effects, including fatigue, breast tenderness and sexual dysfunction. While these effects generally resolve after treatment stops, these medications are not routinely recommended, and more research is needed.

UCLH consultant urological surgeon Benjamin Lamb, one of the review authors, says: “Although short-term hormonal therapy may have a role for selected higher-risk patients, further research is needed before widespread adoption.”

Supplements and diet: promising signals, but limited proof
Interest in dietary supplements remains high among men with prostate cancer. The review reports mixed findings.

A plant-based supplement combining pomegranate, green tea, broccoli and turmeric showed evidence of slowing PSA rise compared with placebo in some studies.

Omega-3 fish oil supplements were more encouraging, with one study showing reduced cancer cell growth following high omega-3, low omega-6 diets with fish oil supplementation.

However, not all supplements have shown benefit. Trials involving vitamin D have not demonstrated meaningful improvements in cancer outcomes for men on surveillance.

UCLH consultant urological surgeon Professor Prabhakar Rajan, also a review author, says: “While certain nutritional approaches are biologically plausible and unlikely to be harmful, evidence remains insufficient to recommend routine use specifically to prevent cancer progression.”

Exercise and lifestyle: clear health benefits
Structured exercise programmes helped men lose weight, reduce blood pressure and enhance overall quality of life. The commonest cause of death in men on active surveillance for prostate cancer is heart disease. Current evidence does not conclusively show that exercise or dietary changes directly slow prostate cancer progression, but they do support a healthy cardiovascular system.

Professor Caroline Moore, another UCLH consultant urological surgeon on the review team, says: “Healthy lifestyle measures remain strongly advisable to reduce the risk of other chronic conditions such as heart disease and diabetes — particularly important given the long life expectancy of many men on active surveillance.”

Smarter monitoring and personalised risk assessment
The review also outlines advances in monitoring techniques. Prof Moore and her team have pioneered the use of MRI for active surveillance, and improvements in standardised scan reporting will help clinicians track tumours more accurately and potentially reduce unnecessary repeat biopsies.

Molecular testing of biopsy tissue is another rapidly developing area. Tests such as Prolaris and Decipher may help refine individual risk assessments and guide decisions about whether a patient should remain on surveillance or consider active treatment.

Individualised decision-making remains key
The overarching message from the review is that management should be tailored to each patient’s risk profile and personal priorities. While some interventions may show promise, none are yet ready for routine implementation as standard care during active surveillance.

Prof Rajan says: “Men at lower risk might benefit from dietary supplements and lifestyle modifications whilst those at higher risk might be candidates for short-term hormone therapy. The key is to balance potential benefits with longer term risks and the impact on quality of life.”

Mr Lamb adds: “With numerous clinical trials underway, clearer guidance on targeted interventions for men on active surveillance is expected in the coming years. Until then, careful monitoring combined with informed, individualised decision-making remains the cornerstone of care.”

And Professor Moore concludes: “What I say to my patients is that if you are on active surveillance, research suggests that there are things you can do yourself – such as a heart-healthy diet and regular exercise which can benefit your overall health and are likely to be good for your prostate too. It is important to maintaining regular tests as advised by your healthcare team.”