Lifestyle Factors and Immune Health: A Critical Strategy for Prostate Cancer Patients on Active Surveillance

New Research Emphasizes Modifiable Risk Factors That May Slow or Prevent Disease Progression

For the IPCSG Newsletter

For men with prostate cancer on active surveillance (AS), the question of what they can actively do to prevent disease progression is paramount. Emerging research on cancer development and the role of lifestyle factors offers encouraging evidence that patients are not powerless—that modifiable behaviors may significantly influence whether low-risk prostate cancer remains indolent or progresses to require treatment.

According to recent insights from Dr. Jason Fung, author of "The Cancer Code," and data from the American Cancer Society, approximately 40 percent of all cancers in the United States are associated with potentially modifiable risk factors, including obesity, poor diet, and physical inactivity. For men on active surveillance, this understanding shifts the focus from passive monitoring to active engagement in disease management through lifestyle optimization.

Why Genetics Isn't Destiny for AS Patients

While some prostate cancer patients may carry genetic mutations like BRCA1 or BRCA2 that increase their risk of aggressive disease, hereditary factors account for only a small fraction of prostate cancer cases overall. The American Cancer Society's Cancer Facts & Figures 2025 report emphasizes that lifestyle choices—including diet, weight management, and smoking cessation—play a far larger role in cancer outcomes than previously understood.

For men on AS, this is profoundly important: the biological environment in which your prostate cancer cells exist may be more influential in determining progression than the genetic characteristics of those cells alone. This means you have agency in creating conditions less favorable for cancer growth.

Obesity, Insulin, and Prostate Cancer Progression

Research from the International Agency for Research on Cancer and a comprehensive 2023 review on obesity and cancer epidemiology have established obesity as a significant risk factor for cancer development and progression. For prostate cancer specifically, obesity has been consistently linked to:

• Higher-grade disease at diagnosis
• Increased risk of biochemical recurrence after treatment
• Greater likelihood of progression from low-risk to higher-risk disease
• Worse overall outcomes

The mechanism involves elevated insulin levels, which are common in overweight and obese individuals. Insulin acts as a growth factor, potentially stimulating prostate cancer cell proliferation. Additionally, obesity creates chronic inflammation and hormonal imbalances—including altered testosterone and estrogen metabolism—that can fuel cancer progression.

What AS patients can do: Achieving and maintaining a healthy body weight through caloric balance and regular physical activity may be one of the most powerful interventions available. Even modest weight loss (5-10% of body weight) can significantly improve metabolic health and reduce inflammatory markers.

The "Cellular Soil" Concept: Creating an Inhospitable Environment for Cancer

Dr. Fung describes cancer as cells that have regressed to a more primitive, survival-driven state in response to chronic cellular damage. Rather than focusing solely on destroying cancer cells, his approach emphasizes improving the biological "soil"—the internal environment in which cancer cells must survive.

For men on active surveillance, this concept is especially relevant. The goal during AS is not necessarily to eliminate all cancer cells (which may be impossible and unnecessary for indolent disease), but rather to maintain an internal environment where those cells remain dormant and non-threatening.

Practical Strategies for AS Patients:

1. Reduce Chronic Inflammation

Chronic inflammation provides fuel for cancer growth and progression. AS patients should:

• Limit pro-inflammatory foods: Reduce or eliminate processed foods, refined sugars, excessive omega-6 oils (corn, soybean, safflower oils), and red and processed meats
• Emphasize anti-inflammatory foods: Increase consumption of vegetables (especially cruciferous vegetables like broccoli, cauliflower, and Brussels sprouts), omega-3-rich fish (salmon, sardines, mackerel), olive oil, nuts, berries, and green tea
• Consider specific anti-cancer compounds: Foods rich in lycopene (cooked tomatoes), sulforaphane (broccoli sprouts), and polyphenols (green tea, pomegranate) have shown promise in prostate cancer research

2. Adopt a Low-Insulin Diet

Reducing insulin levels may slow cancer cell growth. AS patients should:

• Minimize refined carbohydrates and sugars: Eliminate or drastically reduce white bread, pasta, rice, sugary beverages, and desserts
• Choose low-glycemic foods: Emphasize non-starchy vegetables, legumes, nuts, and whole grains in moderation
• Consider intermittent fasting: Time-restricted eating (such as limiting food intake to an 8-10 hour window) may help lower insulin levels and improve metabolic health. Discuss with your physician before implementing
• Balance macronutrients: Include adequate protein and healthy fats to stabilize blood sugar

3. Support Immune Function

The immune system's "cancer surveillance" is critical for keeping indolent prostate cancer in check. AS patients should:

• Prioritize sleep: Aim for 7-9 hours of quality sleep nightly, as sleep deprivation impairs immune function
• Exercise regularly: Aim for at least 150 minutes of moderate-intensity aerobic activity weekly, plus resistance training 2-3 times weekly. Exercise enhances immune surveillance and reduces inflammation
• Optimize vitamin D levels: Have your vitamin D levels checked and supplement if deficient (most prostate cancer patients are), as vitamin D plays a role in immune function and may directly inhibit prostate cancer cell growth
• Consider targeted supplementation: Discuss with your physician whether supplements like omega-3 fatty acids, curcumin, or green tea extract may be appropriate

4. Manage Stress Effectively

Chronic stress elevates cortisol and other hormones that can impair immune function and promote inflammation. AS patients should:

• Practice daily stress reduction: Meditation, deep breathing exercises, yoga, or tai chi
• Address the psychological burden of AS: Consider counseling or support groups to manage the anxiety that often accompanies "watchful waiting"
• Maintain social connections: Social isolation is associated with worse cancer outcomes

5. Eliminate Known Carcinogens

• Quit smoking immediately: Smoking is associated with more aggressive prostate cancer and worse outcomes
• Limit alcohol: Heavy alcohol consumption may increase prostate cancer risk and progression
• Reduce environmental toxin exposure: Minimize pesticide exposure, avoid BPA-containing plastics, and be cautious with endocrine-disrupting chemicals

The Critical Importance of Immune Surveillance

Dr. Fung emphasizes that the immune system continuously detects and eliminates abnormal cells through "cancer surveillance." For AS patients, this process is actively working to control your existing cancer cells and prevent new ones from developing.

However, immune surveillance can be compromised by aging, certain medications, chronic stress, poor sleep, and metabolic dysfunction. This is why men on AS should view immune optimization as a cornerstone of their disease management strategy.

A sobering example illustrates this point: organ transplant recipients taking immunosuppressive drugs experience dramatically increased cancer rates. In one case cited by Dr. Fung, a melanoma patient's organs were donated after accidental death, and recipients developed widespread melanoma because their suppressed immune systems could no longer control dormant cancer cells that the donor's immune system had been keeping in check.

For AS patients, this underscores a vital message: your immune system may be the most powerful tool you have for preventing progression.

What the Evidence Shows for Prostate Cancer Specifically

While Dr. Fung's work addresses cancer broadly, research specific to prostate cancer supports these lifestyle interventions:

• Diet: Multiple studies have associated Mediterranean-style diets, rich in vegetables, fish, and olive oil, with slower prostate cancer progression
• Weight management: Obesity at diagnosis is consistently linked to higher-grade disease and worse outcomes in AS patients
• Exercise: Physical activity has been associated with reduced risk of prostate cancer progression and mortality in multiple cohort studies
• Metabolic health: Men with metabolic syndrome (a cluster of conditions including obesity, high blood pressure, high blood sugar, and abnormal cholesterol) have worse prostate cancer outcomes

A Realistic Perspective

It's important to acknowledge that cancer remains complex, and lifestyle modifications cannot guarantee that disease will not progress. Genetics, age, baseline disease characteristics, and factors we don't yet fully understand all play roles. Some men on AS will eventually require treatment regardless of their lifestyle choices.

However, the evidence increasingly suggests that the internal environment you create through lifestyle choices can influence the trajectory of your disease. For many AS patients, these interventions may extend the time before treatment is needed—or potentially prevent the need for treatment altogether.

Moving from Passive Surveillance to Active Engagement

Active surveillance should not feel passive. While your medical team monitors your PSA, performs periodic biopsies, and uses imaging to track your disease, you can simultaneously work to optimize the biological conditions that influence whether your cancer remains indolent.

Think of it as a two-pronged approach: your physicians provide expert surveillance and will intervene if progression occurs, while you actively work to make progression less likely through lifestyle optimization.

Practical Next Steps for AS Patients

1. Discuss with your physician: Before making significant dietary or lifestyle changes, especially if you have other health conditions or take medications
2. Get baseline measurements: Check weight, waist circumference, vitamin D levels, fasting glucose and insulin, and inflammatory markers (like C-reactive protein)
3. Set realistic, specific goals: Rather than trying to overhaul everything at once, focus on 1-2 changes at a time
4. Track your progress: Monitor not just PSA but also weight, exercise frequency, and how you feel
5. Consider working with specialists: A registered dietitian familiar with cancer, an exercise physiologist, or an integrative oncologist can provide personalized guidance
6. Connect with other AS patients: Share strategies and support through groups like IPCSG

The Bottom Line for AS Patients

You are not powerless while on active surveillance. The emerging understanding of cancer as a disease influenced by cellular environment and immune function—not just genetics—offers a roadmap for active engagement. By reducing inflammation, optimizing metabolic health, supporting immune function, managing stress, and eliminating carcinogens, you may be able to influence whether your prostate cancer remains a manageable condition rather than progressing to require treatment.

These lifestyle strategies won't replace medical surveillance, but they may be powerful complements to it—offering you agency in your disease management and potentially improving not just your cancer outcomes but your overall health and quality of life.

---

Sources and Citations

1. Xu, L., & Fallon, B. (2025, September 23). Cancer Is Not Just in Your Genes: Be Aware of These Key Culprits. The Epoch Times. https://www.theepochtimes.com/health/prevent-cancer-with-lifestyle-choices-5913922

2. American Cancer Society. (2025). Cancer Facts & Figures 2025. Atlanta: American Cancer Society. https://www.cancer.org/research/cancer-facts-statistics.html

3. Fung, J. (2023). The Cancer Code: A Revolutionary New Understanding of a Medical Mystery. Greystone Books.

4. Allott, E. H., Masko, E. M., & Freedland, S. J. (2013). Obesity and prostate cancer: weighing the evidence. European Urology, 63(5), 800-809. https://doi.org/10.1016/j.eururo.2012.11.013

5. Kenfield, S. A., Stampfer, M. J., Giovannucci, E., & Chan, J. M. (2011). Physical activity and survival after prostate cancer diagnosis in the health professionals follow-up study. Journal of Clinical Oncology, 29(6), 726-732. https://doi.org/10.1200/JCO.2010.31.5226

6. Richman, E. L., Kenfield, S. A., Chavarro, J. E., et al. (2013). Fat intake after diagnosis and risk of lethal prostate cancer and all-cause mortality. JAMA Internal Medicine, 173(14), 1318-1326. https://doi.org/10.1001/jamainternmed.2013.6536

7. Giovannucci, E., Liu, Y., Platz, E. A., Stampfer, M. J., & Willett, W. C. (2007). Risk factors for prostate cancer incidence and progression in the health professionals follow-up study. International Journal of Cancer, 121(7), 1571-1578. https://doi.org/10.1002/ijc.22788

8. International Agency for Research on Cancer. (2002). IARC Handbooks of Cancer Prevention, Volume 6: Weight Control and Physical Activity. Lyon, France: IARC Press. https://publications.iarc.fr/

9. Avgerinos, K. I., Spyrou, N., Mantzoros, C. S., & Dalamaga, M. (2019). Obesity and cancer risk: Emerging biological mechanisms and perspectives. Metabolism, 92, 121-135. https://doi.org/10.1016/j.metabol.2018.11.001

10. American Cancer Society. (2024). Prostate Cancer Risk Factors. https://www.cancer.org/cancer/prostate-cancer/causes-risks-prevention/risk-factors.html

---

Note: This article is for informational purposes only and is not intended as medical advice. IPCSG members on active surveillance should consult with their healthcare providers before making any changes to their monitoring protocols or implementing lifestyle modifications, especially if they have other health conditions or take medications.