Impact of a dietary and exercise intervention on health-related quality of life of prostate cancer patients on active surveillance with overweight/obesity: a secondary analysis of a randomized controlled trial.

Alex Zhu, Jeannette M Schenk, Roman Gulati, Sarah J Beatty, Matthew VanDoren, Daniel W Lin, Michael P Porter, Colm Morrissey, Atreya Dash, John L Gore, Ruth Etzioni, Stephen R Plymate, Marian L Neuhouser, Jonathan L Wright

Journal: Supportive care in cancer : official journal of the Multinational Association of Supportive Care in Cancer 2026;34(11):

PMID: 42862393

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Abstract

PURPOSE

Quality of life (QOL) is important for men on active surveillance (AS) for prostate cancer (PCa). To improve QOL, interventions such as those focused on diet and exercise have been proposed. However, their effectiveness remains unclear, especially in individuals with overweight/obesity.

METHODS

We previously conducted and published a randomized controlled trial of a lifestyle intervention for PCa patients on AS with overweight/obesity. Men were randomized to as follows: (1) 6-month diet and exercise intervention with a 7% weight loss goal vs (2) provided US Dietary and Physical Activity Guidelines. Herein, we report the secondary QOL findings from the trial. QOL was assessed at baseline and conclusion of the intervention via four validated questionnaires. Linear regression and two-sided t-tests evaluated mean differences. Subset analyses of the questionnaires were performed using cut-points correlating with clinical assessments.

RESULTS

Between 2016 and 2020, 100 men completed the trial. The intervention group had a mean weight loss of 7.1% vs 1.8% in controls. Despite this, no significant difference was observed between groups in general QOL (EQ-5D-5L), urinary QOL (IPSS), PCa-related QOL (EPIC-26), or PCa specific anxiety (MAX-PC). However, exploratory subgroup analyses demonstrated that participants with poor "bowel function," low "sexual bother," and good "sexual function" had clinically significant improvements of 12 (95% CI 0.1-24.0), 22 (95% CI 4.2-39.0), and 19 points (95% CI 4.4-34.0) on the EPIC-26.

CONCLUSION

In this secondary analysis of a previously published randomized trial, a 6-month diet and exercise intervention did not improve overall QOL among men with overweight/obesity on AS for PCa. While diet and exercise interventions may not universally improve QOL in this population, they remain important for broader health benefits and may offer targeted value for certain patients.

Address: Department of Urology, University of Washington School of Medicine, 1959 NE Pacific St, Seattle, WA , 98195, USA. [email protected].; City of Hope Comprehensive Cancer Center, Irvine, USA. [email protected].; Fred Hutchinson Cancer Center, Seattle, WA, USA.; Department of Urology, University of Washington School of Medicine, 1959 NE Pacific St, Seattle, WA , 98195, USA.; Fred Hutchinson Cancer Center, Seattle, WA, USA.; Department of Urology, University of Washington School of Medicine, 1959 NE Pacific St, Seattle, WA , 98195, USA.; Veterans Affairs Puget Sound Health Care System, Seattle, WA, USA.; Department of Urology, University of Washington School of Medicine, 1959 NE Pacific St, Seattle, WA , 98195, USA.; Veterans Affairs Puget Sound Health Care System, Seattle, WA, USA.; Geriatric Research Education and Clinical Center, Veterans Affairs Puget Sound Health Care System, Seattle, WA, USA.; Department of Urology, University of Washington School of Medicine, 1959 NE Pacific St, Seattle, WA , 98195, USA.; Fred Hutchinson Cancer Center, Seattle, WA, USA.; Veterans Affairs Puget Sound Health Care System, Seattle, WA, USA.

DOI: 10.1007/s00520-026-11298-2

MeSH Terms: Humans, Male, Prostatic Neoplasms, Quality of Life, Middle Aged, Aged, Overweight, Obesity, Surveys and Questionnaires, Exercise, Weight Loss, Watchful Waiting, Exercise Therapy