Diet, nutrition, and hormone therapy for prostate cancer: a systematic review with implications for future interventions

BACKGROUND: Given excellent prostate cancer outcomes, comorbidity management is critical to survivorship. While hormone therapy or androgen deprivation therapy (ADT) is a mainstay of treatment, they can negatively impact quality of life and survivorship through cardiovascular, sexual, and metabolic effects. ADT-induced metabolic syndrome causes impaired glucose tolerance, muscle mass loss, and weight gain. This systematic review examined recent randomized clinical trials (RCTs) investigating the impact of diet and weight management strategies on mitigating ADT-related adverse effects. METHODS: A systematic review of RCTs (2015-2025) was performed using PubMed/Embase following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. To identify how diet and weight management impacts ADT symptoms, search terms included: "prostate cancer," "diet," "nutrition," "glucagon-like peptide-1 receptor agonists" (GLP-1RA), and "ADT." Risk of Bias 2 (ROB2) and Grading of Recommendations Assessment, Development, and Evaluation (GRADE) tools evaluated RCT quality. RESULTS: Of 2799 publications, 16 met inclusion/exclusion criteria (range, 23-96 patients/RCT). No RCTs had a high risk of bias or evaluated GLP-1RA. Outcomes included metabolic labs, body composition, and quality of life. Mediterranean and low-carbohydrate diets with exercise reduced cardiovascular and metabolic risk factors, with variable durability. Creatine trended toward increasing lean muscle mass. Multidisciplinary care and community involvement improved accountability and outcome durability. CONCLUSIONS: This comprehensive review of diet and ADT in prostate cancer identified nutritional interventions that were safe, feasible, and may be recommended as part of prostate cancer treatment and survivorship. Future RCTs should evaluate optimal diet duration, longer follow-up, multidisciplinary patient support, and novel anti-metabolic therapies like GLP-1RA.