Dovey Zach, Horowitz Amir, Waingankar Nikhil
Mount Sinai Health System, Department of Urology Icahn Medical School New York New York USA.
Icahn School of Medicine The Mount Sinai Hospital New York New York USA.
BJUI Compass. 2023 Apr 6;4(4):385-416. doi: 10.1002/bco2.237. eCollection 2023 Jul.
The mostly indolent natural history of prostate cancer (PCa) provides an opportunity for men to explore the benefits of lifestyle interventions. Current evidence suggests appropriate changes in lifestyle including diet, physical activity (PA) and stress reduction with or without dietary supplements may improve both disease outcomes and patient's mental health.
This article aims to review the current evidence on the benefits of all lifestyle programmes for PCa patients including those aimed at reducing obesity and stress, explore their affect on tumour biology and highlight any biomarkers that have clinical utility.
Evidence was obtained from PubMed and Web of Science using keywords for each section on the affects of lifestyle interventions on (a) mental health, (b) disease outcomes and (c) biomarkers in PCa patients. PRISMA guidelines were used to gather the evidence for these three sections (15, 44 and publications, respectively).
For lifestyle studies focused on mental health, 10/15 demonstrated a positive influence, although for those programmes focused on PA it was 7/8. Similarly for oncological outcomes, 26/44 studies demonstrated a positive influence, although when PA was included or the primary focus, it was 11/13. Complete blood count (CBC)-derived inflammatory biomarkers show promise, as do inflammatory cytokines; however, a deeper understanding of their molecular biology in relation to PCa oncogenesis is required (16 studies reviewed).
Making PCa-specific recommendations on lifestyle interventions is difficult on the current evidence. Nevertheless, notwithstanding the heterogeneity of patient populations and interventions, the evidence that dietary changes and PA may improve both mental health and oncological outcomes is compelling, especially for moderate to vigorous PA. The results for dietary supplements are inconsistent, and although some biomarkers show promise, significantly more research is required before they have clinical utility.
前列腺癌（PCa）大多呈惰性自然病程，这为男性探索生活方式干预的益处提供了机会。目前的证据表明，包括饮食、体育活动（PA）以及减压（无论是否使用膳食补充剂）在内的生活方式的适当改变，可能改善疾病结局和患者心理健康。
本文旨在综述目前关于所有生活方式方案对PCa患者益处的证据，包括那些旨在减轻肥胖和压力的方案，探讨它们对肿瘤生物学的影响，并突出具有临床效用的生物标志物。
使用关于生活方式干预对（a）心理健康、（b）疾病结局和（c）PCa患者生物标志物影响的各部分关键词，从PubMed和Web of Science获取证据。PRISMA指南用于收集这三个部分的证据（分别为15篇、44篇和[此处原文缺失数字]篇文献）。
对于专注于心理健康的生活方式研究，10/15显示出积极影响，而对于专注于PA的方案，这一比例为7/8。同样，对于肿瘤学结局，26/44项研究显示出积极影响，不过当PA被纳入或作为主要关注点时，这一比例为11/13。全血细胞计数（CBC）衍生的炎症生物标志物以及炎症细胞因子都显示出前景；然而，需要更深入地了解它们与PCa肿瘤发生相关的分子生物学（共综述16项研究）。
根据目前的证据，很难就生活方式干预提出针对PCa的具体建议。尽管如此，尽管患者群体和干预措施存在异质性，但饮食改变和PA可能改善心理健康和肿瘤学结局的证据令人信服，尤其是对于中等至剧烈强度的PA。膳食补充剂的结果并不一致，虽然一些生物标志物显示出前景，但在它们具有临床效用之前，还需要进行更多的研究。
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