{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,5]],"date-time":"2026-10-05T22:16:19Z","timestamp":1791238579451,"version":"4.1.0"},"reference-count":72,"publisher":"MDPI AG","issue":"9","license":[{"start":{"date-parts":[[2026,4,28]],"date-time":"2026-04-28T00:00:00Z","timestamp":1777334400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Background\/Objectives: Active surveillance (AS) has become the gold standard for managing men diagnosed with low-risk or favorable intermediate-risk prostate cancer. However, both patients and healthcare providers often face a lack of clear, evidence-based guidance regarding lifestyle choices during this period. This systematic review was designed to determine whether specific lifestyle modifications\u2014including dietary changes, physical activity, weight control, and use of supplements\u2014can tangibly impact oncologic outcomes or improve patient-reported quality of life during surveillance. Methods: The research followed PRISMA protocols, searching PubMed, Cochrane, and Scopus for studies published between 2000 and 2025. The team included diverse methodologies, from randomized controlled trials to qualitative interviews, specifically focusing on men on AS. To ensure high standards, two independent reviewers performed data extraction and quality assessments using CASP tools, and the review was formally registered with PROSPERO. Results: The review synthesized data from over 30 heterogeneous studies. The findings suggest that lifestyle interventions are safe and highly feasible. Physical exercise emerged as the most effective intervention, consistently improving cardiorespiratory fitness and reducing psychological burdens such as fatigue and \u201cPSA anxiety.\u201d While dietary changes and weight loss successfully improved metabolic health markers, they did not show a consistent ability to prevent biopsy upgrading or MRI progression. Similarly, supplements showed only minor, short-term effects on PSA kinetics without providing reproducible oncologic protection. Conclusions: For men undergoing active surveillance, lifestyle interventions may be considered as supportive measures, as they appear feasible and may improve physical fitness, metabolic health, and selected patient-reported outcomes. However, current evidence remains insufficient to demonstrate a consistent effect on biopsy upgrading, MRI progression, or long-term deferral of definitive treatment.<\/jats:p>","DOI":"10.3390\/jcm15093369","type":"journal-article","created":{"date-parts":[[2026,4,28]],"date-time":"2026-04-28T13:26:41Z","timestamp":1777382801000},"page":"3369","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Lifestyle Interventions in Patients in Active Surveillance for Prostate Cancer: A Systematic Review"],"prefix":"10.3390","volume":"15","author":[{"given":"Marco","family":"Campetella","sequence":"first","affiliation":[{"name":"Department of Urology, Ospedale Isola Tiberina-Gemelli Isola, 00168 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2119-9023","authenticated-orcid":false,"given":"Francesco Pio","family":"Bizzarri","sequence":"additional","affiliation":[{"name":"Department of Urology, Ospedale Isola Tiberina-Gemelli Isola, 00168 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pierluigi","family":"Russo","sequence":"additional","affiliation":[{"name":"Department of Urology, Fondazione Policlinico Universitario Agostino Gemelli, IRCCS, 00168 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Riccardo","family":"Bientinesi","sequence":"additional","affiliation":[{"name":"Department of Urology, Mater Olbia Hospital, 07026 Olbia, Italy"},{"name":"Department of Medicine and Translational Surgery, Universit\u00e0 Cattolica Del Sacro Cuore, 00168 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Giovanni Battista","family":"Filomena","sequence":"additional","affiliation":[{"name":"Department of Urology, Mater Olbia Hospital, 07026 Olbia, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maria Chiara","family":"Sighinolfi","sequence":"additional","affiliation":[{"name":"Department of Urology, Fondazione Policlinico Universitario Agostino Gemelli, IRCCS, 00168 Rome, Italy"},{"name":"Department of Medicine and Translational Surgery, Universit\u00e0 Cattolica Del Sacro Cuore, 00168 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bernardo","family":"Rocco","sequence":"additional","affiliation":[{"name":"Department of Urology, Fondazione Policlinico Universitario Agostino Gemelli, IRCCS, 00168 Rome, Italy"},{"name":"Department of Medicine and Translational Surgery, Universit\u00e0 Cattolica Del Sacro Cuore, 00168 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4640-8354","authenticated-orcid":false,"given":"Emilio","family":"Sacco","sequence":"additional","affiliation":[{"name":"Department of Urology, Ospedale Isola Tiberina-Gemelli Isola, 00168 Rome, Italy"},{"name":"Department of Medicine and Translational Surgery, Universit\u00e0 Cattolica Del Sacro Cuore, 00168 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,4,28]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"148","DOI":"10.1016\/j.eururo.2024.03.027","article-title":"EAU-EANM-ESTRO-ESUR-ISUP-SIOG Guidelines on Prostate Cancer\u20142024 Update. Part I: Screening, Diagnosis, and Local Treatment with Curative Intent","volume":"86","author":"Cornford","year":"2024","journal-title":"Eur. Urol."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"243","DOI":"10.1016\/j.eururo.2020.09.042","article-title":"EAU-EANM-ESTRO-ESUR-SIOG Guidelines on Prostate Cancer\u20142020 Update. Part 1: Screening, Diagnosis, and Local Treatment with Curative Intent","volume":"79","author":"Mottet","year":"2020","journal-title":"Eur. Urol."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"1914","DOI":"10.1001\/jama.2018.3712","article-title":"Prostate-Specific Antigen\u2013Based Screening for Prostate Cancer","volume":"319","author":"Fenton","year":"2018","journal-title":"JAMA"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"10","DOI":"10.1097\/JU.0000000000002757","article-title":"Clinically Localized Prostate Cancer: AUA\/ASTRO Guideline, Part I: Introduction, Risk Assessment, Staging, and Risk-Based Management","volume":"208","author":"Eastham","year":"2022","journal-title":"J. Urol."},{"key":"ref_5","first-page":"641","article-title":"The role of alternative medicine and complimentary therapies in urologic disease: New horizons","volume":"91","author":"Bizzarri","year":"2024","journal-title":"Urol. J."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"1786","DOI":"10.1016\/j.juro.2009.12.099","article-title":"Do Anxiety and Distress Increase During Active Surveillance for Low Risk Prostate Cancer?","volume":"183","author":"Roobol","year":"2010","journal-title":"J. Urol."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"71","DOI":"10.1136\/bmj.n71","article-title":"The PRISMA 2020 statement: An updated guideline for reporting systematic reviews","volume":"372","author":"Page","year":"2021","journal-title":"BMJ"},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"140","DOI":"10.1001\/jama.2019.20207","article-title":"Effect of a Behavioral Intervention to Increase Vegetable Consumption on Cancer Progression Among Men With Early-Stage Prostate Cancer","volume":"323","author":"Parsons","year":"2020","journal-title":"JAMA"},{"key":"ref_9","doi-asserted-by":"crossref","unstructured":"Kaiser, A., Siddiqui, M.M., Bosley-Smith, J., Wang, S., Aryankalayil, J., Mishra, M.V., Ryan, A.S., and D\u2019adamo, C.R. (2024). Weight Loss, Pathological Changes, and Inflammatory Effects from a Short-Term Ketogenic Diet in Overweight and Obese Men with Untreated Prostate Cancer on Active Surveillance. Nutrients, 16.","DOI":"10.3390\/nu16213716"},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"2108","DOI":"10.1002\/cncr.35241","article-title":"The Prostate Cancer Active Lifestyle Study (PALS): A randomized controlled trial of diet and exercise in overweight and obese men on active surveillance","volume":"130","author":"Wright","year":"2024","journal-title":"Cancer"},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"1487","DOI":"10.1001\/jamaoncol.2021.3067","article-title":"Effects of Exercise on Cardiorespiratory Fitness and Biochemical Progression in Men With Localized Prostate Cancer Under Active Surveillance","volume":"7","author":"Kang","year":"2021","journal-title":"JAMA Oncol."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"20","DOI":"10.1186\/s13063-016-1734-1","article-title":"A lifestyle intervention among elderly men on active surveillance for non-aggressive prostate cancer: A randomised feasibility study with whole-grain rye and exercise","volume":"18","author":"Eriksen","year":"2017","journal-title":"Trials"},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"305","DOI":"10.1038\/pcan.2016.22","article-title":"The role of lifestyle characteristics on prostate cancer progression in two active surveillance cohorts","volume":"19","author":"Vandersluis","year":"2016","journal-title":"Prostate Cancer Prostatic Dis."},{"key":"ref_14","first-page":"1009","article-title":"Influence of physical activity on active surveillance discontinuation in men with low-risk prostate cancer","volume":"30","author":"Papadopoulos","year":"2019","journal-title":"Cancer Causes Control"},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"1151","DOI":"10.1038\/s41391-021-00375-8","article-title":"Physical activity decreases the risk of cancer reclassification in patients on active surveillance: A multicenter retrospective study","volume":"24","author":"Brassetti","year":"2021","journal-title":"Prostate Cancer Prostatic Dis."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"466","DOI":"10.1038\/s41416-019-0380-2","article-title":"Diet quality and Gleason grade progression among localised prostate cancer patients on active surveillance","volume":"120","author":"Gregg","year":"2019","journal-title":"Br. J. Cancer"},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"618","DOI":"10.1080\/01635581.2022.2143537","article-title":"Dietary Patterns and Risk of Gleason Grade Progression among Men on Active Surveillance for Prostate Cancer: Results from the Canary Prostate Active Surveillance Study","volume":"75","author":"Schenk","year":"2022","journal-title":"Nutr. Cancer"},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"2315","DOI":"10.1210\/jc.2012-1451","article-title":"Vitamin D3 Supplementation at 4000 International Units Per Day for One Year Results in a Decrease of Positive Cores at Repeat Biopsy in Subjects with Low-Risk Prostate Cancer under Active Surveillance","volume":"97","author":"Marshall","year":"2012","journal-title":"J. Clin. Endocrinol. Metab."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"1035","DOI":"10.1158\/1940-6207.CAPR-09-0143","article-title":"Oral Selenium Supplementation Has No Effect on Prostate-Specific Antigen Velocity in Men Undergoing Active Surveillance for Localized Prostate Cancer","volume":"3","author":"Stratton","year":"2010","journal-title":"Cancer Prev. Res."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"800","DOI":"10.1200\/JCO.24.00608","article-title":"High Omega-3, Low Omega-6 Diet With Fish Oil for Men With Prostate Cancer on Active Surveillance: The CAPFISH-3 Randomized Clinical Trial","volume":"43","author":"Aronson","year":"2025","journal-title":"J. Clin. Oncol."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"766","DOI":"10.1158\/1940-6207.CAPR-13-0349","article-title":"Prostatic and Dietary Omega-3 Fatty Acids and Prostate Cancer Progression during Active Surveillance","volume":"7","author":"Moreel","year":"2014","journal-title":"Cancer Prev. Res."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"71","DOI":"10.1186\/s40814-025-01654-0","article-title":"The Prostate cancer\u2013Exercise and Metformin randomised controlled feasibility Trial (Pre-EMpT) in men following active surveillance, radical prostatectomy and radiotherapy","volume":"11","author":"Robles","year":"2025","journal-title":"Pilot Feasibility Stud."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"282","DOI":"10.1016\/j.euo.2022.07.008","article-title":"Coffee Intake, Caffeine Metabolism Genotype, and Survival Among Men with Prostate Cancer","volume":"6","author":"Gregg","year":"2022","journal-title":"Eur. Urol. Oncol."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"187","DOI":"10.1038\/s41391-017-0010-0","article-title":"Total energy expenditure and vigorous-intensity physical activity are associated with reduced odds of reclassification among men on active surveillance","volume":"21","author":"Guy","year":"2017","journal-title":"Prostate Cancer Prostatic Dis."},{"key":"ref_25","first-page":"515","article-title":"Physical activity and prostate gene expression in men with low-risk prostate cancer","volume":"25","author":"Magbanua","year":"2014","journal-title":"Cancer Causes Control"},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"180","DOI":"10.1038\/pcan.2014.6","article-title":"A double-blind, placebo-controlled randomised trial evaluating the effect of a polyphenol-rich whole food supplement on PSA progression in men with prostate cancer\u2014The UK NCRN Pomi-T study","volume":"17","author":"Thomas","year":"2014","journal-title":"Prostate Cancer Prostatic Dis."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"193","DOI":"10.1016\/j.euo.2025.10.003","article-title":"Increasing Phytochemical-rich Foods and Lactobacillus Probiotics in Men with Low-risk Prostate Cancer\u2014A Randomised, Double-blind, Placebo-controlled Trial","volume":"9","author":"Thomas","year":"2025","journal-title":"Eur. Urol. Oncol."},{"key":"ref_28","doi-asserted-by":"crossref","unstructured":"Moussa, H., Nguile-Makao, M., Robitaille, K., Guertin, M.-H., Allaire, J., Pelletier, J.-F., Moreel, X., Gevariya, N., Diorio, C., and Desmeules, P. (2019). Omega-3 Fatty Acids Survey in Men under Active Surveillance for Prostate Cancer: From Intake to Prostate Tissue Level. Nutrients, 11.","DOI":"10.3390\/nu11071616"},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"3662","DOI":"10.1200\/JCO-25-01070","article-title":"Metformin Active Surveillance Trial in Low-Risk Prostate Cancer","volume":"43","author":"Fleshner","year":"2025","journal-title":"J. Clin. Oncol."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"110","DOI":"10.1016\/j.urology.2021.04.050","article-title":"Correlative Analysis of Vitamin D and Omega-3 Fatty Acid Intake in Men on Active Surveillance for Prostate Cancer","volume":"155","author":"Campbell","year":"2021","journal-title":"Urology"},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"1877","DOI":"10.1158\/1055-9965.EPI-12-0411","article-title":"Associations of Lifestyle Factors and Anthropometric Measures with Repeat PSA Levels During Active Surveillance\/Monitoring","volume":"21","author":"Burton","year":"2012","journal-title":"Cancer Epidemiol. Biomark. Prev."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"e022331","DOI":"10.1136\/bmjopen-2018-022331","article-title":"Can exercise delay transition to active therapy in men with low-grade prostate cancer? A multicentre randomised controlled trial","volume":"8","author":"Hayne","year":"2018","journal-title":"BMJ Open"},{"key":"ref_33","first-page":"519","article-title":"Effect of a Home-based Walking Intervention on Cardiopulmonary Fitness and Quality of Life Among Men with Prostate Cancer on Active Surveillance: The Active Surveillance Exercise Randomized Controlled Trial","volume":"7","author":"Kenfield","year":"2023","journal-title":"Eur. Urol. Oncol."},{"key":"ref_34","first-page":"165","article-title":"Effect of a 2-year home-based endurance training intervention on physiological function and PSA doubling time in prostate cancer patients","volume":"27","author":"Hvid","year":"2015","journal-title":"Cancer Causes Control"},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"10732748221130964","DOI":"10.1177\/10732748221130964","article-title":"Pilot Study on the Impact of a Home-Based Exercise Program on Inflammatory Cytokines and Quality of Life in Men with Prostate Cancer Under Active Surveillance","volume":"29","author":"Moon","year":"2022","journal-title":"Cancer Control"},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"356","DOI":"10.1016\/j.eururo.2011.07.041","article-title":"The Risk of Upstaged Disease Increases with Body Mass Index in Low-Risk Prostate Cancer Patients Eligible for Active Surveillance","volume":"61","author":"Ploussard","year":"2012","journal-title":"Eur. Urol."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"198","DOI":"10.1016\/j.cct.2014.05.002","article-title":"A randomized trial of diet in men with early stage prostate cancer on active surveillance: Rationale and design of the Men\u2019s Eating and Living (MEAL) Study (CALGB 70807 [Alliance])","volume":"38","author":"Parsons","year":"2014","journal-title":"Contemp. Clin. Trials"},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"534","DOI":"10.1111\/bju.13890","article-title":"Men\u2019s Eating and Living (MEAL) study (CALGB 70807 [Alliance]): Recruitment feasibility and baseline demographics of a randomized trial of diet in men on active surveillance for prostate cancer","volume":"121","author":"Parsons","year":"2017","journal-title":"BJU Int."},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"1702","DOI":"10.1001\/jamaoncol.2024.4406","article-title":"Diet Quality, Dietary Inflammatory Potential, and Risk of Prostate Cancer Grade Reclassification","volume":"10","author":"Su","year":"2024","journal-title":"JAMA Oncol."},{"key":"ref_40","doi-asserted-by":"crossref","unstructured":"Avery, K.N., Donovan, J.L., Horwood, J., Neal, D.E., Hamdy, F.C., Parker, C., Wade, J., and Lane, A. (2014). The importance of dietary change for men diagnosed with and at risk of prostate cancer: A multi-centre interview study with men, their partners and health professionals. BMC Fam. Pr., 15.","DOI":"10.1186\/1471-2296-15-81"},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"270","DOI":"10.1016\/j.clnesp.2021.06.004","article-title":"Feasibility of dietary folic acid reduction intervention for men on active surveillance for prostate cancer","volume":"44","author":"Ullevig","year":"2021","journal-title":"Clin. Nutr. ESPEN"},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"1112","DOI":"10.1016\/S1470-2045(13)70366-8","article-title":"Effect of comprehensive lifestyle changes on telomerase activity and telomere length in men with biopsy-proven low-risk prostate cancer: 5-year follow-up of a descriptive pilot study","volume":"14","author":"Ornish","year":"2013","journal-title":"Lancet Oncol."},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"8152","DOI":"10.1200\/JCO.2005.03.1492","article-title":"Role of Diet in Prostate Cancer Development and Progression","volume":"23","author":"Chan","year":"2005","journal-title":"J. Clin. Oncol."},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"267","DOI":"10.1111\/j.1399-0004.1995.tb04309.x","article-title":"Gorlin-Chaudhry-Moss or Saethre-Chotzen syndrome?","volume":"47","author":"Preis","year":"1995","journal-title":"Clin. Genet."},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"355","DOI":"10.1158\/0008-5472.CAN-16-0687","article-title":"Vitamin D3 Prevents Calcium-Induced Progression of Early-Stage Prostate Tumors by Counteracting TRPC6 and Calcium Sensing Receptor Upregulation","volume":"77","author":"Bernichtein","year":"2017","journal-title":"Cancer Res."},{"key":"ref_46","doi-asserted-by":"crossref","first-page":"1607","DOI":"10.1016\/j.euf.2022.03.007","article-title":"Diet and Health-related Quality of Life Among Men on Active Surveillance for Early-stage Prostate Cancer: The Men\u2019s Eating and Living Study (Cancer and Leukemia Group 70807 [Alliance])","volume":"8","author":"Parsons","year":"2022","journal-title":"Eur. Urol. Focus"},{"key":"ref_47","doi-asserted-by":"crossref","first-page":"135","DOI":"10.1016\/j.ejon.2019.06.006","article-title":"Identifying the exercise-based support needs and exercise programme preferences among men with prostate cancer during active surveillance: A qualitative study","volume":"41","author":"McIntosh","year":"2019","journal-title":"Eur. J. Oncol. Nurs."},{"key":"ref_48","doi-asserted-by":"crossref","first-page":"e026438","DOI":"10.1136\/bmjopen-2018-026438","article-title":"Exercise duRing Active Surveillance for prostatE cancer\u2014The ERASE trial: A study protocol of a phase II randomised controlled trial","volume":"9","author":"Kang","year":"2019","journal-title":"BMJ Open"},{"key":"ref_49","doi-asserted-by":"crossref","first-page":"469","DOI":"10.1038\/s41391-024-00867-3","article-title":"Effects of high-intensity interval training on cardiometabolic biomarkers in patients with prostate cancer undergoing active surveillance: A randomized controlled trial","volume":"28","author":"Kang","year":"2024","journal-title":"Prostate Cancer Prostatic Dis."},{"key":"ref_50","doi-asserted-by":"crossref","first-page":"1044","DOI":"10.1002\/pon.5375","article-title":"Associations between self-reported physical activity, quality of life, and emotional well-being in men with prostate cancer on active surveillance","volume":"29","author":"Papadopoulos","year":"2020","journal-title":"Psycho-Oncology"},{"key":"ref_51","doi-asserted-by":"crossref","first-page":"11","DOI":"10.1038\/s41391-024-00801-7","article-title":"High-intensity interval training versus moderate-intensity continuous training for localized prostate cancer under active surveillance: A systematic review and network meta-analysis","volume":"28","author":"Zhu","year":"2024","journal-title":"Prostate Cancer Prostatic Dis."},{"key":"ref_52","doi-asserted-by":"crossref","first-page":"1535","DOI":"10.1139\/apnm-2021-0365","article-title":"High-intensity interval training or resistance training versus usual care in men with prostate cancer on active surveillance: A 3-arm feasibility randomized controlled trial","volume":"46","author":"Papadopoulos","year":"2021","journal-title":"Appl. Physiol. Nutr. Metab."},{"key":"ref_53","doi-asserted-by":"crossref","first-page":"159","DOI":"10.1038\/ejcn.2016.194","article-title":"The adverse effects of an excessive folic acid intake","volume":"71","author":"Patel","year":"2016","journal-title":"Eur. J. Clin. Nutr."},{"key":"ref_54","doi-asserted-by":"crossref","first-page":"125","DOI":"10.1016\/j.urology.2005.07.056","article-title":"Lifestyle and health-related quality of life of men with prostate cancer managed with active surveillance","volume":"67","author":"Daubenmier","year":"2006","journal-title":"Urology"},{"key":"ref_55","doi-asserted-by":"crossref","first-page":"179","DOI":"10.1186\/s40814-022-01136-7","article-title":"Prostate cancer\u2013Exercise and Metformin Trial (Pre-EMpT): Study protocol for a feasibility factorial randomized controlled trial in men with localised or locally advanced prostate cancer","volume":"8","author":"McGeagh","year":"2022","journal-title":"Pilot Feasibility Stud."},{"key":"ref_56","doi-asserted-by":"crossref","first-page":"841","DOI":"10.1016\/j.eururo.2014.06.005","article-title":"Obesity Is Associated with Risk of Progression for Low-risk Prostate Cancers Managed Expectantly","volume":"66","author":"Bhindi","year":"2014","journal-title":"Eur. Urol."},{"key":"ref_57","first-page":"201.e1","article-title":"Body mass index was associated with upstaging and upgrading in patients with low-risk prostate cancer who met the inclusion criteria for active surveillance","volume":"33","author":"Terracciano","year":"2015","journal-title":"Urol. Oncol. Semin. Orig. Investig."},{"key":"ref_58","doi-asserted-by":"crossref","first-page":"71","DOI":"10.1016\/j.juro.2017.01.073","article-title":"Obesity as a Risk Factor for Unfavorable Disease in Men with Low Risk Prostate Cancer and its Relationship with Anatomical Location of Tumor","volume":"198","author":"Jeong","year":"2017","journal-title":"J. Urol."},{"key":"ref_59","doi-asserted-by":"crossref","first-page":"429","DOI":"10.1097\/COC.0000000000000839","article-title":"The Impact of Body Mass Index on Freedom From Therapeutic Intervention and Quality of Life in Active Surveillance Prostate Cancer Patients","volume":"44","author":"Merrick","year":"2021","journal-title":"Am. J. Clin. Oncol."},{"key":"ref_60","doi-asserted-by":"crossref","first-page":"914","DOI":"10.1016\/j.eururo.2006.07.042","article-title":"Prostate Cancer Nomograms: An Update","volume":"50","author":"Chun","year":"2006","journal-title":"Eur. Urol."},{"key":"ref_61","doi-asserted-by":"crossref","first-page":"617","DOI":"10.1016\/j.euo.2022.07.004","article-title":"Active Surveillance for Intermediate-risk Prostate Cancer: A Systematic Review, Meta-analysis, and Metaregression","volume":"5","author":"Baboudjian","year":"2022","journal-title":"Eur. Urol. Oncol."},{"key":"ref_62","doi-asserted-by":"crossref","first-page":"619","DOI":"10.1016\/j.eururo.2014.10.010","article-title":"Active Surveillance for Prostate Cancer: A Systematic Review of Clinicopathologic Variables and Biomarkers for Risk Stratification","volume":"67","author":"Loeb","year":"2015","journal-title":"Eur. Urol."},{"key":"ref_63","doi-asserted-by":"crossref","first-page":"17562872221106883","DOI":"10.1177\/17562872221106883","article-title":"Role of multi-parametric magnetic resonance imaging fusion biopsy in active surveillance of prostate cancer: A systematic review","volume":"14","author":"Ellis","year":"2022","journal-title":"Ther. Adv. Urol."},{"key":"ref_64","doi-asserted-by":"crossref","unstructured":"Brassetti, A., Cacciatore, L., Bove, A.M., Anceschi, U., Proietti, F., Misuraca, L., Tuderti, G., Flammia, R.S., Mastroianni, R., and Ferriero, M.C. (2024). The Impact of Physical Activity on the Outcomes of Active Surveillance in Prostate Cancer Patients: A Scoping Review. Cancers, 16.","DOI":"10.3390\/cancers16030630"},{"key":"ref_65","doi-asserted-by":"crossref","first-page":"207","DOI":"10.1016\/j.prnil.2024.08.001","article-title":"The association between behavioral habits and physical health status in prostate cancer patients: A large US national health-related survey","volume":"12","author":"Chen","year":"2024","journal-title":"Prostate Int."},{"key":"ref_66","doi-asserted-by":"crossref","first-page":"188","DOI":"10.1016\/j.acuro.2020.04.011","article-title":"Papel de la resonancia magn\u00e9tica multiparam\u00e9trica en la selecci\u00f3n y el seguimiento de pacientes en vigilancia activa por c\u00e1ncer de pr\u00f3stata. Revisi\u00f3n del grupo de Uro-Tecnolog\u00eda (ESUT) de la EAU","volume":"45","author":"Rivas","year":"2021","journal-title":"Actas Urol. Esp."},{"key":"ref_67","doi-asserted-by":"crossref","first-page":"751","DOI":"10.1111\/j.1464-410X.2005.05394.x","article-title":"Radical prostatectomy for clinically advanced (cT3) prostate cancer since the advent of prostate-specific antigen testing: 15-year outcome","volume":"95","author":"Ward","year":"2005","journal-title":"BJU Int."},{"key":"ref_68","doi-asserted-by":"crossref","first-page":"376","DOI":"10.1016\/j.euo.2023.10.010","article-title":"Nonsurgical Interventions to Prevent Disease Progression in Prostate Cancer Patients on Active Surveillance: A Systematic Review and Meta-analysis","volume":"7","author":"Matsukawa","year":"2023","journal-title":"Eur. Urol. Oncol."},{"key":"ref_69","first-page":"4911","article-title":"Physical exercise and quality of life in patients with prostate cancer: Systematic review and meta-analysis","volume":"29","author":"Rendeiro","year":"2021","journal-title":"Support. Care Cancer"},{"key":"ref_70","doi-asserted-by":"crossref","unstructured":"Fang, C.Y., Galloway, T.J., Egleston, B.L., Bauman, J.R., Ebersole, B., Chwistek, M., B\u00fchler, J.G., Longacre, M.L., Ridge, J.A., and Manne, S.L. (2020). Development of a Web-Based Supportive Care Program for Patients With Head and Neck Cancer. Front. Oncol., 10.","DOI":"10.3389\/fonc.2020.602202"},{"key":"ref_71","doi-asserted-by":"crossref","first-page":"743","DOI":"10.1016\/j.eururo.2019.07.012","article-title":"Robust Health Utility Assessment Among Long-term Survivors of Prostate Cancer: Results from the Cancer of the Prostate Strategic Urologic Research Endeavor Registry","volume":"76","author":"Jeong","year":"2019","journal-title":"Eur. Urol."},{"key":"ref_72","doi-asserted-by":"crossref","first-page":"102996","DOI":"10.1016\/j.ctrv.2025.102996","article-title":"Exercise in patients with metastatic prostate cancer: A comprehensive review","volume":"139","author":"Carrillo","year":"2025","journal-title":"Cancer Treat. Rev."}],"container-title":["Journal of Clinical Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2077-0383\/15\/9\/3369\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,4,28]],"date-time":"2026-04-28T14:02:04Z","timestamp":1777384924000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2077-0383\/15\/9\/3369"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,4,28]]},"references-count":72,"journal-issue":{"issue":"9","published-online":{"date-parts":[[2026,5]]}},"alternative-id":["jcm15093369"],"URL":"https:\/\/doi.org\/10.3390\/jcm15093369","relation":{},"ISSN":["2077-0383"],"issn-type":[{"value":"2077-0383","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,4,28]]}}}