{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,10]],"date-time":"2026-08-10T14:11:31Z","timestamp":1786371091548,"version":"build-2736575974"},"reference-count":87,"publisher":"MDPI AG","issue":"10","license":[{"start":{"date-parts":[[2026,5,20]],"date-time":"2026-05-20T00:00:00Z","timestamp":1779235200000},"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: Prostate cancer (PCa) is the most commonly diagnosed malignancy in men and a leading cause of cancer-related mortality worldwide. Growing evidence indicates that metabolic syndrome components, including obesity, insulin resistance, and hyperglycemia, contribute to PCa development, and progression to more aggressive form. At the same time, standard treatments such as androgen deprivation therapy (ADT) and androgen receptor pathway inhibitors (ARPIs) significantly improve oncologic outcomes but are associated with adverse metabolic effects, including increased fat mass, insulin resistance, and sarcopenia, potentially worsening patients\u2019 overall metabolic profile and quality of life. Tumor progression in PCa is strongly driven by androgen receptor (AR) signaling, which is closely linked to cellular metabolic reprogramming, highlighting metabolism as a potential therapeutic target. Aim: The aim of this study was to evaluate and synthesize current evidence on the role of the ketogenic diet (KD) in PCa, with particular emphasis on its interaction with hormonal therapies, underlying metabolic and endocrine mechanisms, and its potential application as an adjunctive strategy in integrated oncologic care. Results: The KD, characterized by high fat and very low carbohydrate intake, induces a metabolic state of ketosis that reduces circulating glucose, insulin, and insulin-like growth factor 1 (IGF-1), potentially counteracting metabolic alterations associated with PCa and its treatments. Preclinical studies consistently demonstrate that carbohydrate restriction and KD can slow tumor growth, modulate key oncogenic pathways such as PI3K\/AKT\/mTOR, reduce systemic insulin signaling, and enhance survival in prostate cancer models. Additionally, emerging evidence suggests possible synergistic effects when KD is combined with standard therapies, including ADT and immunotherapy. Clinical data, although limited, indicate that low-carbohydrate dietary interventions may improve metabolic parameters and could delay biochemical progression, as suggested by increased prostate-specific antigen (PSA) doubling time. However, results across studies remain heterogeneous, and robust evidence on long-term oncologic outcomes is lacking. Conclusions: Overall, the KD represents a promising but still experimental strategy in PCa management, requiring careful nutritional supervision to avoid adverse effects such as unintended weight loss or sarcopenia. Further well-designed randomized clinical trials are needed to clarify its safety, efficacy, and role in routine clinical practice.<\/jats:p>","DOI":"10.3390\/jcm15103946","type":"journal-article","created":{"date-parts":[[2026,5,20]],"date-time":"2026-05-20T14:12:54Z","timestamp":1779286374000},"page":"3946","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Ketogenic and Low-Carbohydrate Diets in Prostate Cancer: Metabolic Rationale, Preclinical Evidence, and Preliminary Clinical Data"],"prefix":"10.3390","volume":"15","author":[{"given":"Silvia","family":"Manfrini","sequence":"first","affiliation":[{"name":"Fondazione Policlinico Universitario Campus Bio-Medico, 00128 Roma, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andrea","family":"Malgeri","sequence":"additional","affiliation":[{"name":"Area Oncologia, Universit\u00e0 Campus Bio-Medico di Roma, 00128 Roma, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Carmine","family":"Mone","sequence":"additional","affiliation":[{"name":"Area Oncologia, Universit\u00e0 Campus Bio-Medico di Roma, 00128 Roma, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ludovica Di","family":"Francesco","sequence":"additional","affiliation":[{"name":"Scienza dell\u2019Alimentazione e della Nutrizione Umana, Universit\u00e0 Campus Bio-Medico di Roma, 00128 Roma, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Giulia","family":"Pecora","sequence":"additional","affiliation":[{"name":"Unit\u00e0 di Endocrinologia, Diabetologia e Andrologia, Dipartimento di Medicina Clinica e Molecolare, AOU Sant\u2019Andrea, Universit\u00e0 Sapienza di Roma, 00185 Roma, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rossella","family":"Mazzilli","sequence":"additional","affiliation":[{"name":"Unit\u00e0 di Endocrinologia, Diabetologia e Andrologia, Dipartimento di Medicina Clinica e Molecolare, AOU Sant\u2019Andrea, Universit\u00e0 Sapienza di Roma, 00185 Roma, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2425-5609","authenticated-orcid":false,"given":"Giuseppe","family":"Defeudis","sequence":"additional","affiliation":[{"name":"Fondazione Policlinico Universitario Campus Bio-Medico, 00128 Roma, Italy"},{"name":"Department of Theoretical and Applied Sciences, eCampus University, 22060 Novedrate, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4729-3125","authenticated-orcid":false,"given":"Manon Yeganeh","family":"Khazrai","sequence":"additional","affiliation":[{"name":"Scienza dell\u2019Alimentazione e della Nutrizione Umana, Universit\u00e0 Campus Bio-Medico di Roma, 00128 Roma, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9324-3946","authenticated-orcid":false,"given":"Antongiulio","family":"Faggiano","sequence":"additional","affiliation":[{"name":"Unit\u00e0 di Endocrinologia, Diabetologia e Andrologia, Dipartimento di Medicina Clinica e Molecolare, AOU Sant\u2019Andrea, Universit\u00e0 Sapienza di Roma, 00185 Roma, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,5,20]]},"reference":[{"key":"ref_1","first-page":"209","article-title":"Global Cancer Statistics 2020: GLOBOCAN Estimates of Incidence and Mortality Worldwide for 36 Cancers in 185 Countries","volume":"71","author":"Sung","year":"2021","journal-title":"CA Cancer J. Clin."},{"key":"ref_2","first-page":"471","article-title":"Metabolic syndrome and cancer risk","volume":"49","author":"Esposito","year":"2015","journal-title":"Endocrine"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"34485","DOI":"10.18632\/oncotarget.26128","article-title":"Abdominal obesity and prostate cancer risk: Epidemiological evidence from the EPICAP study","volume":"9","author":"Lavalette","year":"2018","journal-title":"Oncotarget"},{"key":"ref_4","first-page":"154","article-title":"Survival rates of familial and sporadic prostate cancer patients","volume":"37","author":"Plonis","year":"2015","journal-title":"Exp. Oncol."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"10544","DOI":"10.1038\/srep10544","article-title":"A Family History of Lethal Prostate Cancer and Risk of Aggressive Prostate Cancer in Patients Undergoing Radical Prostatectomy","volume":"5","author":"Raheem","year":"2015","journal-title":"Sci. Rep."},{"key":"ref_6","first-page":"1521","article-title":"Prostate cancer and BMI","volume":"171","author":"Freedland","year":"2004","journal-title":"J. Urol."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"238","DOI":"10.1001\/jama.294.2.238","article-title":"Androgen Deprivation Therapy for Prostate Cancer","volume":"294","author":"Sharifi","year":"2005","journal-title":"JAMA"},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"2719","DOI":"10.1038\/emboj.2011.158","article-title":"The androgen receptor fuels prostate cancer by regulating central metabolism and biosynthesis","volume":"30","author":"Massie","year":"2011","journal-title":"EMBO J."},{"key":"ref_9","first-page":"211","article-title":"Cancer metabolism review","volume":"17","author":"Swinnen","year":"2020","journal-title":"Nat. Rev. Urol."},{"key":"ref_10","first-page":"587","article-title":"Metabolic control in prostate cancer","volume":"66","year":"2017","journal-title":"Mol. Cell"},{"key":"ref_11","first-page":"293","article-title":"Prostate cancer treatment","volume":"1","author":"Huggins","year":"1941","journal-title":"Cancer Res."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"1402","DOI":"10.1200\/JCO.2015.64.2702","article-title":"Trial Design and Objectives for Castration-Resistant Prostate Cancer: Updated Recommendations from the Prostate Cancer Clinical Trials Working Group 3","volume":"34","author":"Scher","year":"2016","journal-title":"J. Clin. Oncol. Off. J. Am. Soc. Clin. Oncol."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"3595","DOI":"10.1200\/JCO.23.00041","article-title":"Darolutamide Plus Androgen-Deprivation Therapy and Docetaxel in Metastatic Hormone-Sensitive Prostate Cancer by Disease Volume and Risk Subgroups in the Phase III ARASENS Trial","volume":"41","author":"Hussain","year":"2023","journal-title":"J. Clin. Oncol."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"4271","DOI":"10.1200\/JCO-24-01798","article-title":"Darolutamide in Combination with Androgen-Deprivation Therapy in Patients with Metastatic Hormone-Sensitive Prostate Cancer from the Phase III ARANOTE Trial","volume":"42","author":"Saad","year":"2024","journal-title":"J. Clin. Oncol."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"352","DOI":"10.1056\/NEJMoa1704174","article-title":"Abiraterone plus Prednisone in Metastatic, Castration-Sensitive Prostate Cancer","volume":"377","author":"Fizazi","year":"2017","journal-title":"N. Engl. J. Med."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"1616","DOI":"10.1200\/JCO.22.00193","article-title":"Improved Survival with Enzalutamide in Patients with Metastatic Hormone-Sensitive Prostate Cancer","volume":"40","author":"Armstrong","year":"2022","journal-title":"J. Clin. Oncol. Off. J. Am. Soc. Clin. Oncol."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"121","DOI":"10.1056\/NEJMoa1903835","article-title":"Enzalutamide with Standard First-Line Therapy in Metastatic Prostate Cancer","volume":"381","author":"Davis","year":"2019","journal-title":"N. Engl. J. Med."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"13","DOI":"10.1056\/NEJMoa1903307","article-title":"Apalutamide for Metastatic, Castration-Sensitive Prostate Cancer","volume":"381","author":"Chi","year":"2019","journal-title":"N. Engl. J. Med."},{"key":"ref_19","first-page":"707","article-title":"ADT side effects","volume":"12","author":"Morgans","year":"2014","journal-title":"J. Natl. Compr. Cancer Netw."},{"key":"ref_20","first-page":"993","article-title":"Cardiovascular risk with ADT","volume":"69","author":"Sun","year":"2016","journal-title":"Eur. Urol."},{"key":"ref_21","first-page":"E742","article-title":"Metabolic effects of ADT","volume":"96","author":"Hamilton","year":"2011","journal-title":"J. Clin. Endocrinol. Metab."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"1124","DOI":"10.1158\/1940-6207.CAPR-10-0071","article-title":"Low-Carbohydrate Diets and Prostate Cancer: How Low Is \u201cLow Enough\u201d?","volume":"3","author":"Masko","year":"2010","journal-title":"Cancer Prev. Res."},{"key":"ref_23","unstructured":"Klement, R.J. (2014). KD as cancer therapy. Front. Nutr., 1."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"963","DOI":"10.1016\/j.redox.2014.08.002","article-title":"Ketogenic diets as an adjuvant cancer therapy: History and potential mechanism","volume":"2","author":"Allen","year":"2014","journal-title":"Redox Biol."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1007\/s11154-020-09546-9","article-title":"Confusion in the nomenclature of ketogenic diets blurs evidence","volume":"21","author":"Trimboli","year":"2020","journal-title":"Rev. Endocr. Metab. Disord."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"552","DOI":"10.1007\/s13668-024-00560-w","article-title":"A New Nomenclature for the Very Low-Calorie Ketogenic Diet (VLCKD): Very Low-Energy Ketogenic Therapy (VLEKT). Ketodiets and Nutraceuticals Expert Panels: \u2018KetoNut\u2019, Italian Society of Nutraceuticals (SINut) and the Italian Association of Dietetics and Clinical Nutrition (ADI)","volume":"13","author":"Barrea","year":"2024","journal-title":"Curr. Nutr. Rep."},{"key":"ref_27","unstructured":"Masood, W., Annamaraju, P., Khan Suheb, M.Z., and Uppaluri, K.R. (2025, July 11). Ketogenic Diet, StatPearls, Available online: http:\/\/www.ncbi.nlm.nih.gov\/books\/NBK499830\/."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"1800","DOI":"10.1080\/10408398.2020.1847030","article-title":"Could ketogenic diet \u201cstarve\u201d cancer? Emerging evidence","volume":"62","author":"Barrea","year":"2022","journal-title":"Crit. Rev. Food Sci. Nutr."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"1365","DOI":"10.1007\/s40618-019-01061-2","article-title":"Very-low-calorie ketogenic diet (VLCKD) in the management of metabolic diseases: Systematic review and consensus statement from the Italian Society of Endocrinology (SIE)","volume":"42","author":"Caprio","year":"2019","journal-title":"J. Endocrinol. Investig."},{"key":"ref_30","unstructured":"AIOM (2024). Linee Guida: Carcinoma Della Prostata, AIOM (Associazione Italiana di Oncologia Medica)."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"102","DOI":"10.1016\/j.molmet.2019.06.026","article-title":"Ketogenic diet in the treatment of cancer\u2014Where do we stand?","volume":"33","author":"Weber","year":"2019","journal-title":"Mol. Metab."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"132","DOI":"10.1007\/s12032-017-0991-5","article-title":"Beneficial effects of ketogenic diets for cancer patients: A realist review with focus on evidence and confirmation","volume":"34","author":"Klement","year":"2017","journal-title":"Med. Oncol."},{"key":"ref_33","doi-asserted-by":"crossref","unstructured":"Fujita, K., Hayashi, T., Matsushita, M., Uemura, M., and Nonomura, N. (2019). Obesity, Inflammation, and Prostate Cancer. J. Clin. Med., 8.","DOI":"10.3390\/jcm8020201"},{"key":"ref_34","doi-asserted-by":"crossref","unstructured":"Hayashi, T., Fujita, K., Matsushita, M., and Nonomura, N. (2019). Main Inflammatory Cells and Potentials of Anti-Inflammatory Agents in Prostate Cancer. Cancers, 11.","DOI":"10.3390\/cancers11081153"},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"2898","DOI":"10.1016\/j.clnu.2021.02.005","article-title":"ESPEN practical guideline: Clinical Nutrition in cancer","volume":"40","author":"Muscaritoli","year":"2021","journal-title":"Clin. Nutr."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"125","DOI":"10.1007\/s11060-014-1362-0","article-title":"Targeting metabolism with a ketogenic diet during the treatment of glioblastoma multiforme","volume":"117","author":"Champ","year":"2014","journal-title":"J. Neuro-Oncol."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"1843","DOI":"10.3892\/ijo.2014.2382","article-title":"ERGO: A pilot study of ketogenic diet in recurrent glioblastoma","volume":"44","author":"Rieger","year":"2014","journal-title":"Int. J. Oncol."},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"3","DOI":"10.1186\/s40170-015-0129-1","article-title":"Treatment of glioma patients with ketogenic diets: Report of two cases treated with an IRB-approved energy-restricted ketogenic diet protocol and review of the literature","volume":"3","author":"Schwartz","year":"2015","journal-title":"Cancer Metab."},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"267","DOI":"10.1007\/s11060-016-2364-x","article-title":"Changes in cerebral metabolism during ketogenic diet in patients with primary brain tumors: 1H-MRS study","volume":"132","author":"Artzi","year":"2017","journal-title":"J. Neuro-Oncol."},{"key":"ref_40","first-page":"1263","article-title":"Efficacy of a ketogenic diet with concomitant intranasal perillyl alcohol as a novel strategy for the therapy of recurrent glioblastoma","volume":"15","author":"Santos","year":"2018","journal-title":"Oncol. Lett."},{"key":"ref_41","doi-asserted-by":"crossref","unstructured":"Elsakka, A.M.A., Bary, M.A., Abdelzaher, E., Elnaggar, M., Kalamian, M., Mukherjee, P., and Seyfried, T.N. (2018). Management of Glioblastoma Multiforme in a Patient Treated with Ketogenic Metabolic Therapy and Modified Standard of Care: A 24-Month Follow-Up. Front. Nutr., 5.","DOI":"10.3389\/fnut.2018.00020"},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"643","DOI":"10.1080\/01635581.2018.1460677","article-title":"The Modified Ketogenic Diet in Adults with Glioblastoma: An Evaluation of Feasibility and Deliverability within the National Health Service","volume":"70","author":"Marson","year":"2018","journal-title":"Nutr. Cancer"},{"key":"ref_43","first-page":"5525","article-title":"Effects of Pre-surgical Vitamin D Supplementation and Ketogenic Diet in a Patient with Recurrent Breast Cancer","volume":"35","author":"Branca","year":"2015","journal-title":"Anticancer Res."},{"key":"ref_44","doi-asserted-by":"crossref","unstructured":"Klement, R.J., and Sweeney, R.A. (2016). Impact of a ketogenic diet intervention during radiotherapy on body composition: I. Initial clinical experience with six prospectively studied patients. BMC Res. Notes, 9.","DOI":"10.1186\/s13104-016-1959-9"},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"584","DOI":"10.3892\/ol.2015.3923","article-title":"The development of tumours under a ketogenic diet in association with the novel tumour marker TKTL1: A case series in general practice","volume":"11","author":"Jansen","year":"2016","journal-title":"Oncol. Lett."},{"key":"ref_46","doi-asserted-by":"crossref","first-page":"743","DOI":"10.1667\/RR14668.1","article-title":"Consuming a Ketogenic Diet while Receiving Radiation and Chemotherapy for Locally Advanced Lung and Pancreatic Cancer: The University of Iowa Experience of Two Phase I Clinical Trials","volume":"187","author":"Zahra","year":"2017","journal-title":"Radiat. Res."},{"key":"ref_47","doi-asserted-by":"crossref","unstructured":"Cohen, C.W., Fontaine, K.R., Arend, R.C., Soleymani, T., and Gower, B.A. (2018). Favorable Effects of a Ketogenic Diet on Physical Function, Perceived Energy, and Food Cravings in Women with Ovarian or Endometrial Cancer: A Randomized, Controlled Trial. Nutrients, 10.","DOI":"10.3390\/nu10091187"},{"key":"ref_48","doi-asserted-by":"crossref","first-page":"1253","DOI":"10.1093\/jn\/nxy119","article-title":"A Ketogenic Diet Reduces Central Obesity and Serum Insulin in Women with Ovarian or Endometrial Cancer","volume":"148","author":"Cohen","year":"2018","journal-title":"J. Nutr."},{"key":"ref_49","doi-asserted-by":"crossref","first-page":"180","DOI":"10.1016\/j.jtcme.2019.03.007","article-title":"A ketogenic diet exerts beneficial effects on body composition of cancer patients during radiotherapy: An interim analysis of the KETOCOMP study","volume":"10","author":"Klement","year":"2020","journal-title":"J. Tradit. Complement. Med."},{"key":"ref_50","doi-asserted-by":"crossref","first-page":"87","DOI":"10.1186\/s12937-020-00596-y","article-title":"Does a ketogenic diet have beneficial effects on quality of life, physical activity or biomarkers in patients with breast cancer: A randomized controlled clinical trial","volume":"19","author":"Khodabakhshi","year":"2020","journal-title":"Nutr. J."},{"key":"ref_51","doi-asserted-by":"crossref","first-page":"981","DOI":"10.1007\/s00066-022-01941-2","article-title":"Impact of a ketogenic diet intervention during radiotherapy on body composition: V. Final results of the KETOCOMP study for head and neck cancer patients","volume":"198","author":"Klement","year":"2022","journal-title":"Strahlenther. Onkol."},{"key":"ref_52","doi-asserted-by":"crossref","unstructured":"Yang, Y.F., Mattamel, P.B., Joseph, T., Huang, J., Chen, Q., Akinwunmi, B.O., Zhang, C.J.P., and Ming, W.K. (2021). Efficacy of Low-Carbohydrate Ketogenic Diet as an Adjuvant Cancer Therapy: A Systematic Review and Meta-Analysis of Randomized Controlled Trials. Nutrients, 13.","DOI":"10.3390\/nu13051388"},{"key":"ref_53","doi-asserted-by":"crossref","first-page":"1222","DOI":"10.1080\/01635581.2021.1942081","article-title":"The effect of ketogenic diet on weight loss in adult patients with cancer: A systematic review and meta-analysis of controlled clinical trials","volume":"74","author":"Taftian","year":"2022","journal-title":"Nutr. Cancer"},{"key":"ref_54","doi-asserted-by":"crossref","unstructured":"Chen, S., Su, X., Feng, Y., Li, R., Liao, M., Fan, L., Liu, J., Chen, S., Zhang, S., and Cai, J. (2023). Ketogenic Diet and Multiple Health Outcomes: An Umbrella Review of Meta-Analysis. Nutrients, 15.","DOI":"10.3390\/nu15194161"},{"key":"ref_55","doi-asserted-by":"crossref","first-page":"R219","DOI":"10.1530\/ERC-15-0556","article-title":"Androgen control of cell metabolism in prostate cancer: Novel insights and future directions","volume":"23","author":"Butler","year":"2016","journal-title":"Endocr. Relat. Cancer"},{"key":"ref_56","first-page":"433","article-title":"Prostatic fluid electrolyte composition and its significance","volume":"5","author":"Costello","year":"1984","journal-title":"Prostate"},{"key":"ref_57","first-page":"1185","article-title":"Metabolic reprogramming in prostate cancer: Recent advances and future directions","volume":"130","author":"Lin","year":"2024","journal-title":"Br. J. Cancer"},{"key":"ref_58","first-page":"671","article-title":"Steroid receptor coactivators: Critical players in steroid hormone receptor action","volume":"34","author":"Schmidt","year":"2013","journal-title":"Endocr. Rev."},{"key":"ref_59","doi-asserted-by":"crossref","first-page":"15","DOI":"10.1016\/j.urology.2006.03.073","article-title":"Is there a role for a low-carbohydrate ketogenic diet in the management of prostate cancer?","volume":"68","author":"Mavropoulos","year":"2006","journal-title":"Urology"},{"key":"ref_60","doi-asserted-by":"crossref","first-page":"T57","DOI":"10.1530\/ERC-13-0515","article-title":"Androgen-regulated metabolism and biosynthesis in prostate cancer","volume":"21","author":"Barfeld","year":"2014","journal-title":"Endocr.-Relat. Cancer"},{"key":"ref_61","doi-asserted-by":"crossref","first-page":"545","DOI":"10.1158\/1940-6207.CAPR-14-0442","article-title":"Dietary patterns after prostate cancer diagnosis in relation to disease-specific and total mortality","volume":"8","author":"Yang","year":"2015","journal-title":"Cancer Prev. Res."},{"key":"ref_62","doi-asserted-by":"crossref","first-page":"2462","DOI":"10.1002\/ijc.29608","article-title":"Dairy intake after prostate cancer diagnosis in relation to disease-specific and total mortality","volume":"137","author":"Yang","year":"2015","journal-title":"Int. J. Cancer"},{"key":"ref_63","doi-asserted-by":"crossref","first-page":"887","DOI":"10.1016\/j.eururo.2013.08.009","article-title":"Mediterranean diet and prostate cancer risk and mortality in the Health Professionals Follow-up Study","volume":"65","author":"Kenfield","year":"2014","journal-title":"Eur. Urol."},{"key":"ref_64","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":"2023","journal-title":"Nutr. Cancer"},{"key":"ref_65","doi-asserted-by":"crossref","first-page":"e249053","DOI":"10.1001\/jamanetworkopen.2024.9053","article-title":"Plant-Based Diets and Disease Progression in Men with Prostate Cancer","volume":"7","author":"Liu","year":"2024","journal-title":"JAMA Netw. Open"},{"key":"ref_66","doi-asserted-by":"crossref","first-page":"11","DOI":"10.1002\/pros.20683","article-title":"Carbohydrate restriction, prostate cancer growth, and the insulin-like growth factor axis","volume":"68","author":"Freedland","year":"2008","journal-title":"Prostate"},{"key":"ref_67","doi-asserted-by":"crossref","first-page":"557","DOI":"10.1158\/1940-6207.CAPR-08-0188","article-title":"The effects of varying dietary carbohydrate and fat content on survival in a murine LNCaP prostate cancer xenograft model","volume":"2","author":"Mavropoulos","year":"2009","journal-title":"Cancer Prev. Res."},{"key":"ref_68","doi-asserted-by":"crossref","first-page":"1062","DOI":"10.1111\/j.1464-410X.2012.10971.x","article-title":"Carbohydrate restriction and lactate transporter inhibition in a mouse xenograft model of human prostate cancer","volume":"110","author":"Kim","year":"2012","journal-title":"BJU Int."},{"key":"ref_69","doi-asserted-by":"crossref","first-page":"449","DOI":"10.1002\/pros.22586","article-title":"The effect of carbohydrate restriction on prostate cancer tumor growth in a castrate mouse xenograft model","volume":"73","author":"Caso","year":"2013","journal-title":"Prostate"},{"key":"ref_70","doi-asserted-by":"crossref","first-page":"165","DOI":"10.1038\/pcan.2016.73","article-title":"Impact of carbohydrate restriction in the context of obesity on prostate tumor growth in the Hi-Myc transgenic mouse model","volume":"20","author":"Allott","year":"2017","journal-title":"Prostate Cancer Prostatic Dis."},{"key":"ref_71","doi-asserted-by":"crossref","first-page":"625","DOI":"10.1194\/jlr.M082040","article-title":"Low ketolytic enzyme levels in tumors predict ketogenic diet responses in cancer cell lines in vitro and in vivo","volume":"59","author":"Zhang","year":"2018","journal-title":"J. Lipid Res."},{"key":"ref_72","doi-asserted-by":"crossref","first-page":"1589","DOI":"10.1074\/mcp.M112.023887","article-title":"Quantitative proteomics reveals that enzymes of the ketogenic pathway are associated with prostate cancer progression","volume":"12","author":"Saraon","year":"2013","journal-title":"Mol. Cell Proteom."},{"key":"ref_73","doi-asserted-by":"crossref","first-page":"372","DOI":"10.1002\/pros.22758","article-title":"Evaluation and prognostic significance of ACAT1 as a marker of prostate cancer progression","volume":"74","author":"Saraon","year":"2014","journal-title":"Prostate"},{"key":"ref_74","doi-asserted-by":"crossref","first-page":"1597","DOI":"10.1158\/0008-5472.CAN-23-2742","article-title":"Ketogenic diet alters the epigenetic and immune landscape of prostate cancer to overcome resistance to immune checkpoint blockade therapy","volume":"84","author":"Murphy","year":"2024","journal-title":"Cancer Res."},{"key":"ref_75","doi-asserted-by":"crossref","first-page":"24","DOI":"10.1038\/s41389-025-00567-0","article-title":"Ketone drink enhances therapeutic efficacy in prostate cancer by targeting EZH2","volume":"14","author":"Yum","year":"2025","journal-title":"Oncogenesis"},{"key":"ref_76","doi-asserted-by":"crossref","first-page":"525","DOI":"10.1080\/1750743X.2025.2511472","article-title":"Dietary influences on prostate cancer immunotherapy","volume":"17","author":"Duong","year":"2025","journal-title":"Immunotherapy"},{"key":"ref_77","doi-asserted-by":"crossref","first-page":"359","DOI":"10.1158\/1541-7786.MCR-22-0796","article-title":"Multisubstrate metabolic tracing reveals marked heterogeneity and dependence on fatty acid metabolism in human prostate cancer","volume":"21","author":"Fidelito","year":"2023","journal-title":"Mol. Cancer Res."},{"key":"ref_78","doi-asserted-by":"crossref","first-page":"3035","DOI":"10.1158\/1078-0432.CCR-19-3873","article-title":"A randomized controlled trial of a 6-month low-carbohydrate intervention on disease progression in men with recurrent prostate cancer: Carbohydrate and Prostate Study 2 (CAPS2)","volume":"26","author":"Freedland","year":"2020","journal-title":"Clin. Cancer Res."},{"key":"ref_79","doi-asserted-by":"crossref","first-page":"770","DOI":"10.1038\/s41391-022-00525-6","article-title":"Serum metabolomic analysis of men on a low-carbohydrate diet for biochemically recurrent prostate cancer reveals the potential role of ketogenesis to slow tumor growth: A secondary analysis of the CAPS2 diet trial","volume":"25","author":"Chi","year":"2022","journal-title":"Prostate Cancer Prostatic Dis."},{"key":"ref_80","doi-asserted-by":"crossref","first-page":"1221","DOI":"10.1080\/07853890.2022.2069853","article-title":"Weight loss via a low-carbohydrate diet improved the intestinal permeability marker, zonulin, in prostate cancer patients","volume":"54","author":"Lin","year":"2022","journal-title":"Ann. Med."},{"key":"ref_81","doi-asserted-by":"crossref","first-page":"k4365","DOI":"10.1136\/bmj.k4365","article-title":"Sodium glucose cotransporter 2 inhibitors and risk of serious adverse events: Nationwide register based cohort study","volume":"363","author":"Ueda","year":"2018","journal-title":"BMJ"},{"key":"ref_82","doi-asserted-by":"crossref","first-page":"949","DOI":"10.1016\/S2213-8587(19)30154-8","article-title":"SGLT2 inhibitors as adjunctive therapy for type 1 diabetes: Balancing benefits and risks","volume":"7","author":"Taylor","year":"2019","journal-title":"Lancet Diabetes Endocrinol."},{"key":"ref_83","doi-asserted-by":"crossref","first-page":"1687","DOI":"10.2337\/dc15-0843","article-title":"Euglycemic diabetic ketoacidosis: A potential complication of treatment with sodium\u2013glucose cotransporter 2 inhibition","volume":"38","author":"Peters","year":"2015","journal-title":"Diabetes Care"},{"key":"ref_84","doi-asserted-by":"crossref","first-page":"150","DOI":"10.1016\/j.eururo.2020.08.011","article-title":"Apalutamide and overall survival in prostate cancer","volume":"79","author":"Smith","year":"2021","journal-title":"Eur. Urol."},{"key":"ref_85","doi-asserted-by":"crossref","first-page":"2465","DOI":"10.1056\/NEJMoa1800536","article-title":"Enzalutamide in men with nonmetastatic, castration-resistant prostate cancer","volume":"378","author":"Hussain","year":"2018","journal-title":"N. Engl. J. Med."},{"key":"ref_86","first-page":"508","article-title":"Androgen deprivation therapy and cardiovascular risk in prostate cancer","volume":"74","author":"Fiori","year":"2022","journal-title":"Minerva Urol. Nephrol."},{"key":"ref_87","doi-asserted-by":"crossref","first-page":"11","DOI":"10.1016\/j.clnu.2016.07.015","article-title":"ESPEN guidelines on nutrition in cancer patients","volume":"36","author":"Arends","year":"2017","journal-title":"Clin. Nutr."}],"container-title":["Journal of Clinical Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2077-0383\/15\/10\/3946\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,5,22]],"date-time":"2026-05-22T09:45:15Z","timestamp":1779443115000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2077-0383\/15\/10\/3946"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,5,20]]},"references-count":87,"journal-issue":{"issue":"10","published-online":{"date-parts":[[2026,5]]}},"alternative-id":["jcm15103946"],"URL":"https:\/\/doi.org\/10.3390\/jcm15103946","relation":{},"ISSN":["2077-0383"],"issn-type":[{"value":"2077-0383","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,5,20]]}}}