Dietary pathways in prostate cancer: Insulin and inflammation

In discussing the links between diet and prostate cancer, Stephen J. Freedland, MD, a professor of urology at Cedars-Sinai in Los Angeles, California, emphasized 2 primary biological mechanisms: insulin signaling and inflammation. Across multiple studies, diets that increase insulin levels and inflammatory responses have consistently been associated with higher risk of developing prostate cancer or experiencing disease progression. Conversely, diets that lower insulin and inflammation appear protective. Observational data, such as findings that nonsteroidal anti-inflammatory drugs may reduce prostate cancer risk, further highlight the role of inflammation, though randomized trial data remain limited.

For clinicians counseling patients Freedland acknowledged the challenge of distilling complex and heterogeneous dietary data into actionable advice during brief appointments. He recommends a practical approach: advise patients to avoid simple sugars, ultra-processed foods, and refined carbohydrates—dietary factors that spike insulin and inflammation. Instead, patients should focus on plant-based, whole-food dietary patterns or low-carbohydrate diets, both of which align with mechanisms shown to be protective. He stressed that consistency is key, whether patients lean toward Mediterranean, plant-based, or low-carb frameworks, provided the diet minimizes processed foods and emphasizes natural, unprocessed sources. Vigorous exercise, though outside the scope of the reviewed studies, was also highlighted as strongly supportive of overall health.

Importantly, Freedland placed dietary guidance within the broader context of survivorship care. With advances in systemic therapies, imaging, and local interventions, prostate cancer for many men now resembles a chronic disease. Consequently, heart disease has emerged as the leading cause of death in this population. Lifestyle modifications—healthy weight maintenance, regular exercise, smoking cessation, blood pressure and cholesterol control—provide dual benefits, supporting both cardiovascular and prostate cancer outcomes. He framed lifestyle change as a “twofer”: offering cancer protection alongside heart health, with minimal risks and substantial potential benefits.

REFERENCE

1. Lin P-H, Burwell AD, Giovannucci EL, et al. Dietary patterns in prostate cancer prevention and management: A systematic review of prospective cohort studies and randomized clinical trials. Eur Urol. 2025 Aug 19:S0302-2838(25)00433-6. doi:10.1016/j.eururo.2025.07.017