To determine whether post-diagnosis dietary patterns, lifestyle scores, and related indices are associated with prostate cancer (PCa) clinical outcomes, with the goal of informing evidence-based strategies for survivorship and secondary prevention.

Adult men (≥18 years) diagnosed with PCa.

Clinical trials and cohort studies reporting on PCa progression, recurrence, PCa-specific mortality (PCSM), and PSA kinetics. All-cause mortality (ACM) was considered only when accompanied by PCa-specific endpoints.

PubMed, Embase and the Cochrane Library were searched from January 1, 2005 to May 3, 2025. Eligible studies assessed individual-level post-diagnosis diet or lifestyle exposures using diet or composite indices. Titles and abstracts were screened by two independent reviewers, with full texts of eligible studies assessed in duplicate.

A total of 21 studies were included.Although not all studies agree, several studies suggest that eating plant foods, adopting healthful diets and lifestyle patterns (as defined herein), and minimizing consumption of inflammatory foods and those with higher insulinemic potential may potentially lower the risk of PCa progression and PCSM. The data also indicate that following Mediterranean, Healthy Eating Index, and Prudent dietary patterns, healthy behaviors, and World Cancer Research Fund/American Institute of Cancer Research recommendations are associated with lower risk of ACM, while the Western dietary pattern and eating foods with higher insulinemic potential are associated with increased risk of ACM.

Current evidence suggests that healthy dietary practices combined with healthy lifestyle behaviors (not smoking, regular physical activity, maintaining a healthy weight) may reduce PCa progression and ACM, with some evidence reported for PCSM. Additional robust cohort and interventional studies with longer follow-up and a greater number of PCSM events are needed. Consideration should be given to incorporating principles of healthy diet and lifestyle as part of PCa survivorship care. A summary Table with diet and lifestyle recommendations is provided for health-care providers.