Exercise appears well positioned as one component of a broader survivorship strategy during active surveillance for low-risk prostate cancer, with current value best supported for health, fitness, function, and well-being rather than as an anticancer treatment, and it should complement rather than replace evidence-based oncologic surveillance.
Exercise-oncology evidence and AS-specific trials support benefits of structured exercise on cardiorespiratory fitness and selected psychosocial outcomes in men on active surveillance.
A 2024 systematic review and meta-analysis of six randomized trials found improved VO2peak with exercise during active surveillance, while effects on quality of life and PSA were less certain.
Evidence is insufficient to show that exercise or other lifestyle interventions consistently affect biopsy upgrading, MRI progression, durable deferral of treatment, or long-term prostate cancer outcomes.
The review proposes a survivorship framework for individualized exercise prescription during active surveillance, including readiness monitoring as an emerging concept.
Readiness monitoring, including the Hooper Wellness Index, has not been validated in men on active surveillance and is hypothesis-generating rather than established clinical practice.
Exercise should complement rather than replace evidence-based oncologic surveillance in men on active surveillance.
This review looked at what is known about exercise for men with low-risk prostate cancer who are being monitored with active surveillance instead of receiving immediate treatment. Because monitoring can last for years, the author argues that attention to overall health and well-being during this time is important. The research summarized suggests exercise can improve cardiorespiratory fitness (measured as VO2peak). A 2024 meta-analysis of six randomized trials with 332 participants found this improvement, but effects on quality of life and PSA levels were less clear. There is not enough evidence to say exercise changes biopsy results, MRI progression, how long treatment can be put off, or long-term cancer outcomes. The review also proposes a framework for tailoring exercise programs and floats the idea of tracking how ready someone is to exercise, for example with the Hooper Wellness Index. This idea has not been tested in men on active surveillance. Overall, this research suggests exercise is best viewed as support for fitness and well-being alongside, not instead of, regular cancer monitoring.
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Upload Your LabsMiller J. (2026). Exercise During Active Surveillance for Localized Low-Risk Prostate Cancer: Current Evidence and a Survivorship Framework.. Current oncology (Toronto, Ont.). https://doi.org/10.3390/curroncol33100599