Exercise-Based Interventions for Metabolic and Immune Modulation in Prostate Cancer: A Systematic Review and Meta-Analysis of RCTs

Abstract

Purpose

Prostate cancer is the most common malignancy in men and often leads to treatment-related morbidity, including metabolic alterations and chronic low-grade inflammation. Exercise has been proposed as a supportive strategy to mitigate treatment-related adverse effects. This study systematically reviews the impact of exercise on metabolic-, inflammatory-, hormonal- and tumour-related biomarkers in men with prostate cancer. A meta-analysis explored potential effects according to exercise type.

Methods

This systematic review followed PRISMA guidelines and included studies from PubMed, Scopus and Web of Science. Eligible studies involved prostate cancer patients, an exercise intervention and reported outcomes on metabolic, immune or tumour markers. Only randomised controlled trials with a control group were included. Twenty-five articles fulfilled the inclusion criteria. The methodological quality of the studies was assessed using the Cochrane Collaboration’s tool.

Results

A total of 1,093 male participants were included across trials involving resistance, aerobic, combined exercise or yoga interventions. The meta-analysis showed a significant reduction in insulin levels within the combined exercise subgroup (p = 0.03). C-reactive protein was also significantly reduced in pooled analyses (p = 0.001). No consistent significant effects were observed for testosterone, glucose, IL-6 or prostate-specific antigen.

Conclusions

Exercise may induce modest changes in selected systemic biomarkers, particularly CRP, in men with prostate cancer undergoing treatment. However, effects were heterogeneous and generally small, and current evidence does not demonstrate consistent tumour-related modification. Exercise remains an important supportive strategy to enhance physiological resilience, but larger, high-quality trials are required to clarify clinical relevance.