Evidence-based perioperative nutritional management for patients undergoing prostate cancer surgery: a systematic...

Perioperative nutritional management is crucial for patients undergoing prostate cancer (PCa) surgery, as malnutrition is prevalent and strongly associated with increased complications and impaired recovery. Despite numerous guidelines for cancer or surgical patients, evidence specific to the perioperative care of prostatectomy patients remains fragmented, inconsistent, and lacks a unified, up-to-date synthesis, creating a barrier to consistent clinical application. This review aimed to systematically search, appraise, and synthesize the best available evidence on perioperative nutritional support for patients undergoing PCa surgery, addressing the current fragmentation in existing guidelines and recommendations.

The PICOS framework defined the scope: Patients undergoing PCa surgery; Interventions of perioperative nutritional management; Compared to standard care or alternative strategies; Outcomes including nutritional indicators, complications, and quality of life; Study types including guidelines, expert consensus, systematic reviews, evidence summaries, and randomized controlled trials (RCTs). A comprehensive search of PubMed, Embase, CINAHL, Cochrane Library, and CNKI was conducted up to March 2026. Two reviewers (T.C., M.L.) independently screened studies, assessed quality [using Appraisal of Guidelines for Research & Evaluation II (AGREE II) for guidelines and JBI tools for other study types], and extracted data. Evidence was synthesized and graded (JBI system, Level 1-5).

Fourteen studies were included: 4 guidelines, 5 expert consensus documents, 3 systematic reviews, 1 evidence summary, and 1 RCT. The guidelines demonstrated high methodological quality. All other study types were rated as "yes" across all evaluated items, indicating acceptable to high quality. From these, 30 best-evidence recommendations were synthesized, covering six domains: preoperative nutritional assessment, optimal timing of supplementation, personalized formulation, enteral nutrition selection, management strategies, and health education.

This review consolidates evidence-based recommendations to guide perioperative nutritional care for prostatectomy patients, supporting early screening, personalized oral nutritional supplements (ONS), and sustained health education. However, evidence regarding stage-specific needs, particularly for patients receiving androgen deprivation therapy (ADT), remains limited and represents a key priority for future high-quality research.