Exercise During Active Surveillance for Localized Low-Risk Prostate Cancer: Current Evidence and a Survivorship...

Active Surveillance (AS) is an established management strategy for appropriately selected men with localized low-risk prostate cancer, allowing many to defer or avoid definitive treatment while remaining under structured oncologic monitoring. Because surveillance may continue for years, survivorship needs during this period warrant greater attention.

This narrative and conceptual review summarizes current evidence regarding structured exercise during AS and proposes a survivorship framework for individualized exercise prescription, including readiness monitoring as an emerging concept.

Exercise-oncology evidence and AS-specific trials support benefits in cardiorespiratory fitness and selected psychosocial outcomes. A 2024 systematic review and meta-analysis of six randomized trials (332 participants) found improved VO2peak, while effects on quality of life and PSA were less certain. Recent reviews likewise conclude that exercise and other lifestyle interventions are feasible and may provide supportive benefits, but evidence remains insufficient to demonstrate consistent effects on biopsy upgrading, MRI progression, durable deferral of treatment, or long-term prostate cancer outcomes. Readiness monitoring, including potential use of the Hooper Wellness Index, has not been validated in this population and is therefore hypothesis-generating rather than established clinical practice.

Exercise appears well positioned as one component of a broader survivorship strategy during AS. Its current value is 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.