Prostate cancer (PC) is a highly prevalent malignant tumour associated with significant morbidity and mortality. While physical activity has been linked to a lower risk of PC and exercise has been shown to reduce mortality, the evidence for the association between physical activity and mortality is limited.
This study aimed to assess the association between physical activity and mortality risk in men with or at risk of PC.
A systematic search was conducted in Medline, Scopus and Web of Science from inception until April 2026. Observational studies analysing physical activity and all-cause and PC-specific mortality were included. The data were synthesised and interpreted using a synthesis without meta-analysis (SWiM) approach. The quality of the studies was assessed using the NHLBI tool. The certainty of the evidence was assessed using the GRADE framework.
Fifteen observational studies were included. The hazard ratio (HR) was the predominant effect measure. Physical activity was associated with a reduction in all-cause mortality (HRs: 0.40-0.88; highest versus lowest categories), and a dose-response gradient was observed within two cohorts. Associations with PC-specific mortality were less consistent, with significant inverse findings concentrated in post-diagnosis assessments. The quality of the studies was generally poor, and the certainty of the evidence was very low for both outcomes.
Physical activity was associated with lower all-cause mortality risk in men with or at risk of PC, and the most consistent inverse estimates were observed in post-diagnostic assessments. These findings are observational and should not be interpreted as a clinical recommendation. A dose-response pattern was noted within individual studies, although the certainty of evidence was very low for this outcome. Additionally, evidence for PC-specific mortality was inconsistent and of very low certainty. Prospective studies with standardised, objective measures of physical activity are required.
Healthcare (Basel, Switzerland). 2026 Jul 05*** epublish ***
Nacho García-Miralles, Irene Martínez-García, Irene Marcilla-Toribio, Andrea Herreros-Solano, Jaime Fernández-Bravo-Rodrigo, Silvana Patiño-Cardona, Elena Moreno-Charco, Amparo María Ortega-Armiñana, María Gregori-Navarro, Carlos Pascual-Morena
Health and Social Research Center, University of Castilla-La Mancha, 16071 Cuenca, Spain., Faculty of Nursing, University of Castilla-La Mancha, 02006 Albacete, Spain., CarVasCare Research Group, Faculty of Nursing, University of Castilla-La Mancha, 16001 Cuenca, Spain.