Review Article|Articles in Press

Should Men Eat More Plants? A Systematic Review of the Literature on the Effect of Plant-Forward Diets on Men's Health



      To perform a systematic review of the literature on plant-based and plant-forward diets and the prevention/treatment of the following common men's health conditions: prostate cancer (PCa), erectile dysfunction (ED), and benign prostatic hyperplasia (BPH).


      The Preferred Reporting Items for Systematic Reviews and Meta-Analyses system criteria were utilized to search PubMed and Medline databases for the following search terms: “Diet (Mesh)” OR “Diet Therapy (Mesh)” AND “Prostatic Hyperplasia (Mesh)” OR “Prostatic Neoplasm (Mesh)” OR “Erectile Dysfunction (Mesh).” Articles in English published from 1989 to 2022 using human participants were analyzed, data summarized, and assessed for bias.


      Studies reporting on plant-based or vegetable-forward diets (Mediterranean) as an intervention were included. Cohort and cross-sectional studies using food frequency questionnaires or diet classification indices to quantify plant-based food intake patterns were included in the study. Ultimately, 12 PCa articles, 4 BPH articles, 6 ED articles, and 2 articles related to both BPH and ED were reviewed. Overall, the literature suggests plant-forward diets confer a protective effect on the men's health conditions reviewed.


      Evaluation of the literature on the impact of plant-forward diets on urologic conditions includes a heterogenous range of dietary patterns and study designs. The greatest amount of research has evaluated the application of plant-forward diets for PCa. While there is currently a lack of high-quality evidence for the use of plant-forward diets as prevention and/or treatment for PCa, ED, or BPH, reported outcomes suggest a consistent small beneficial impact alongside well-established benefits for common chronic conditions.
      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to Urology
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • McManus KD.
        What is a plant-based diet and why should you try it?.
        Harvard Health Blog blog. 2021; (Available at:) (Accessed April 16, 2022): 2021
        • Crimarco A
        • Springfield S
        • Petlura C
        • et al.
        A randomized crossover trial on the effect of plant-based compared with animal-based meat on trimethylamine-N-oxide and cardiovascular disease risk factors in generally healthy adults: study with appetizing plantfood-meat eating alternative trial (SWAP-MEAT).
        Am J Clin Nutr. 2020; 112: 1188-1199
        • Nielsen IQ.
        Plant-based food options are sprouting growth for retailers.
        (Available at:)
      1. Baden MY, Liu G, Satija A, et al. Changes in plant-based diet quality and total and cause-specific mortality. Circulation. 2019;140:979-991.

        • Poore J
        • Nemecek T.
        Reducing food's environmental impacts through producers and consumers.
        Science. 2018; 360: 987-992
        • Corrin T
        • Papadopoulos A.
        Understanding the attitudes and perceptions of vegetarian and plant-based diets to shape future health promotion programs.
        Appetite. 2017; 109: 40-47
        • Aleksandrowicz L
        • Green R
        • Joy EJ
        • Smith P
        • Haines A.
        The impacts of dietary change on greenhouse gas emissions, land use, water use, and health: a systematic review.
        PLoS One. 2016; 11e0165797
        • McMacken M
        • Shah S.
        A plant-based diet for the prevention and treatment of type 2 diabetes.
        J Geriatr Cardiol. 2017; 14: 342-354
        • Utami DB
        • Findyartini A.
        Plant-based diet for HbA1c reduction in type 2 diabetes mellitus: an evidence-based case report.
        Acta Med Indones. 2018; 50: 260-267
        • Kahleova H
        • Fleeman R
        • Hlozkova A
        • Holubkov R
        • Barnard ND.
        A plant-based diet in overweight individuals in a 16-week randomized clinical trial: metabolic benefits of plant protein.
        Nutr Diabetes. 2018; 8: 58
        • Ozemek C
        • Laddu DR
        • Arena R
        • Lavie CJ.
        The role of diet for prevention and management of hypertension.
        Curr Opin Cardiol. 2018; 33: 388-393
        • Trautwein EA
        • McKay S.
        The role of specific components of a plant-based diet in management of dyslipidemia and the impact on cardiovascular risk.
        Nutrients. 2020; 122671
        • Kalantar-Zadeh K
        • Joshi S
        • Schlueter R
        • et al.
        Plant-dominant low-protein diet for conservative management of chronic kidney disease.
        Nutrients. 2020; 12
        • Joshi S
        • McMacken M
        • Kalantar-Zadeh K.
        Plant-based diets for kidney disease: a guide for clinicians.
        Am J Kidney Dis. 2021; 77: 287-296
        • Oncina-Cánovas A
        • Vioque J
        • González-Palacios S
        • et al.
        Pro-vegetarian food patterns and cardiometabolic risk in the PREDIMED-Plus study: a cross-sectional baseline analysis.
        Eur J Nutr. 2022; 61: 357-372
        • Kim H
        • Caulfield LE
        • Garcia-Larsen V
        • Steffen LM
        • Coresh J
        • Rebholz CM.
        Plant-based diets are associated with a lower risk of incident cardiovascular disease, cardiovascular disease mortality, and all-cause mortality in a general population of middle-aged adults.
        J Am Heart Assoc. 2019; 8e012865
        • Mocanu CA
        • Simionescu TP
        • Mocanu AE
        • Garneata L.
        Plant-based versus animal-based low protein diets in the management of chronic kidney disease.
        Nutrients. 2021; 133721
        • Allkanjari O
        • Vitalone A.
        What do we know about phytotherapy of benign prostatic hyperplasia?.
        Life Sci. 2015; 126: 42-56
        • Cassidy A
        • Franz M
        • Rimm EB.
        Dietary flavonoid intake and incidence of erectile dysfunction.
        Am J Clin Nutr. 2016; 103: 534-541
        • Page MJ
        • McKenzie JE
        • Bossuyt PM
        • et al.
        The PRISMA 2020 statement: an updated guideline for reporting systematic reviews.
        BMJ. 2021; 372: n71
        • Lo CK
        • Mertz D
        • Loeb M.
        Newcastle-ottawa scale: comparing reviewers' to authors' assessments.
        BMC Med Res Methodol. 2014; 14: 45
        • Sterne JAC
        • Savović J
        • Page MJ
        • et al.
        RoB 2: a revised tool for assessing risk of bias in randomised trials.
        Bmj. 2019; 366: l4898
        • Frattaroli J
        • Weidner G
        • Dnistrian AM
        • et al.
        Clinical events in prostate cancer lifestyle trial: results from two years of follow-up.
        Urology. 2008; 72: 1319-1323
        • Esposito K
        • Ciotola M
        • Giugliano F
        • et al.
        Mediterranean diet improves erectile function in subjects with the metabolic syndrome.
        Int J Imp Res. 2006; 18: 405-410
        • Nguyen JY
        • Major JM
        • Knott CJ
        • Freeman KM
        • Downs TM
        • Saxe GA.
        Adoption of a plant-based diet by patients with recurrent prostate cancer.
        Integr Cancer Ther. 2006; 5: 214-223
      2. Saxe GA, Hebert JR, Carmody JF, et al. Can diet in conjunction with stress reduction affect the rate of increase in prostate specific antigen after biochemical recurrence of prostate cancer? J Urol. 166:2202-7.

        • Saxe GA
        • Major JM
        • Nguyen JY
        • Freeman KM
        • Downs TM
        • Salem CE.
        Potential attenuation of disease progression in recurrent prostate cancer with plant-based diet and stress reduction.
        Integr Cancer Ther. 2006; 5: 206-213
      3. Saxe GA, Major JM, Westerberg L, Khandrika S, Downs TM. Biological mediators of effect of diet and stress reduction on prostate cancer. Integr Cancer Ther. 2008;7:130-8.

        • Chen YC
        • Chiang CI
        • Lin RS
        • Pu YS
        • Lai MK
        • Sung FC.
        Diet, vegetarian food and prostate carcinoma among men in Taiwan.
        Br J Cancer. 2005; 93: 1057-1061
        • Er V
        • Lane JA
        • Martin RM
        • et al.
        Adherence to dietary and lifestyle recommendations and prostate cancer risk in the prostate testing for cancer and treatment (ProtecT) trial.
        Cancer Epidemiol Biomarkers Prev. 2014; 23: 2066-2077
      4. Mills PK, Beeson WL, Phillips RL, Fraser GE. Cohort study of diet, lifestyle, and prostate cancer in adventist men. Cancer. 64(3):598-604.

        • Gilsing AM
        • Weijenberg MP
        • Goldbohm RA
        • Dagnelie PC
        • van den Brandt PA
        • Schouten LJ.
        Vegetarianism, low meat consumption and the risk of lung, postmenopausal breast and prostate cancer in a population-based cohort study.
        Eur J Clin Nutr. 2016; 70: 723-729
        • Tantamango-Bartley Y
        • Knutsen SF
        • Knutsen R
        • et al.
        Are strict vegetarians protected against prostate cancer?.
        Am J Clin Nutr. 2016; 103: 153-160
        • Loeb S
        • Fu BC
        • Bauer SR
        • et al.
        Association of plant-based diet index with prostate cancer risk.
        Am J Clin Nutr. 2022; 115: 662-670
        • Mouzannar A
        • Kuchakulla M
        • Blachman-Braun R
        • et al.
        Impact of plant-based diet on PSA level: data from the national health and nutrition examination survey.
        Urology. 2021; 156: 205-210
        • Satija A
        • Bhupathiraju SN
        • Spiegelman D
        • et al.
        Healthful and unhealthful plant-based diets and the risk of coronary heart disease in U.S. adults.
        J Am Coll Cardiol. 2017; 70: 411-422
        • Lu Y
        • Tian J
        • Wang S
        • et al.
        The association between plant-based diet and erectile function in Chinese young healthy men: a population-based study.
        Andrologia. 2021; 53e14038
        • Ramírez R
        • Pedro-Botet J
        • García M
        • et al.
        Erectile dysfunction and cardiovascular risk factors in a Mediterranean diet cohort.
        Int Med J. 2016; 46: 52-56
        • Chen Y
        • Yu W
        • Zhou L
        • et al.
        Relationship among diet habit and lower urinary tract symptoms and sexual function in outpatient-based males with LUTS/BPH: a multiregional and cross-sectional study in China.
        BMJ Open. 2016; 6e010863
        • Carto C
        • Pagalavan M
        • Nackeeran S
        • et al.
        Consumption of a healthy plant-based diet is associated with a decreased risk of erectile dysfunction: a cross-sectional study of the national health and nutrition examination survey.
        Urology. 2022; 161: 76-82
        • Bauer SR
        • Breyer BN
        • Stampfer MJ
        • Rimm EB
        • Giovannucci EL
        • Kenfield SA.
        Association of diet with erectile dysfunction among men in the health professionals follow-up study.
        JAMA Network Open. 2020; 3e2021701
        • Liu ZM
        • Wong CKM
        • Chan D
        • Tse LA
        • Yip B
        • Wong SY.
        Fruit and vegetable intake in relation to lower urinary tract symptoms and erectile dysfunction among southern chinese elderly men: a 4-year prospective study of Mr OS Hong Kong.
        Medicine (Baltimore). 2016; 95: e2557
        • Yang H
        • Breyer BN
        • Rimm EB
        • et al.
        Plant-based diet index and erectile dysfunction in the health professionals follow-up study.
        BJU Int. 2022; 130: 514-521
        • Chiuve SE
        • Fung TT
        • Rimm EB
        • et al.
        Alternative dietary indices both strongly predict risk of chronic disease.
        J Nutr. 2012; 142: 1009-1018
        • Bravi F
        • Bosetti C
        • Dal Maso L
        • et al.
        Food groups and risk of benign prostatic hyperplasia.
        Urology. 2006; 67: 73-79
        • Bravi F
        • Bosetti C
        • Dal Maso L
        • et al.
        Macronutrients, fatty acids, cholesterol, and risk of benign prostatic hyperplasia.
        Urology. 2006; 67: 1205-1211
        • Ambrosini GL
        • de Klerk NH
        • Mackerras D
        • Leavy J
        • Fritschi L.
        Dietary patterns and surgically treated benign prostatic hyperplasia: a case control study in Western Australia.
        BJU Int. 2008; 101: 853-860
        • Kristal AR
        • Arnold KB
        • Schenk JM
        • et al.
        Dietary patterns, supplement use, and the risk of symptomatic benign prostatic hyperplasia: results from the prostate cancer prevention trial.
        Am J Epidemiol. 2008; 167: 925-934
        • Gupta N
        • Patel HD
        • Taylor J
        • et al.
        Systematic review of the impact of a plant-based diet on prostate cancer incidence and outcomes.
        Prostate Cancer Prostatic Dis. 2022; 25: 444-452
        • Wolk A
        • Mantzoros CS
        • Andersson SO
        • et al.
        Insulin-like growth factor 1 and prostate cancer risk: a population-based, case-control study.
        J Natl Cancer Inst. 1998; 90: 911-915
        • Allen NE
        • Appleby PN
        • Davey GK
        • Key TJ.
        Hormones and diet: low insulin-like growth factor-I but normal bioavailable androgens in vegan men.
        Br J Cancer. 2000; 83: 95-97
        • Russo GI
        • Broggi G
        • Cocci A
        • et al.
        Relationship between dietary patterns with benign prostatic hyperplasia and erectile dysfunction: a collaborative review.
        Nutrients. 2021; 134148
        • De Nunzio C
        • Roehrborn CG
        • Andersson KE
        • McVary KT.
        Erectile dysfunction and lower urinary tract symptoms.
        Eur Urol Focus. 2017; 3: 352-363
        • Rizzo NS
        • Sabaté J
        • Jaceldo-Siegl K
        • Fraser GE.
        Vegetarian dietary patterns are associated with a lower risk of metabolic syndrome: the adventist health study 2.
        Diabetes Care. 2011; 34: 1225-1227
        • Skolarus TA
        • Wolf AM
        • Erb NL
        • et al.
        American Cancer Society prostate cancer survivorship care guidelines.
        CA Cancer J Clin. 2014; 64: 225-249
        • Ab Rahman AA
        • Al-Sadat N
        • Yun Low W
        Help seeking behaviour among men with erectile dysfunction in primary care setting.
        J Men's Health. 2011; 8: S94-S96
        • Buvat J
        • Glasser D
        • Neves RC
        • Duarte FG
        • Gingell C
        • Moreira Jr, ED
        Sexual problems and associated help-seeking behavior patterns: results of a population-based survey in France.
        Int J Urol. 2009; 16: 632-638