Mediterranean and low-carbohydrate diets combined with exercise significantly reduced cardiovascular and metabolic risk factors in prostate cancer patients receiving androgen deprivation therapy (ADT), according to analysis of 16 randomized trials involving 23-96 patients each. Creatine supplementation showed promise for preserving lean muscle mass against ADT-induced sarcopenia. This evidence addresses a critical gap in prostate cancer survivorship care. With five-year survival rates exceeding 95%, managing treatment-related side effects becomes paramount for quality of life. ADT, while effective against cancer recurrence, triggers metabolic syndrome characterized by insulin resistance, muscle wasting, and weight gain—mimicking accelerated aging. The findings suggest targeted nutritional interventions can partially reverse these effects, potentially extending healthspan for the 3.3 million American prostate cancer survivors. However, the small study sizes and variable intervention durations limit definitive recommendations. The research landscape notably lacks trials of GLP-1 receptor agonists, despite their proven efficacy for metabolic dysfunction in other populations. This represents both a research gap and therapeutic opportunity, as these medications could offer more potent metabolic protection than dietary changes alone.