Multiple studies of the impact of lifestyle factors on the development of prostate cancer have yielded inconsistent results. This may be due to unrecognized heterogeneity of the study populations, specifically genetic polymorphisms, which directly affect lifestyle interventions. We review some known polymorphisms and mechanisms of action as related to dietary and other lifestyle interventions and prostate cancer carcinogenesis. Further identification of genes affected by dietary/environmental changes will enable knowledgeable lifestyle interventions on an individual basis.