We’ve said it before and we’ll say it again: exercise offers better outcomes for prostate cancer patients. This time, we’re basing our advice on an exciting development in the field of cancer research.

Oncology, or the medical specialty dealing with cancer, is increasingly interested in the relationship between exercise and cancer survival. A noted authority is Rob Newton, Professor of Exercise Medicine at Edith Cowan University in Australia. In 2019 he was named Western Australia Premier’s Scientist of the Year. Prof. Newton is particularly interested in the relationship between exercise and prostate cancer (PCa). In August, 2024 he made medical news for his and others’ work showing that:

…exercise unleashes more than 20 physiological mechanisms within the body that may slow or stop the progression of prostate cancer. He has also conducted research demonstrating that muscle mass (which can only be improved through exercise) is more important for the survival of men with prostate cancer than fat mass (which is most effectively controlled by diet therapy).

In fact, it’s widely recognized that in general, physical activity (PA) promotes longer cancer survival. A review of 136 published studies concluded, “Higher prediagnosis and postdiagnosis levels of PA were associated with improved survival outcomes for at least 11 cancer types, providing support for global promotion of PA guidelines following cancer.”^[i] How does this apply to PCa in particular?

A particularly relevant paper by Brassetti, et al. (2021)^[ii] on PA and PCa reports a study of 85 patients on Active Surveillance (AS). As you know, AS patients are monitored at regular intervals to make sure that their cancer is not showing signs of increased activity (reclassification); if reclassification occurs, AS is no longer considered safe. Since the point of AS is to avoid treatment as long as possible, the longer a patient can delay reclassification, the longer he can remain on AS.

For the Brassetti study, each participant’s baseline activity level was assessed at one of three levels: a) sedentary or no activity, b) moderately active, and c) active. The purpose of the study was to determine if PA could delay reclassification. As the researchers found, the less active the patient, the higher the risk of reclassification. Here are the probabilities of reclassification at two years after starting AS, and at 5 years after starting AS:

Risk of reclassification while on AS	Sedentary	Moderate	Active
At 2 years	39%	21%	13%
At 5 years	66%	35%	13%

As this table shows, those participants who were physically active had the least chance of reclassification, even as far out as 5 years on AS. The authors write, “At a median follow-up of 37 months, one out of three patients experienced reclassification, and these patients were characterized as less physically active at baseline…”

An analysis and commentary on the Brassetti study appeared in the journal Nature, in which the authors noted the following important points:

… the data suggest that men with prostate cancer who are active could defer or even avoid treatment and their adverse side effects, and moreover, combat common cancer-related health outcomes, including anxiety, depression, fatigue, poor physical function, and other health related quality of life metrics. Unfortunately, very few patients will experience this benefit. In this study, only 18% of the population was considered active, while 54% were moderately active, and 28% were sedentary. These figures align with current trends in the United States where 34% of cancer survivors aged 18 years and older report no physical activity in their leisure time and only 16% meet national guidelines for aerobic and muscle-strengthening physical activity.^[iii]

The fact that only 16% of adult cancer patients in the U.S. meet national recommendations for cardio and strength building exercise should be a wake-up call for all of us. While it’s not reasonable to expect that many cancer patients’ ability to exercise vigorously is compromised either by the nature of their disease, or the treatments received for advanced cancers, this is not the case for men diagnosed with early stage, low risk PCa. Yet these are the patients with the most to gain from adherence to national guidelines. The Brassetti study fulfills the ideal of expert exercise physiologist Rob Newton, who has aptly paraphrased the wisdom of the ancient Greek physician Hippocrates: “Let exercise be thy medicine, and medicine be thy exercise.” If you want the best PCa survival outcomes, get moving!

NOTE: This content is solely for purposes of information and does not substitute for diagnostic or medical advice. Talk to your doctor if you are experiencing pelvic pain, or have any other health concerns or questions of a personal medical nature.

References

[i] Friedenreich CM, Stone CR, Cheung WY, Hayes SC. Physical Activity and Mortality in Cancer Survivors: A
Systematic Review and Meta-Analysis. JNCI Cancer Spectr. 2019 Oct 17;4(1):pkz080.
[ii] Brassetti A, Ferriero M, Napodano G, Sanseverino R et al. Physical activity decreases the risk of cancer
reclassification in patients on active surveillance: a multicenter retrospective study. Prostate Cancer Prostatic Dis. 2021 Dec;24(4):1151-1157.
[iii] Kenfield, S.A., Chan, J.M. More evidence that physical activity is beneficial for prostate cancer. Prostate Cancer Prostatic Dis 25, 383–384 (2022).