Exercise Before and After Prostate Cancer Treatment
By: Dan Sperling, MD
“Like most people I can be lazy, so it’s nice to have a goal or deadline or reason to work out. I feel better when I get to exercise, or when I’m outdoors. I like to hike, swim and run, and I love to play soccer.” Viggo Mortensen, actor
There are many goals or reasons to work out. When it comes to prostate cancer, published studies continue to provide evidence that exercise can make a powerful difference, both for prevention and for sustaining positive treatment outcomes. The following three articles summarize the latest findings between physical activity and prostate cancer (PCa).
A very interesting prospective study out of Italy was designed to correlate the level of pre-biopsy physical activity and overall health with prostate cancer diagnosis (De Nunzio et al., 2015).[i] The well-designed study began in 2011 by recruiting consecutive men recommended for prostate biopsy based on a PSA of > 4 ng/mL and/or positive digital rectal exam. Prior to the biopsy, the following information for each patient was entered into the research database:
- Body mass index (BMI) and waist circumference
- Fasting blood samples that were tested for total PSA, glucose, high-density cholesterol and triglyceride levels
- Blood pressure
- Metabolic syndrome (MetS, a measure of physical precursors or vulnerabilities for cardiovascular disease and diabetes)
- Individual level of physical activity was scored before biopsy based on a PASE (Physical Activity Scale for the Elderly) questionnaire
By the end of the study, 286 patients had been enrolled. The median age was 68 and median PSA was 6.1. Median BMI was 26.4 kg/m2 (overweight) and waist circumference was 102 cm (40.16”). 75 men (26%) presented with MetS. After biopsy results were in, 106 patients (37%) had prostate cancer. There was a positive association between prostate cancer and higher PSA levels accompanied by lower PASE scores (less physical activity). Even taking into account PCa risk factors (age, PSA level, and prostate volume), the authors found that a low level of physical activity as scored by PASE was an independent risk factor for PCa. Even more sobering was its correlation with high-grade cancer, meaning lack of physical activity can serve as a pre-biopsy predictor for aggressive cancer. Thus, the researchers concluded that “… increased physical activity, evaluated by the PASE questionnaire, is associated with a reduced risk of prostate cancer and of high-grade prostate cancer at biopsy.” The team called for more research to understand the biochemical connections and processes behind this observation.
Exercise as an aid to prostatectomy recovery
After a man has been diagnosed and treated for PCa, can exercise play a role in boosting recovery? The next study explores this question with regard to men who underwent radical prostatectomy (RP). A group of German researchers launched a multicenter, 2-armed nonrandomized controlled trial called the ProRehab study 6-12 weeks after RP.[ii] The participants were assigned to either an intervention group (56 men) who took part in a 15-month supervised multimodal exercise program, or to a control group (29 men) for a total study population of 85. The exercise group participated in weekly 60-minute moderate exercise sessions, while the control group received no intervention. According to the authors, “Outcomes included aerobic fitness, activity levels, quality of life, disease- and treatment-related adverse effects, such as urinary incontinence and erectile dysfunction, and relapse-relevant blood values. Intention-to-treat analysis was performed. Perhaps not surprisingly, significant differences were observed between the two groups. The urinary symptom score was better in the exercise group. In addition, overall fitness, continence, emotional and social functioning and any further treatment-related side effects were improved more than in the control group. The authors point out that shorter term studies have also shown similar differences, but this was the first such study over 15 months. More study is needed to determine if exercise can actually accelerate recovery.
Exercise and long-term older PCa survivors
A multicenter research project from a team of Dutch, Australian and New Zealanders examined the effects of a year-long exercise program on health-related quality of life (HRQoL) in older long-term PCa survivors.[iii] This study tracked 100 older PCa survivors (average age 71.7 years) over a period of 12 months. The men were randomly assigned to one of two arms:
- 6 months of supervised aerobic and resistance exercise followed by 6 months of a home-based exercise maintenance group (EX group) or
- Printed education material on physical activity for 12 months (PA group).
Participants were assessed along several lines at baseline, 6 months and 12 months. At 6 months, the EX group members exhibited significant benefits in terms of physical and social function compared with the PA group; for the EX group, physical function effects were sustained at 12 months. Greater benefit was seen in EX group members who were married, who began exercising sooner after diagnosis, and who had previously used bisphosphonates (to improve bone density). The researchers concluded that aerobic and resistance exercise seems to have beneficial effects on health-related quality of life for older, long-term survivors of prostate cancer.
This brief sample of clinical literature on the relationship between exercise and prostate cancer shows that no matter a patient’s age, stage or experience with the disease, exercise is beneficial both physically and in terms of lifestyle and quality.
[i] De Nunzio C, Presicce F, Lombardo R et al. Physical activity as a risk factor for prostate cancer diagnosis: a prospective biopsy cohort analysis. BJU Int. 2015 Apr 24. doi: 10.1111/bju.13157. [Epub ahead of print][i]
[ii] Zopf EM, Bloch W, Machtens S et al. Effects of a 15-Month Supervised Exercise Program on Physical and Psychological Outcomes in Prostate Cancer Patients Following Prostatectomy: The ProRehab Study. Integr Cancer Ther. 2015 Apr 27. pii: 1534735415583552. [Epub ahead of print]
[iii] Buffart LM, Newton RU, Chinapaw MJ et al. The effect, moderators, and mediators of resistance and aerobic exercise on health-related quality of life in older long-term survivors of prostate cancer. Cancer. 2015 Apr 17. doi: 10.1002/cncr.29406. [Epub ahead of print]