Sperling Prostate Center

How to Do Active Surveillance for More Heart Health, Less Prostate Cancer

The average male human heart is slightly less than a half percent of total body weight, and it weighs about ten times more than the same man’s prostate gland. Most people would likely agree that the heart is at least ten times more important than the prostate. However, I suspect that the average man thinks at least ten times more often about his sexual function than his heart function. The loss of his potency would probably not put his life on the line, but it would certainly cause heartache.

One threat to a man’s potency is whole-gland treatment for prostate cancer (PCa). Radical prostatectomy and whole-gland radiation continue to be the predominant standard of care. While whole-gland treatments don’t jeopardize cardio well-being, their possible side effects can compromise a man’s quality of life.

Since many PCa patients with low-risk disease are seeking an alternative to immediate radical treatment, Active Surveillance (AS) monitored by biomarkers and MRI is increasingly proven to be a safe way to buy time until monitoring reveals an uptick in tumor activity. However, slightly more than half of AS patients undergo radical treatment within 10 years based on either evidence or fear of PCa progression.

Exercise helps control PCa progression

A new study demonstrates a lifestyle choice that turns out to be a two-fer. In August 2021, the prestigious Journal of the American Medical Association (JAMA) published a paper by Kang, et al. reporting the results of a 2-group randomized clinical trial that tested the effect of high-intensity interval training on cardio function and biochemical progression of PCa.

As designed, the trial was named The Exercise During Active Surveillance for Prostate Cancer (ERASE). Between 2018-2020, a total of 52 otherwise healthy PCa patients were enrolled in the study. One half (26 men) were randomly assigned to receive usual care while the other half was assigned to a high intensity interval training group (HIIT). The HIIT consisted of 12 weeks, three times per week of supervised aerobic sessions on a treadmill at 85-95% of peak oxygen consumption, while the other group continued their usual exercise levels. For the HIIT group, exercise intensity and duration increased gradually over the 12-week study period.

Blood samples were used to assess PSA (prostate-specific antigen) and its kinetics (doubling time, velocity) and sex hormone levels. Functional fitness was evaluated using the Senior Fitness Test, and other metrics (weight, height, waist/hip circumference) were recorded. Electronic medical records provided additional information.

Supported by previously published studies on the relationship between exercise, cardio health, and PCa progression, the authors’ findings are a significant contribution to our understanding of the importance of vigorous aerobic exercise during AS. The team writes: “…12 weeks of high-intensity interval training significantly improved peak oxygen consumption, decrease prostate-specific antigen levels, and decreased prostate-specific antigen velocity compared with usual care.”[i]More to the point, the HIIT program also inhibited the growth of the prostate cancer cell line labeled LNCaP (evidenced by cell biomarkers derived from patient blood samples and compared in the lab before and after the study).

One intervention, two important successes

If you’re old enough to remember the Certs Breath Mint two-mints-in-one TV ads, it’s no Madison Avenue promotion to say that this study is “two-successes-in-one”. First, it underscores the value of aerobic workouts for total cardiovascular health; second, it measurably demonstrates that exercise helps keep PCa in control during AS. As long as PCa progression risk is contained, whole-gland treatment can be deferred—theoretically, indefinitely.

Other studies,like that of Ornish, et al. (2008), explore the genomic changes that are a response to healthy lifestyle during AS. This includes dietary choices like the Mediterranean diet. One of the strengths of the Kang paper is comparing the difference between AS patients following their usual workouts vs. those on HIIT.

What conclusion can we apply in the real world? Just this. If you are on AS for low-risk PCa and can only change one thing in your life, add a program of vigorous aerobic exercise three times per week. You will be doing your heart a favor, honoring your prostate gland, and contributing to a long and enjoyable sex life. What could be better?

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.

[i] Kang DW, Feirey AS, Boulé NG, Field CJ et al. Effects of exercise on cardiorespiratory fitness and biochemical progression in men with localized prostate cancer under active surveillance: the ERASE randomized clinical trial.
JAMA Oncol. Published online August 19, 2021. Doi:10.1001/majaoncol.2021.3067.

 

About Dr. Dan Sperling

Dan Sperling, MD, DABR, is a board certified radiologist who is globally recognized as a leader in multiparametric MRI for the detection and diagnosis of a range of disease conditions. As Medical Director of the Sperling Prostate Center, Sperling Medical Group and Sperling Neurosurgery Associates, he and his team are on the leading edge of significant change in medical practice. He is the co-author of the new patient book Redefining Prostate Cancer, and is a contributing author on over 25 published studies. For more information, contact the Sperling Prostate Center.

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