Can Working Out Slow Prostate Cancer Progression?
— Intense exercise improved markers of biochemical progression in patients on active surveillance
by Mike Bassett, Staff Writer, MedPage Today August 19, 2021
Rigorous exercise not only boosted cardiorespiratory fitness, but also improved indicators of prostate cancer biochemical progression in patients undergoing active surveillance, according to results of a randomized trial.
Patients participating in a 12-week high-intensity interval training (HIIT) regimen saw an increase in peak oxygen consumption (VO2) — the study’s primary outcome — of 0.9 mL/kg/min, while a usual-care group saw a decrease of 0.5 mL/kg/min, for an adjusted between-group mean difference of 1.6 mL/kg/min (95% CI 0.3-2.9, P=0.01), reported Kerry Courneya, PhD, of the University of Alberta in Canada, and colleagues.
Additionally, the patients in the HIIT program experienced decreased prostate-specific antigen (PSA) levels (-1.1 μg/L, 95% CI -2.1 to 0.0, P=0.04), PSA velocity (-1.3 μg/L/y, 95% CI -2.5 to -0.1, P=0.04), and lymph node carcinoma of the prostate cell growth (-0.13 optical density unit, 95% CI -0.25 to -0.02, P=0.02), “suggesting that HIIT may have played an inhibitory role in prostate cancer cell growth in this setting,” they wrote in JAMA Oncology.
Patients on active surveillance for prostate cancer have a three times higher risk of cardiovascular disease-specific death than prostate cancer-specific death, and more than half will experience disease progression and require radical treatment within 10 years, the authors noted.
“Interventions during active surveillance to boost cardiovascular health, delay disease progression, and precondition these men for possible radical treatments would be desirable,” they wrote.
The single-center, phase II Exercise During Active Surveillance for Prostate Cancer (ERASE) trial included 52 patients (mean age 63, 89% white) who were randomized 1:1 to either the HIIT regimen or usual care. Patients randomized to HIIT participated in a supervised exercise program 3 times a week over a 12-week period that involved treadmill work at 85% to 95% of peak VO2.
Usual care patients maintained their usual exercise levels.
Of the 52 patients in the trial, 88% completed the post-intervention peak VO2 assessment, while 94% provided blood samples.
Patients in the HIIT program also had improved increased peak VO2 in liter per minute, upper body strength, and lower body flexibility compared with the usual care group.
In addition, Courneya and colleagues noted that patients in the HIIT group experienced improved PSA doubling time, but the difference between groups was not statistically significant. There was also no significant difference in testosterone levels.
“It is worth noting that the usual care group did in fact experience a diminution in VO2 peak,” wrote Neha Vapiwala, MD, of Perelman School of Medicine at the University of Pennsylvania in Philadelphia, in an accompanying commentary.
“This suggests cardiovascular deconditioning over a 12-week period relative to baseline when following the usual care protocol, which raises the possibility that participation in the control group of this study may have promoted a more sedentary lifestyle than typical for some patients, in turn contributing to the dramatic and statistically significant difference seen,” she continued.
Courneya and colleagues acknowledged several study limitations, such as the fact that they needed to shorten the intervention period for several participants because of the onset of the COVID-19 pandemic, as well as potential recruitment bias (i.e., more fit and active men) and a lack of long-term follow-up for clinical outcomes.
“Larger randomized clinical trials are warranted to determine whether improvements in cardiorespiratory fitness and prostate cancer-related markers translate into better long-term clinical outcomes in men with prostate cancer on active surveillance,” they concluded.
Vapiwala said that the results with HIIT alone — without dietary changes — in men on active surveillance are “novel and noteworthy.”
The ERASE trial could empower prostate cancer patients “to be in better physical, functional, and psychological shape for any future medical interventions they may need,” she wrote.
Mike Bassett is a staff writer focusing on oncology and hematology. He is based in Massachusetts.
This study was supported by grants from the Canadian Institutes of Health Research and Prostate Cancer Canada.
Courneya was supported by the Canada Research Chairs Program. Co-author Kang was supported by the Alberta Innovates Graduate Studentship. Exercise equipment was donated by Apple Fitness in Edmonton, Alberta, Canada.
The study authors reported no other disclosures.
Vapiwala reported no conflicts of interest.
Source Reference: Kang D-W, 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 2021; DOI: 10.1001/jamaoncol.2021.3067.