Exercise May Improve Outcomes for Patients with Prostate Cancer Beginning ADT

A short-term study, published in BJU International, of supervised exercise in patients with prostate cancer beginning androgen-deprivation therapy (ADT) resulted in sustained improvements in quality of life (QoL) and cardiovascular events risk profile.¹

These data suggest that clinicians should prescribe a short-term exercise program at the beginning of ADT to try and assuage these important treatment-related side-effects.

“The problem is ADT has several side-effects, including increased body fat, decreased cardiopulmonary fitness and increased fatigue,” Anthony S. Leicht, associate professor in the College of Healthcare Sciences at James Cook University in Australia, said in a press release.² “These can increase the risk of a cardiovascular event and reduce health-related quality of life.”

In a cohort of 50 patients with prostate cancer scheduled for ADT, 24 were randomized to an exercise group and 26 to a control group. The exercise group did 3 months of supervised aerobic and resistance exercise training twice a week for 60 minutes, followed by 3 months of self-directed exercise. Researchers assessed the outcomes at baseline, 3, and 6 months.

The primary outcome for the study was difference in fat mass at 3-months. Secondary outcomes included fat-free mass, cardiopulmonary exercise testing variables, QRISK2 (ClinRisk Ltd, Leeds, UK) score, anthropometry, blood-borne biomarkers, fatigue, and QoL.

At 3-months, exercise training prevented adverse changes in peak O₂ uptake (1.9 mL/kg/min; P = 0.038), ventilatory threshold (1.7 mL/kg/min; P = 0.013), O₂ uptake efficiency slope (0.21, P = 0.005), and fatigue (between-group difference in Functional Assessment of Chronic Illness Therapy-Fatigue score of 4.5 points; P= 0.024) compared with controls. After withdrawing the supervised exercise though, the differences in cardiopulmonary fitness and fatigue were not sustained, but the exercise group did demonstrate significantly better QoL (Functional Assessment of Cancer Therapy-Prostate difference of 8.5 points; P = 0.034) and a reduced QRISK2 score (-2.9%; P = 0.041) compared to controls.

“What was important, and different from most other studies, was that the patients started the exercise program before the ADT treatment began,” Leicht said. “Other studies have examined patients already undergoing treatment.”

However, lack of time, financial costs, and transport difficulties are common barriers to exercise cited by patients with cancer and older adults in general. Additionally, using self-report questionnaires may have exposed the study to subjective bias, though anecdotal evidence helped confirm whether or not the patients maintained the exercise. Researchers suggested that future studies should seek to better understand how to improve participation within this patient group in exercise training programs. 

“In older people we often see reductions in strength and physical function just 3 months after halting supervised exercise. They may stop exercising because of cost or other reasons,” said Leicht. “A more pragmatic approach such as home-based exercise or a shorter period of supervision with follow-on remote support could help get around these restrictions and provide measurable benefits to prostate cancer sufferers.”

References:

1. Ndjavera W, Orange ST, O’Doherty AF, et al. Exercise-induced attenuation of treatment side-effects in patients with newly diagnosed prostate cancer beginning androgen-deprivation therapy: a randomized controlled trial. BJU International. doi:10.1111/bju.14922.

2. Exercise works for those beginning cancer treatment [news release]. Australia. Published March 12, 2020. jcu.edu.au/news/releases/2020/march/exercise-works-for-those-beginning-cancer-treatment. Accessed March 18, 2020.