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Impact of Exercise on Disease Progression in Men with Localized Prostate Cancer
An increasing number of men with low-risk prostate cancer are being managed with active surveillance in lieu of immediate, local curative intent therapy, although up to 55% of these men will undergo definitive intervention within 10 years. Given the disease biology and the age range of this population, it is no surprise that these patients have a 3-fold higher risk of cardiovascular- related death than prostate cancer–specific death.
In an effort to improve cardiovascular health and delay prostate cancer disease progression, investigators evaluated the effect of high-intensity interval training (HIIT) in low–intermediate risk patients deemed appropriate for active surveillance. In a phase 2 trial, patients were randomized to HIIT (supervised exercise 3 times per week for 12 weeks) or usual care. Crossover at 12 weeks was permitted. The primary outcome measure was peak oxygen consumption (V̇O2) during a graded exercise test; changes in prostate-specific antigen (PSA) parameters were secondary outcomes.
Over a 20-month period, 56 men with a median age of 63 were randomized. There was a 96% compliance rate in the HIIT arm. Compared with the usual care group, the HIIT group had a statistically significant improvement in V̇O2 along with a decrease in total PSA level and PSA velocity, with no differences in PSA doubling time or testosterone levels.
Comment
As noted in an editorial, the ERASE trial, while small, had an extremely low drop-out rate (3 patients). The editorialist also comments that the allowance of crossover at 12 weeks, while ethically reasonable, will complicate downstream comparisons. Importantly, the editorialist notes that benefits seen in the experimental group, including improved upper body strength and lower body flexibility, may “preemptively optimize patient fitness” for those who eventually require prostate cancer therapy and/or experience cardiovascular morbidity. Other similar trials powered to assess impact on overall survival (INTERVAL-GAP4) are ongoing.
Citation(s)
Author:
Kang D-W et al.
Title:
Effects of exercise on cardiorespiratory fitness and biochemical progression in men with localized prostate cancer under active surveillance: The ERASE randomized clinical trial.
Source:
JAMA Oncol
2021
Aug
19; [e-pub].
(Abstract/FREE Full Text)
Author:
Vapiwala N.
Title:
The power of exercise to influence cardiovascular and oncologic outcomes — Survival of the fittest.
Source:
JAMA Oncol
2021
Aug
19; [e-pub].
(Abstract/FREE Full Text)
Empfohlen von
Robert Dreicer, MD, MS, MACP, FASCO