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Exercise and prostate cancer treatment: what you need to know

PCFA_OC_Manager
Community Manager
Community Manager
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Written by Exercise Physiologist Molly Lowther in collaboration with Exercise & Sports Science Australia (ESSA).

Prostate cancer is currently one of the most common cancers in Australia, with 1 in 6 men diagnosed by the age of 851. Receiving a cancer diagnosis can be traumatic and life changing for patients. The time immediately after diagnosis has been described as lonely, stressful and frustrating, particularly prior to treatment2. Exercise is now considered a primary treatment throughout the cancer care continuum, and helps men prepare and recover from surgery, chemotherapy, radiation and hormone therapy.

Active Surveillance (AS)
Men who are placed on AS have been shown to have significantly higher anxiety symptoms regarding their diagnosis when compared to those on active treatment3. This is likely due to the perception of the patient feeling they are not actively fighting their cancer3. While exercise as a primary treatment for men with localised prostate cancer needs further clinical trials, it is shown to have high adherence, and be a safe and feasible way to slow progression to active treatment4,5. This was shown very well in the ERASE randomised trial, where patients who completed a 12 week HIIT program had improved peak oxygen consumption, decreased prostate-specific antigen levels and velocity and inhibited growth of prostate cancer cell line LNCaP4.

Surgery
Exercise can help manage complications caused by prostate cancer surgeries, both before and after the surgery by reducing the risk of complications, length of stay and the likelihood of long term incontinence6. Regular exercise can also improve recovery of sexual function, overall strength, fitness and body composition, psychological wellbeing and slow disease progression following RARP7. The preoperative period is an ideal time for a “teachable moment8” and have the men undergo a multimodal intervention, to ensure they are physically and psychologically well placed to introduce modifiable behaviours to optimise recovery9. A recent study showed that men who completed a supervised 8-12 week exercise program prior to surgery lead to significantly greater physical activity levels at 6 months post-surgery8.

ADT
Hormone therapy, or ADT, comes with a long list of potential side effects including: muscle and bone loss, increased fat mass and bone fracture risk, sexual dysfunction and loss of libido, hot flashes, decreased mood and fatigue. A tailored exercise program, commenced at the same time as ADT, can improve fatigue and mood swings, muscle mass, overall strength and quality of life and libido, while maintaining bone mineral density to reduce fracture risk10.

Radiation
Radiation therapy is another common prostate cancer treatment that can create a range of side effects including: fatigue, dry red or itchy skin, anxiety or depression, loss of appetite, weight and muscle strength, reduce physical function and bladder and bowel problems. Exercising before, during and after treatment can improve cardiorespiratory fitness and muscle strength, flexibility, fatigue while decreasing the severity of incontinence and maintaining sexual function11. Exercise prior to receiving radiation may also improve the effectiveness of the therapy12.

Bone Metastases
The most recent recommendations also focus on safely exercising with bone metastases, which are diagnosed in 88% of men diagnosed with metastatic prostate cancer13. Where previously anyone with bone metastases were told not to exercise for fear of injury, the latest recommendations14 promote regular physical activity to manage the side effects of cancer treatment, with consideration of location and presentation of bone lesions. The exercise prescription should have a strong emphasis on posture, controlled movement and proper technique and be assessed and prescribed by a Cancer Specialist Exercise Physiologist to reduce any potential risks14.

In 2019 Exercise and Sports Science Australia released a position statement on the importance of exercise medicine in cancer management15. The main takeaway is to ensure every cancer patient receives a personalised exercise assessment and targeted exercise prescription by a Cancer Specialist Exercise Physiologist, focussing on general and cancer-specific health issues and patient goals.

You can find an Accredited Exercise Physiologist by visiting www.essa.org.au/find-aep and select ‘cancer’ as the speciality.

Alternatively, give PCFA’s Prostate Cancer Specialist Telenursing team a call on 1800 22 00 99 to talk about how you may be eligible for a subsidy to help reduce the costs associated with seeing an Exercise Physiologist.

References:

1. Cancer Council Australia. 2021. Facts and figures: Cancer statistics in Australia. Accessed 29th March 2022. {https://www.cancer.org.au/cancer-information/what-is-cancer/facts-and-figures}

2. Tang, C., Turczyniak, M., Sayner, A., Haines, K., Butzkueven, S. & O’Connell, H. (2020). Adopting a collaborative approach in developing a prehabilitation program for patients with prostate cancer utilising experience-based co-design methodology. Supportive Care in Cancer, 28, 5195-5202.

3. Ruane-McAteer, E., Porter, S., O’Sullivan, J., Dempster, M. & Prue, G. (2019). Investigating the psychological impact of active surveillance or active treatment in newly diagnosed favourable-risk prostate cancer patients: A 9-month longitudinal study. Psycho-Oncology, 28(8), 1743-1752.

4. Kang, D., Fairey, A., Boule, N., Field, C., Wharton, S. & Courneya, K. (2021). Effects of Exercise on Cardiorespiratory Fitness and Biomechanical Progression in Men With Localised Prostate Cancer Under Active Surveillance. The ERASE Randomized Clinical Trial. JAMA Health Forum, 7(10), 1487-1495.

5. Bourke, L., Stevenson, R., Turner, R., Hooper, R., Sasieni, P., Greasley, R., Morrissey, D., Loosemore, M., Fisher, A., Payne, H., Taylor, S. & Rosario, D. (2018). Exercise training as a novel primary treatment for localised prostate cancer: a multi-site randomised controlled phase II study. Scientific Reports, 8(8374).

6. John, J. B. & McGrath, J. S. (2021). ERAS Protocol in RARP. Robotic Surgery; 1201-1209.

7. Jaime, A. T, Huynh, L. M., Derderian, R., Choi, E. & Wei, H. (2021). Heart-healthy diet and high-intensity interval training as a lifestyle intervention for patients with prostate cancer recurrence following radical prostatectomy. American Urological Association; 203(4), 903-904.

8. Flannigan, R., Locke, J., Schulz, G., Campbell, K., Van Patten, C., Goldenberg, L. & Black, P. Getting advantage from the “teachable moment” at initial diagnosis of prostate cancer-results of a randomized controlled physical exercise program. Cochrane Central Register of Controlled Trials, 8, e1031.

9. Paterson, C., Roberts, C., Toohey, K. & McKie, A. (2020). Prostate Cancer Prehabilitation and the Importance of Multimodal Interventions for Person-centred Care and Recovery. Semin Oncol Nurs. 36(4), 151048.

10. Taaffe, D. R., Galvao, D. A., Spry, N., Joseph, D., Chambers, S. K., Gadiner, R. A., Hayne, D., Cormie, P., Shu, D. H. & Newton, R. U. (2019). Immediate versus delayed exercise in men initiating androgen deprivation: effects on bone density and soft tissue composition. BJU Int; 123(2), 261-169.

11. Segal, R. J., Reid, R. D., Courneya, K. S., Sigal, R. J., Kenny, G. P., Prud’Homme, D. G., Malone, S. C., Wells, G. A., Scott, C. G. & D-Angelo, M. e. (2009). Randomized controlled trial of resistance or aerobic exercise in men receiving radiation therapy for prostate cancer. J Clin Oncol; 27(3), 344-351.

12. Schumacher, O., Galvao, D., Taaffe, D., Chee, R., Spry, N. & Newton, R. (2020). Exercise modulation of tumour perfusion and hypoxia to improve radiotherapy response in prostate cancer. Prostate Cancer and Prostatic Diseases, 24, 1-14.

13. Huang, J., Shen, J., Rengan, R., Silvestris, N., Wang, M., Erosa, L., Zheng X., Belli, A., Zhang X., Li, Y. & Wu, A. (2020). Incidence of patients with bone metastases at diagnosis of solid tumours in adults: a large population-based study. Ann Transl Med; 8(7), 482.

14. Campbell, K. L., Cormie, P., Weller, S., Alibhai, S., Bolam, K., Campbell, A., Cheville, A. L., Dalzell, M., Hart, N., Higano, C., Lane, K., Mansfield, S., McNeely, M., Newton, R. U., Quist, M., Rauw, J., Rosenberger, F., Santa Mina, D., Schmitz, K. H., Winters-Stone, K. M., Wiskemann, J. & Goulart, J. (2022). Exercise Recommendations for People With Bone Metastases: Expert Consensus for Health Care Providers and Exercise Professionals. JCO Oncology Practice.

15. Turner, J., Marthick, M., Murmane, A., Atkinson, M., Czosnek, L., Lawrence, A., Vardy, J., Krishnasamy, M., Emery, J. & Cormie, P. (2022). ESSA Consencus Statement on the role of accredited exercise physiologists in the treatment of cancer.

 


Help is Available

Prostate Cancer Specialist Telenursing Service

If your life has been impacted by prostate cancer, our Specialist Telenursing Service is available to help. If you would like to reach out to the PCFA Prostate Cancer Specialist Telenurse Service for any questions you have about your prostate cancer experience, please phone 1800 22 00 99 Monday - Friday 9am - 5pm, Wednesday 10am-8pm (AEST).

Prostate Cancer Support Groups

PCFA is proud to have a national network of affiliated support groups in each state and territory of Australia consisting of men and women who have a passion for assisting others who encounter prostate cancer. This network is made up of over 170 affiliated groups who meet locally to provide one-to-one support, giving a vision of life and hope after treatment. Call us on 1800 22 00 99 to find your local group.

MatesCONNECT Telephone-based peer support

MatesCONNECT is a telephone-based peer support program for men affected by prostate cancer. If you’ve recently been diagnosed with prostate cancer, our MatesCONNECT service can connect you to a trained volunteer who understands what you’re going through. All of our volunteers have been through prostate cancer. Simply call us on 1800 22 00 99 to be connected with a volunteer.

Newly diagnosed? or need to find more information? Access the PCFA resources here.

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