Exercise program offers psychological benefits during active prostate cancer surveillance

In men on active surveillance as an alternative to immediate treatment for prostate cancer, a supervised exercise program may reduce anxiety and fear of cancer progression, reports a study in The Journal of Urology®, an official journal of the American Urological Association (AUA). The journal is published in Wolters Kluwer’s Lippincott portfolio.

In our study, a high-intensity interval training program produced significant mental and physical health benefits for men who chose active surveillance for the initial management of low-grade prostate cancer.

Kerry S. Courneya, PhD, lead author, University of Alberta, Edmonton, Canada

“These findings may be particularly important for the subgroup of patients who transition to surgery or other treatment due to anxiety or fear that their prostate cancer is progressing during active surveillance.” The study was led by Dong-Woo Kang, PhD, who is now a postdoctoral fellow at the Dana-Farber Cancer Institute in Boston.

Psychological benefits of exercise training during AS for prostate cancer

Active surveillance (AS) is used as a way to watch for slow-growing, “low-risk” or localized prostate cancer rather than treating it right away. Men opting for AS typically undergo regular prostate-specific antigen (PSA) screenings, prostate exams, imaging tests, and repeat biopsies to carefully monitor the growth or progression of prostate cancer. the prostate without compromising long-term results. The purpose of AS is to avoid or delay unnecessary treatment and its side effects.

Understandably, many men experience increased anxiety and fear of cancer progression while on AS, which can lower their quality of life (QOL). These concerns lead some patients to move on to permanent treatment, such as surgery or radiation therapy, even if their cancer has not progressed. “Interventions to reduce anxiety and fear of cancer progression in these men may improve quality of life and reduce the risk that they will opt for medically unnecessary treatments,” write Dr. Courneya and coauthors.

In a study called the ERASE (Exercise During Prostate Cancer Active Surveillance) trial, researchers evaluated a 12-week supervised high-intensity interval training (HIIT) program for men undergoing AS. Published last year, the main results of the study showed a significant improvement in cardiovascular fitness and a reduction in PSA levels in men assigned to the exercise program.

Could exercise also reduce anxiety and fear during AS? Dr. Courneya and colleagues conducted a secondary analysis of these and other mental health outcomes among participants in the ERASE trial. The analysis included 25 men assigned to the exercise program and a control group of 25 patients receiving usual care.

The HIIT program improved key patient-reported outcomes. Results included a small but significant reduction in prostate cancer-related anxiety: a difference of about 3 points on a 54-point scale. Fear of cancer progression showed a greater decrease: by 2 points on a 12-point scale.

Exercise participants saw an improvement in hormonal symptoms such as lack of energy, depression, or change in body weight. The HIIT program was also linked to reduced stress and fatigue and a significant increase in self-esteem. Quality of life assessments suggested “borderline significant” increases in general health and emotional functioning.

Active surveillance has become an increasingly popular option for men with early-stage prostate cancer. However, recent studies have shown that many patients go from AS to definitive treatment within a few years, sometimes without signs of cancer progression. “Our findings may be particularly relevant to a subset of AS patients who opt for radical treatment to manage their distress,” the researchers write.

Dr Courneya comments: “Previous reports have suggested that exercise may help manage anxiety in other groups of cancer patients, but our study is the first to show an improvement in anxiety and fear of cancer progression in men opting for AS.” The researchers call for larger studies to confirm their findings and demonstrate the long-term benefits of physical and mental exercise for this growing group of patients.


Journal reference:

Kang, DW., et al. (2022) A randomized trial of the effects of exercise on anxiety, fear of cancer progression, and quality of life in patients with prostate cancer under active surveillance. Journal of Urology. doi.org/10.1097/JU.0000000000002334.

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