COMMENTARY

Exercise May Lower Prostate Cancer-Specific Mortality

Gerald Chodak, MD

Disclosures

October 05, 2017

Hello. I am Dr Gerald Chodak for Medscape. Today's topic is the potential value of physical activity for men diagnosed with prostate cancer. The American Heart Association, the American College of Sports Medicine, and the American Cancer Society have all recommended that adults engage in at least 75 minutes of vigorous activity or 150 minutes of moderate activity weekly.[1,2]

The Prostate Cancer Prevention Trial (PCPT) began in 1993 and followed men with nonmetastatic prostate cancer through 2012. Wang and colleagues[3] used data from the PCPT to examine the relationship between recreational physical activity and causes of death from prostate cancer and other diseases. This analysis included approximately 7300 men who reported exercising before the diagnosis of prostate cancer and 5300 men who exercised after diagnosis. They assigned different metabolic levels of activity (metabolic equivalent hours) to different exercises, such as jogging, dancing, biking, walking, and swimming.

The investigators found that for men diagnosed with low-risk disease who had exercised before the diagnosis of prostate cancer, engaging in 17.5 hours or more of metabolic activity per week resulted in a significantly lower risk of dying from prostate cancer, compared with men who engaged in less than 8.75 hours of metabolic activity per week. Low-risk disease was defined as stage T1 to T2 and a Gleason score of 2 to 7. For men with high-risk prostate cancer, there was no association with physical activity before diagnosis and risk for death. Fortunately, if a man engaged in 17.5 hours or more of physical activity after prostate cancer diagnosis, there was a statistically significant reduction in the likelihood of dying from prostate cancer. The authors made every attempt to control for possible confounding factors such as reverse causation, meaning that perhaps a man could not exercise as much because of prostate disease.

What does this tell us? Clearly, more and more men who are diagnosed with low-risk disease are choosing active surveillance. They often want to know what they can do that may help them in addition to simply observing their cancer. Vigorous physical activity, to the tune of more than 17 hours of metabolic activity per week, is one practice they can incorporate into their lifestyles, along with a healthy diet. This may help reduce their risk of dying of cardiovascular disease, and, based on these data, it may also reduce their risk of dying from prostate cancer. It is important that physicians convey this information to their patients, particularly those who are on active surveillance.

This is a helpful study. It's not perfect, but it does yield some additional information on what patients can do to improve their outcomes. I look forward to your comments. Thank you.

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