Prostate cancer is one of the most commonly diagnosed cancers in the United States. Estimates report that more than 3 million men in the US are currently living with the disease.¹ Although prostate cancer is one of the leading causes of cancer death in men, it is also a very treatable disease. However, the disease itself as well as the treatments used can lead to side effects that negatively affect quality of life.

Androgen deprivation therapy (ADT) is often the backbone of prostate cancer treatment. As testosterone is the driver of the disease, suppressing this hormone through androgen deprivation removes the fuel that is spreading the disease and decreases the growth of the cancer. Hormone suppression can be used in both adjuvant treatment settings as well as metastatic settings and can be accomplished through surgical castration or more commonly the use of GnRH agonists and antagonists.²

An unfortunate adverse effect of ADT is that it can cause cardiovascular events such as stroke, myocardial infarction, and hypertension. It can also lead to the weakening of bones as well as decreased muscle mass and increased fat stores.³

Other Disease and Treatment Adverse Effects

Local treatments for prostate cancer include prostatectomy, the surgical removal of the prostate, as well as radiation. Systemic treatments for metastatic disease include chemotherapy, immunotherapy, and targeted therapy. Each of these treatments have adverse effects that can negatively impact a man’s quality of life. Some of these effects include⁴:

• Urinary incontinence
• Sexual dysfunction, such as erectile dysfunction
• Fatigue
• Depression symptoms
• Decreased muscle strength
• Hot flashes

Research has demonstrated the benefits of exercise in many patient populations. Men living with prostate cancer can benefit from exercise as well.

Benefits of Exercise

A study published in 2022 demonstrated a significant benefit to exercise for men with prostate cancer who were being treated with ADT. The men participated in 1 to 2 supervised group exercise sessions weekly for a total of 16 sessions, and were prescribed home-based exercises as well. The program was supervised by an exercise physiologist and was tailored to each man’s ability.⁴

The results of this study demonstrated improvement in many areas, including reduced blood pressure and improved muscle strength. The benefits were not purely physical, as the men reported an improved sense of well-being, motivation, and improved attitude towards exercise.⁴

Other studies have shown benefits to exercise in men with prostate cancer as well. In a study of men being treated with ADT and radiation therapy, improvements from exercise were noted in those who participated in a 6-month supervised exercise program. This included improvement in walking endurance, increased muscle strength, decreased pain, decreased dyspnea, and less fatigue. This study also noted that although there was no increase in sexual function, the exercise cohort did not experience the same decline in sexual function as those who did not exercise.⁵

Types of Exercise

Although not always mentioned specifically in the studies, the type of exercise prescribed was often a mix of aerobic and resistance exercises. Aerobic exercise included walking or jogging on a treadmill, cycling, or rowing. Multiple resistance exercises were utilized, which included⁵:

• Chest press
• Shoulder press
• Seated row
• Leg press
• Leg curl
• Leg extension

Resistance exercises were performed on exercise machines or with resistance bands. Impact exercises such as skipping, hopping, and jumping were prescribed to some participants.

Barriers to Implementation

An important factor was that exercise sessions were supervised by a trained professional, and that programs were adapted to meet the specific needs of the participant. Safety is an important consideration when starting an exercise program, especially for those who previously did not exercise or had limited experience. This certainly can be a barrier to some who don’t have access to a professional trainer or physical therapist, either due to geographical location or financial reasons.

There are currently no specific exercise guidelines for men with prostate cancer. However, there are some general suggestions for physical activity that can be helpful when discussing exercise with patients.³

• Some form of exercise should be done on most days of the week.
• Aim for 75 minutes of vigorous exercise to 150 minutes of moderate-intensity exercise each week (can be a combination of activities).
• Additionally, aim for at least 2 resistance training sessions per week:

• 6 to 8 exercises that work all major muscle groups
  • Perform 1 to 4 sets of 6 to 12 repetitions each

• Shorter, more frequent bouts of exercise may be better than loading the full week’s exercise into 2 or 3 days.
• If no bone metastases are present, impact exercises can help slow bone loss.

• Suggested schedule is 4 days a week.
  • 50 impacts per session (3 to 5 sets of 10 to 20 repetitions).
  • Exercises include hopping, heel drops, bench stepping.

Clinicians need to remember that these guidelines may not be appropriate for every man with prostate cancer. If there are underlying conditions or comorbidities, these need to be taken into consideration and adjustments should be made. Consultation with a physical therapist or exercise physiologist, if available, can be helpful.

References

1. American Cancer Society. Key statistics for prostate cancer. American Cancer Society website. Last revised January 12, 2022. Accessed January 20, 2023. https://www.cancer.org/cancer/prostate-cancer/about/key-statistics.html
2. Hu JR, Duncan MS, Morgans AK, et al. Cardiovascular effects of androgen deprivation therapy in prostate cancer: contemporary meta-analyses. Arterioscler Thromb Vasc Biol. 2020;40(3):e55-e64. doi:10.1161/ATVBAHA.119.313046
3. Newton RU, Hart NH, Galvão DA, Taaffe DR, Saad F. Prostate cancer treatment with exercise medicine. Trends Urol Mens Health. 2022;13(6):14-19. doi:10.1002/tre.884
4. Schumacher O, Galvão DA, Taaffe DR, et al. Nationwide industry-led community exercise program for men with locally advanced, relapsed, or metastatic prostate cancer on androgen-deprivation therapy. JCO Oncol Pract. 2022;18(8):e1334-e1341. doi:10.1200/OP.21.00745
5. Schumacher O, Galvão DA, Taaffe DR, et al. Effect of exercise adjunct to radiation and androgen deprivation therapy on patient-reported treatment toxicity in men with prostate cancer: a secondary analysis of 2 randomized controlled trials. Pract Radiat Oncol. 2021;11(3):215-225. doi:10.1016/j.prro.2021.01.005