Men with prostate cancer who are undergoing active surveillance have a 3 times higher risk of dying from cardiovascular disease (CVD) than from a prostate cancer-specific cause. Despite that statistic, only 1 study has been conducted in the clinical setting to examine the potential benefit of exercise in improving cardiovascular health and slowing disease progression in these men.
Until now. A team of researchers launched the Exercise During Active Surveillance for Prostate Cancer (ERASE) trial at the University of Alberta in Edmonton, Canada (ClinicalTrials.gov Identifier: NCT03203460). ERASE is a single-center, phase 2 randomized clinical trial examining the effects of exercise on both cardiorespiratory fitness and biochemical disease progression in this population. The researchers’ findings were published in JAMA Oncology.
In this study, 52 men were enrolled and randomly assigned to a high-intensity interval training (HIIT) program for 12 weeks or to a control group. The primary outcome measured was peak oxygen consumption (VO2), which represented cardiorespiratory fitness and serves as a surrogate marker for CVD and CVD-related death. Secondary outcomes were factors relative to the prostate cancer progression, including prostate-specific antigen (PSA) levels, PSA kinetics, and the proliferation of plasma prostate cancer cell line LNCaP.
They found that V02 decreased by 0.5 mL/kg in the control group, which did not alter its usual routine; but it increased by 0.9 mL/kg in the HIIT group. The adjusted mean-group difference was 1.6 mL/kg (P =.01).
Both PSA levels and PSA velocity were significantly decreased in the HIIT group compared with the control group. LNCaP cell growth was significantly inhibited in the HIIT group compared with the control group. Although PSA doubling time was better in the HIIT group, it did not reach statistical significance.
“These improvements appear to be meaningful and may translate into better outcomes for patients with prostate cancer who are being managed by active surveillance,” the researchers wrote. They noted that the increased VO2 in the HIIT group suggests potential long-term cardioprotective benefit.
Although this study was a randomized clinical trial, it did have limitations: failure to reach the target sample size (87%) and some missing data (6% to 12%). Three participants had shortened participation time. The study’s results may also have been influenced by potential recruitment bias of the participants.
Kang DW, Fairey AS, Boule NG, Field CJ, Wharton SA, Courneya KS. Effects of exercise on cardiorespiratory fitness and biochemical progression in men with localized prostate cancer under active surveillance: the ERASE randomized clinical trial. JAMA Oncol. Published online August 19, 2021. doi:10.1001/jamaoncol.2021.3067