The effect of exercise on the disease progression of patients with localized prostate cancer

This article is from the NEJM Journal Watch Impact of Exercise on Disease Progression in Men with Localized Prostate Cancer.
Comment on the impact of the movement on the disease progression of patients with localized prostate cancer.
Author: Robert Dreicer, MD, MS, MACP, FASCOERASE Trial Finding 12 Weekly high-intensity interval training is beneficial
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More and more low-risk prostate cancer patients are undergoing active monitoring instead of immediate local radical treatment, but 55% of them will receive definitive treatment within 10 years
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Considering the disease biology and age range of this population, it is not surprising that the risk of cardiovascular disease-related death in these patients is three times the risk of prostate cancer-specific death
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In order to improve cardiovascular health and delay the progression of prostate cancer, researchers evaluated the impact of high-intensity interval training (HIIT) on low- to intermediate-risk patients who are suitable for active monitoring
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In a phase 2 trial, patients were randomly divided into two groups, one group underwent HIIT (exercise three times a week under the supervision of others for 12 weeks), and the other group received conventional treatment
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This trial allows patients to cross groups at 12 weeks
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The main outcome was the peak oxygen consumption during the graded exercise test; the secondary outcome was the change in prostate-specific antigen (PSA) parameters
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During the 20-month period, 56 men were randomized and their median age was 63 years
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The compliance rate in the HIIT group was 96%
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Compared with the conventional treatment group, the peak oxygen consumption of the HIIT group was significantly improved, and the total PSA level was reduced, and the rate of PSA rise slowed down; there was no difference in PSA doubling time and testosterone levels between the two groups
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Comment As stated in a review, although the ERASE trial is small, the dropout rate is extremely low (3 patients)
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The comment writer also pointed out that although it is ethical to allow cross-groups at 12 weeks, it will complicate subsequent comparisons
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Importantly, the comment writer pointed out that for patients who will eventually need treatment for prostate cancer and/or will eventually develop cardiovascular disease, the benefits shown by the experimental group (including improvements in upper body strength and lower body flexibility) may be “previous” Improved the patient’s health"
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Other similar trials (INTERVAL-GAP4) with sufficient statistical power to assess the impact on overall survival are ongoing
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Commented article [1] Kang DW et al.
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 2021 Aug 19; [e-pub].
(https ://doi.
org/10.
1001/jamaoncol.
2021.
3067)[2] Vapiwala N.
The power of exercise to influence cardiovascular and oncologic outcomes — Survival of the fittest.
JAMA Oncol 2021 Aug 19; [e-pub].
(https: //doi.
org/10.
1001/jamaoncol.
2021.
3065) NEJM Journal Collection NEJM Journal Watch (NEJM Journal Watch) is published by NEJM Group.
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