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Can prostate cancer be treated with exercise?

Can prostate cancer be treated with exercise? | Jo Divine

Exercise is recommended to help people recover after cancer treatment but now a new Cancer Research UK study (2016) is being introduced as a treatment for prostate cancer.

The PANTERA study being conducted by Sheffield Hallam University will concentrate on 50 men who have prostate cancer, but whose cancer has not spread.

Many men have a slow growing form of prostate cancer that poses little risk to health so the treatment for this is to wait and see, keeping it under surveillance. Many men choose this option as chemotherapy and radiotherapy have many side effects which can impact upon health long after the cancer has gone.

Research has found that regular exercise can help men with benign prostatic hyperplasia (BPH), an enlarged prostate which causes frequent night time visits to the toilet.

This study, believed to be the first of its kind in the world sets out to see if regular exercise can prevent prostate cancer from spreading to other parts of the body and may be considered a viable treatment in the NHS.

Study leader Dr Liam Bourke, principal research fellow at Sheffield Hallam University says that there is evidence to suggest that men who are physically active after a prostate cancer diagnosis have a better survival rate that men who are inactive. This may be due to the effect that exercise has on some genes which regulate cancer cell growth and repair.

Update on PANTERA Study

Research by Sheffield Hallam University that explores whether exercise training could be used in treatment for prostate cancer, has been included in new guidelines released by the European Association of Urology (EAU). The guidelines present evidence of best practice and Dr Bourke is the lead author of a chapter that focuses on improving the quality of life of patients with prostate cancer across all stages of the disease.

International Clinical Trials

Initial clinical trials from University of Montreal Hospital Research Centre (2016) has found that intense physical exercise has a direct effect upon cancer, just as effective as drugs, for treating patients with prostate cancer, even in the advanced stages.

They are now launching the first international study involving 900 men which aims to show that exercise can extend the life of men living with metastatic prostate cancer through intensive exercise which will include three one hour sessions of resistance and aerobic training each week.

Often patients with metastases become sedentary which may speed up the disease process and exercise may halt or slow it down.

Researchers from Canada, USA, Australia, Ireland, the UK and the Netherlands will be involved but the result will not be known for five years.

The Global Action Plan 4 Global Prostate Cancer (GAP4) will bring together 150 researchers around the world to share their expertise to improve the life chances of prostate cancer patients and is led by The Movember Foundation.

UK Clinical Exercise Trials

Pioneering pre-surgery exercise sessions Fit-4-Surgery for cancer patients are going to be piloted at gyms and cancer support centres across the south in the first project of its kind in the UK (2017).

Having been trialled at Southampton General Hospital in 2014 by consultant Professor Mike Grocott and his team into the effect of tailored exercise programmes on bowel cancer patients after chemotherapy and radiotherapy but before surgery, they discovered patients benefited from reduced hospital stay, lower readmission rates and less cardiorespiratory complications.

The Wessex Cancer Alliance, Wessex Cancer Trust and council and community gym have partnered up, to look at whether or not the exercise sessions, along with psychological wellbeing support, can be taken out of hospital and delivered to more patients across the south. This is so beneficial to improving the quality of life post treatment.

The benefits of exercise

Exercise has long been considered an excellent way to help people recover after cancer treatment and living with cancer. Spending time exercising minimises side effects of treatment, in addition to preventing recurrence of disease.

The University of Copenhagen (2015) found that one hour of soccer training each week can increase bone density, improve cardiac function and strengthen muscles. Often men who have prostate cancer have an increased risk of brittle bones as a result of side effects to their treatment, similar to osteoporosis which can occur as a result of the menopause in women. Running around the pitch, jumping, accelerating, braking and kicking the ball can counteract the effects of the treatment.

The social aspect of team sports can also help prevent depression, often experienced when you have cancer.

A new study from Dana-Faber Cancer Institute (August 2019) found that patients with metastatic colorectal cancer who engaged in moderate exercise while undergoing chemotherapy tended to have delayed progression of their disease and fewer severe side effects from treatment.

M.Carayol et al (2012) found that women who had had breast cancer were less likely to be anxious or depressed if they exercised for half an hour four times each week. The sooner the women started their exercise after their cancer treatment had finished, the better they felt.

Research from the Netherlands Cancer Institute (2015) and published in the Journal of Clinical Oncology found that women who followed a physical exercise programme during their chemotherapy treatment experienced less side effect such as nausea, pain, fatigue and reduced physical fitness. In the past patients were advised to take it slow when undergoing chemotherapy but this research shows that even doing a small amount of exercise can be beneficial.

As to whether the chemotherapy works more efficiently isn’t proven and further research is needed to ascertain this. However, becoming active during treatment may help you recover quicker, overcoming side effects and keep exercising too.

Researchers from the University of Stirling (2016) found health and exercise sessions currently provided to individuals recovering from heart disease could also help people who have undergone bowel cancer surgery. The patients with bowel cancer were referred to the cardiac rehabilitation classes and found cardiac patients welcomed those with cancer into their classes. Both groups enjoyed exercising together and supported each other to make a full recovery.

New research from Cancer Research UK published in the British Journal of Cancer (2018) has found that high-intensity interval training reduces tiredness and improves self-esteem for testicular cancer survivors. Although a small sample group, it is easy to replicate according to Professor Kerry S Courneya who says,

“What’s so exciting is that this programme would be easy to introduce to patients as it’s as simple as jogging for two minutes and walking for two minutes. It can also be specifically targeted at men who aren’t fit and suffer with tiredness.”

Many NHS trusts offer exercise classes for people with heart disease which improve their chances of survival and quality of life but there is currently no equivalent rehabilitation program for patients with cancer.

Lack of advice and guidance about exercise

Yet research by Macmillan Cancer Support (2012) found that 4 out of 5 cancer patients said their GPs (82%), oncologists (77%) and clinical nurse specialists (79%) did not speak to them about the importance of being physically active once they had completed their treatment.

An extensive Cancer Research UK study (2015) found that more than two-thirds (69 per cent) of bowel cancer patients said they weren’t advised to exercise regularly after their diagnosis despite evidence that brisk physical activity is linked to better survival in bowel cancer.

Those given advice to exercise during or after cancer treatment were often already active whereas women and the elderly were not routinely informed, despite numerous studies demonstrating that exercising can be beneficial following a cancer diagnosis and treatment.

Some NHS Trusts offer a 6 week exercise course following cancer treatment to help patients get back into exercising but this provision is not offered across the UK. Many patients need guidance as to what type of exercise they can undertake, according to where their cancer is and how it was treated.

Great Manchester Sport offer Fit After Cancer Treatment, a group designed to support cancer patients with physical, mental and emotional fitness once their treatment is complete.

Jo Taylor from ABC Diagnosis piloted the first Breast Cancer Retreat in Yorkshire this summer which included Yoga, Walking/Nordic walking, Running, Cycling, Relaxation & possible therapies, and how to deal with menopause, all with trained professionals which received a great response.

Taking regular exercise is good for everyone, not just if you have cancer. Research published in JAMA Internal Medicine (May 2016) found that taking more physical activity reduced the risk of developing cancer in 13 of the 26 cancers reviewed from a pool of more than a million Europeans and Americans.
However, taking exercise isn’t the only factor that can help reduce your risk to developing cancer, lifestyle choices play a part.

Many people, including athletes, who do exercise regularly still develop cancer as a result of gene mutations which is out of their control.

However, it will be interesting to see if regular exercise is a useful and viable form of treatment for some prostate cancer patients. If shown to be beneficial, research involving people with other forms of cancer would be helpful too.

It is hoped that this study will lead to a full scale trial to look at the potential benefits of combining active surveillance and exercise for some men with prostate cancer.

Useful websites

Prostate Cancer UK : www.prostatecanceruk.org
Macmillan : www.macmillan.org.uk
Orchid : www.orchid-cancer.org.uk
Tackle Prostate Cancer : www.tackleprostate.org
College of Relationship and Sexual Therapists : www.cosrt.org.uk