High-intensity exercise regimen may boost active surveillance outcomes in prostate cancer

Findings from the phase 2 ERASE trial suggest that men with localized prostate cancer undergoing active surveillance can increase their cardiorespiratory fitness levels and potentially improve clinical their outcomes by following a high intensity interval training (HIIT) exercise regimen.¹

The results, which were published in JAMA Oncology, showed that patients who adhered to the HIIT regimen had a peak oxygen consumption (VO2) increase by 0.9 mL/kg/min and usual care group experienced a decrease by 0.5 mL/kg/min (adjusted mean difference between groups, 1.6 mL/kg/min (95% CI, 0.3-2.9; P = .01). Patients in the HIIT group experienced decreased prostate-specific antigen (PSA) levels (-1.1 μg/L; 95% CI, -2.1 to 0.0; P = .04), PSA velocity (-1.3 μg /L/y; 95% CI, -2.5 to -0.1; P = .04), and LNCaP cell growth (-0.13 optical density unit; 95% CI, -0.25 to -0.02; P = .02).

Additionally, investigators did not identify statistically significant differences in PSA doubling time or testosterone. In addition to experiencing a significant increase in peak VO2 in liter per minute patients in the HIIT cohort experienced upper body strength and lower body flexibility.

“To our knowledge, the ERASE trial was the first randomized clinical trial to examine the efficacy of HIIT in men with localized prostate cancer undergoing active surveillance. As we hypothesized, a supervised 12-week HIIT program significantly improved cardiorespiratory fitness and indicators of prostate cancer biochemical progression,” the study’s investigators wrote.

The trial enrolled 52 eligible male patients, 26 of whom were randomized to the HIIT group and 26 to the usual care group. The average age was 63.4 years, and 89% (n = 46) of patient’s self-identified as White. In total, 88% (n = 46) of patients completed the postintervention peak VO2 assessment and 94% (n = 49) of patients completed the postintervention blood draw.

The mean baseline resistance exercise behavior was unbalanced between groups with the HIIT group utilizing an 18 (42) min/wk and the usual care group utilizing a 44 (62) min/wk, which was adjusted for analyses because of prognostic association with PSA and fitness outcomes.

This study was completed 2 weeks earlier than anticipated at 10-weeks for the last 6 participants—3 per each group—due to the impending closures of facilities during the COVID-19 outbreak.

Investigators reported a 100% adherence rate to intensity and duration, and patients attended 96% (n = 880) of planned exercise sessions. In total, 15% (n = 8) of patients reported aggravation of previous medical issues, including joint pain (n = 6), chest discomfort (n = 1), and light-headedness (n = 1); the medical issues were related to HIIT. Additionally, 1 patient reported stomach bleeding of a Dieulafoy lesion that was not related to HITT.

The PSA doubling time was better in the HIIT group, although it did not reach statistical significance (adjusted between-group mean difference, 17.9 months; 95% CI, -3.8 to 39.6; P = .10). Investigators did not identify an adjusted between-group mean difference in testosterone (1.0 nmol/L; 95% CI, -0.7 to 2.6; P = .24). The LNCap cell growth was significantly inhibited in the HIIT group vs the usual care group, with the adjusted between-group mean difference being -0.13 optical density unit (95% CI, -0.25 to -0.02; P = .02; or -5.1%).

“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 investigators concluded.

Reference

1. Kang DW, Fairey AS, Boulé 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