“Certainly, I think it depends on the age of the patient. If you have patients under active surveillance, you can already extrapolate that many of them will be younger and may be in good enough shape to do high intensity training. These workouts are not for the faint of heart. They are not intended for people who are not active to begin with.

Will this be possible among this group of patients? I guess it could be.

Certainly, my experience with patients under surveillance, who meet the criteria for active surveillance, [is that they] tend to be younger, healthier patients, so I don’t see why. I certainly think that’s a reasonable thing to tell them.

As for the concept of high intensity interval training, I should know more about the science behind it and how they make the science work with it.

But… some men would definitely do it. Certainly, I think many of the men who are actively monitored are healthy enough patients to do this type of training. I think they would be able to, and I think if they’re willing to watch the cancer in active surveillance, they’d be willing to put in the effort to control it even better with high intensity training . I don’t see why they wouldn’t.

Guillermo Patino, DO, FACS

Las Vegas, Nevada

“Over the years we’ve all done general urology, although I haven’t done much prostate cancer for a few years.

Certainly, I think most men with prostate cancer are very interested in research into preventing recurrence and progression. So most men, if they are physically able, would probably be interested in looking into any type of research like that and moving forward.

This may depend on the patient’s age, comorbidities and capabilities. [From] past [experience], I know a lot of men…would be willing to look into any kind of adjuvant therapy they could find that would reduce risk, because if they’re on active watch, they want it to continue. They don’t want any disease progression. So if there’s something that actually gives them a bit more control over their disease process that they can do to stop the cancer from progressing and having to go into active treatment, a lot of men would ready to pursue it. .

In terms of the concept, aside from prostate cancer, every time you increase your physical activity and increase that cardiac stress, that’s good for every patient, [whether they have] prostate cancer, benign prostatic hyperplasia, [or] prolapse. Anything that improves your overall physical health is beneficial.

Stephanie Pothoven, DO

Clive, Iowa

“The confounding factor, of course, is that people who train are healthier and have better cardiovascular health anyway. It would be very important to separate individuals with good cardiovascular health, normal body mass index , normal cholesterol, normal blood pressure and no diabetes.

If men are already active, the question is how much more would that activity help them compared to someone who was mildly obese who actually lost 20-30 pounds and lowered their cholesterol.

It also depends on the genetics of prostate cancer. Individuals will be tested. And to be honest, if these tests show less than 1% risk of metastatic disease in 10 years, why would they exercise?

Because we have genetic testing, which is the genetic behavior of cancers, it might not even have a marginal impact on prostate cancer progression.

If the patient is obese, but the genes tell him he is low risk, what incentive does he have to lose weight?

If the patient is intermediate risk and decides to wait under watch, then loses 45 pounds due to high intensity interval training and is suddenly determined to be low risk, that would be profound. You would reverse the course of cancer by exercising. If genetic testing already classifies men as low risk, I don’t see the huge incentive for them to exercise unless they’re already motivated, to be honest.

It is good for heart health. There’s a familiar thing we used to say, “Anything good for the heart is good for the prostate.”

Obviously, this is not a guarantee that will solve all prostate problems, but I think exercise would have a marginal impact in light of the genomics that is widely available.

For sedentary people, if genomics show they are at low risk, it will be difficult to convince them that they should exercise to lower their risk of prostate cancer even further. “

Matthew Karlovsky, MD

Phoenix, Arizona

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. 2021;7(10):1487-1495. doi:10.1001/jamaoncol.2021.3067