# Exercise as it relates to Disease/Exercise and Prostate cancer
## Background

The Prostate gland is part of the internal urinary and reproductive organs in the male. Abnormal cells forming in this gland may cause a range of urinary related symptoms. Prostate cancer is the most common cancer in Australian men, and the second most prevalent cause of cancer related death. The obverse of these statistics is that some research has shown promising outcomes for exercise therapy in patients with existing prostate cancer. Even modest amounts of vigorous exercise have been demonstrated to result in a reduction of non-metastatic prostate cancer death risk by up to 61%, with indications being that inactivity should be avoided, even during treatment.

## Prostate Cancer Prevention

Exercise for health in general, via reduction in inflammation markers and protective antioxidant effect, is greatly supported by research. Exercise specifically for Prostate Cancer prevention, however, is not thoroughly proved in research and only has a probable preventative effect.

## Prostate Cancer Diagnosis: Relevant Issues

Androgen Deprivation Therapy/Androgen Suppression Therapy (ADT/AST) is a drug-based male hormone inhibitory therapy, used to starve tumours of androgens. Should the Prostate cancer reach a certain stage of advancement, ADT/AST may be suggested and undertaken as part of treatment. Side effects of ADT include increased tendency to osteoporosis and fracture, loss of muscle mass, a concurrent increased risk of falling due to the combination these two factors, sexual dysfunction, weight gain, and additional fatigue load - and exercise is indicated as an effective method to combat these.
Medication with Bisphosphonates may also be recommended in order to attempt to preserve Bone Mineral Density (BMD). Without an adaptive stimuli, supplementation alone is unlikely to generate the adaptive response required to optimise the effectiveness of this therapy, and exercise is strongly indicated as an appropriate adjunct.
Take-up and maintenance of an exercise habit is positively indicated as a method of combating the negative effects of ADT/AST. Exercise also helps ameliorate the above increased risks by building resistance to fatigue

## Recommendations

There is evidence to suggest that exercise is actually beneficial to management of cancerous conditions by moderating inflammation responses typical of precancerous metabolic states. Exercise has also been recommended to reduce or combat fatigue induced by treatment regimes, as well as improve overall quality of life of the patient.
Recommended Exercise types and durations for Prostate Cancer management
* Aerobic Exercise
20–60 minutes per session, 3-5 sessions per week, at 60-90% of maximum effort.
* Resistance Exercise
6-8 exercises, 3 sets per exercise, 6-12 repetitions per set. Aim for a minimum of 2 sessions per week
* Flexibility
2-4 sets of each exercise, 2-3 times per week
These recommendations should be modified to suit the patient, depending on factors such as ability or pain due to possible locations of metastasis. An exercise recommended in literature is brisk walking. The uptake of the 10,000 steps a day program is mentioned. If possible for the patient, this is an excellent baseline for an exercise protocol for prostate cancer management, as reduction of BMI to a healthy range should be a continuing goal. In addition, though there is no definite set of guidelines, general stress reduction should also be a continuing goal. Meditative, mindfulness-based stress alleviation practices have been indicated as useful, and should be practiced as appropriate.
Vigorous exercise is conservatively recommended, depending on the patient. Each patient's individual capability and immune function should be considered; overload with high intensity exercise is associated with immune suppression, and may push the patient in to weight loss when this is not the goal, or further exacerbate BMD loss. Such overload would be relative to the patient's health profile and treatment history, and exertion should be monitored to prevent poor outcomes. In addition, some research demonstrates decline of program adherence post-intervention. This would seem to indicate that commencing or continued biopsychosocial intervention may be needed in cases where patients begin to demonstrate poor motivation or adherence. This could include, for example, group resistance work to ensure continued program adherence

## Recommended reading/Further information and resources

* Cancer Council Victoria website http://www.cancervic.org.au/about-cancer/cancer_types/prostate_cancer
* Prostate Cancer Foundation http://www.prostate.org.au/articleLive/
* Exercise is Medicine http://exerciseismedicine.org.au/
* Exercise and Prostate Cancer: Presentation by Jennifer Chan https://www.youtube.com/watch?v=gjsU9Up4eyw

## References

* ↑ Cancer Council Victoria website, http://www.cancervic.org.au/about-cancer/cancer_types/prostate_cancer
* ↑ Exercise is Medicine Prostate Cancer Factsheet, http://exerciseismedicine.org.au/wp-content/uploads/2011/03/prostate-cancer_full.pdf
* ↑ Newton, R.U. & Galvao D.A. (2013) Exercise medicine for prostate cancer, Eur Rev Aging Phys Act (2013) 10:41–45 DOI 10.1007/s11556-012-0114-4
* ↑ Dato, S., Crocco, P., D’Aquila, P., de Rango, F., Bellizzi, D., Rose, G., & Passarino, G. (2013) Exploring the Role of Genetic Variability and Lifestyle in Oxidative Stress Response for Healthy Aging and Longevity, Int. J. Mol. Sci. 2013, 14, 16443-16472; doi:10.3390/ijms140816443
* ↑ Hayes, S.C., Spence, R.R., Galvão, D.A. & Newton, R.U. (2009) Australian Association for Exercise and Sport Science position stand : optimising cancer outcomes through exercise. Journal of Science and Medicine in Sport , 12(4). pp. 428-434.
* ↑ Friedenreich, C. M., & Orenstein, M. R. (2002). Physical activity and cancer prevention: etiologic evidence and biological mechanisms. The Journal of Nutrition, 132(11), 3456S-3464S.
* ↑ Polascik, T.J. (2008) Bone health in prostate cancer patients receiving androgen-deprivation therapy: the role of bisphosphonates, Prostate Cancer and Prostatic Diseases (2008) 11, 13–19
* ↑ Tombal, B. (2009) A Holistic Approach to Androgen Deprivation Therapy: Treating the Cancer without Hurting the Patient, Urol Int 2009;83:373–378, DOI: 10.1159/000251174
* ↑ Tombal, B. (2009) A Holistic Approach to Androgen Deprivation Therapy: Treating the Cancer without Hurting the Patient, Urol Int 2009;83:373–378, DOI: 10.1159/000251174
* ↑ Polascik, T.J. (2008) Bone health in prostate cancer patients receiving androgen-deprivation therapy: the role of bisphosphonates, Prostate Cancer and Prostatic Diseases (2008) 11, 13–19
* ↑ Fuchs, R.K., Shea, M., Durski, S.L., Winters-Stone, K.M., Widrick, J. & Snow C.M. (2007) Individual and combined effects of exercise and alendronate on bone mass and strength in ovariectomized rats, Bone 41 290–296, doi:10.1016/j.bone.2007.04.179
* ↑ Bourke, L., Doll, H., Crank, H., Daley, A., Rosario, D., & Saxton, J.M. (2011) Lifestyle Intervention in Men with Advanced Prostate Cancer Receiving Androgen Suppression Therapy: A Feasibility Study, Cancer Epidemiol Biomarkers Prev 2011;20:647-657, DOI: 10.1158/1055-9965.EPI-10-1143
* ↑ Kenfield, S.A., Stampfer, M.J., Giovannucci, E., & Chan, J.M. (2011) Physical Activity and Survival After Prostate Cancer Diagnosis in the Health Professionals Follow-Up Study, J Clin Oncol 29:726-732, DOI: 10.1200/JCO.2010.31.5226
* ↑ Segal, R.J., Reid, R.D., Courneya, K. S., Malone, S. C., Parliament, M.B., Scott, C.G., Venner, P.M., Quinney, H.A., Jones, L.W., D’Angelo, M.E.S., & George A. Wells (2003) Resistance Exercise in Men Receiving Androgen Deprivation Therapy for Prostate Cancer, Journal of Clinical Oncology, Vol 21, No 9 (May 1), 2003: pp 1653-1659, DOI: 10.1200/JCO.2003.09.534
* ↑ Exercise is Medicine Prostate Cancer Factsheet, http://exerciseismedicine.org.au/wp-content/uploads/2011/03/prostate-cancer_full.pdf
* ↑ Galvao, D.A., Taaffe, D.R., Spry, N., Joseph, D. & Newton, R.U. (2010) Combined Resistance and Aerobic Exercise Program Reverses Muscle Loss in Men Undergoing Androgen Suppression Therapy for Prostate Cancer Without Bone Metastases: A Randomized Controlled Trial, J Clin Oncol 28:340-347 DOI: 10.1200/JCO.2009.23.2488
* ↑ Galvao, D.A., Taaffe, D.R., Spry, N., & Newton, R.U. (2007) Exercise can prevent and even reverse adverse effects of androgen suppression treatment in men with prostate cancer, Prostate Cancer and Prostatic Diseases, 1–7
* ↑ Galvao, D.A. & Newton, R.U. (2005) Review of Exercise Intervention Studies in Cancer Patients, J Clin Oncol 23:899-909, DOI: 10.1200/JCO.2005.06.085
* ↑ Newton, R.U. & Galvao, D.A. (2008) Exercise in Prevention and Management of Cancer, Current Treatment Options in Oncology, DOI 10.1007/s11864-008-0065-1
* ↑ Kenfield, S.A., Stampfer, M.J., Giovannucci, E., & Chan, J.M. (2011) Physical Activity and Survival After Prostate Cancer Diagnosis in the Health Professionals Follow-Up Study, J Clin Oncol 29:726-732, DOI: 10.1200/JCO.2010.31.5226
* ↑ Diet, physical activity and prostate cancer fact sheet http://prostatecanceruk.org/media/11576/diet_physical_activity_and_prostate_cancer_final.pdf
* ↑ Carlson, L.E., Speca, M., Patel, K.D., & Goodey, E. (2003) Mindfulness-Based Stress Reduction in Relation to Quality of Life, Mood, Symptoms of Stress, and Immune Parameters in Breast and Prostate Cancer Outpatients, Psychosomatic Medicine 65:571–581
* ↑ Kenfield, S.A., Stampfer, M.J., Giovannucci, E., & Chan, J.M. (2011) Physical Activity and Survival After Prostate Cancer Diagnosis in the Health Professionals Follow-Up Study, J Clin Oncol 29:726-732, DOI: 10.1200/JCO.2010.31.5226
* ↑ Speck, R.M., Courneya, K.S., Mâsse, L.C., Duval, S., & Schmitz, K.H. (2010) An update of controlled physical activity trials in cancer survivors: a systematic review and meta-analysis, J Cancer Surviv (2010) 4:87–100, DOI 10.1007/s11764-009-0110-5
* ↑ Exercise is Medicine Prostate Cancer Factsheet, http://exerciseismedicine.org.au/wp-content/uploads/2011/03/prostate-cancer_full.pdf
* ↑ Culos-Reed, S.N., Robinson, J.L., Lau, H., O’Connor, K. & Keats, M.R. (2007) Benefits of a Physical Activity Intervention for Men With Prostate Cancer, Journal of Sport & Exercise Psychology, 2007, 29, 118-127
* ↑ Galvao, D.A., Taaffe, D.R., Spry, N., Joseph, D. & Newton, R.U. (2009) Cardiovascular and metabolic complications during androgen deprivation: exercise as a potential countermeasure, Prostate Cancer and Prostatic Diseases, 1–8