medwireNews: Men with localized prostate cancer undergoing active surveillance who follow a high-intensity interval training (HIIT) regimen can expect improvements in cardiorespiratory fitness and indicators of biochemical progression, early findings indicate.
“These improvements appear to be meaningful and may translate into better outcomes” for this patient population, say the ERASE investigators, but they stress the need for larger randomized trials to evaluate longer-term clinical outcomes.
The phase 2 trial included 52 men with very low- to favorable intermediate-risk, localized prostate cancer who had been on active surveillance for an average of 23 months. The intervention period was 12 weeks and comprised thrice-weekly, supervised aerobic sessions on a treadmill at 85–95% of peak oxygen consumption (VO2) for those who were randomly assigned to the HIIT group, while the usual care group were asked to maintain their regular exercise levels.
Participants were aged an average of 63.4 years, 89% were White, and 90% had clinical stage T1c disease. In all, 88% completed a peak VO2 test after the intervention period and 94% provided blood samples at this timepoint. All but two of the 26 patients in the HIIT group attended at least 80% of the exercise sessions.
Kerry Courneya and colleagues from the University of Alberta in Edmonton, Canada, report that the primary outcome of peak VO2 – “an established surrogate marker” for cardiovascular disease and related death – was significantly improved with HIIT versus usual care.
Specifically, peak VO2 increased by a mean of 0.9 mL/kg per min from baseline in the HIIT group, compared with a decrease of 0.5 mL/kg per min in the usual care group, which equated to an average between-group difference of 1.6 mL/kg per min after adjusting for baseline peak VO2 values and resistance exercise behavior.
The HIIT intervention was also associated with a significant reduction in prostate-specific antigen (PSA) levels and PSA velocity relative to usual care; the respective adjusted mean differences between the groups were –1.1 µg/L and –1.3 µg/L per year.
And as reported in JAMA Oncology, PSA doubling time was numerically but not statistically significantly improved in the HIIT versus usual care group, with an adjusted mean between-group difference of 17.9 months.
The researchers believe that “[m]ore research in active surveillance clinical settings is necessary to identify the biophysiological associations between exercise and prostate cancer and to further explore potential tumor-related biomarkers.”
Writing in a related commentary, Neha Vapiwala (University of Pennsylvania, Philadelphia, USA) describes the trial as “well constructed,” and commends the researchers “on completing what may be the first randomized clinical trial examining efficacy of physiologic conditioning in men with untreated localized [prostate cancer] using a well-established metric for aerobic fitness that reflects bodily ability to effectively transport, extract, and use oxygen at the cellular level.”
She notes that “while not powered to examine overall survival, like the Movember Foundation’s Intense Exercise for Survival Among Men With Metastatic Prostate Cancer (INTERVAL-GAP4) trial, the ERASE trial does empower patients with [prostate cancer] on [active surveillance] to be in better physical, functional, and psychological shape for any future medical interventions they may need.”
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JAMA Oncol 2021; doi:10.1001/jamaoncol.2021.3067
JAMA Oncol 2021; doi:10.1001/jamaoncol.2021.3065