Can exercise ameliorate treatment toxicity during the initial phase of testosterone suppression in prostate cancer patients? Is this more effective than delayed rehabilitation and what is the time course and persistence of benefits?

Principal researchers

Professor Robert Newton¹ 
Daniel Galvao¹
Nigel Spry²
Dennis Taaffe³
Suzanne Chambers ^{4, 5}
Robert "Frank” Gardiner ⁶
David Shum⁵
Prue Cormie¹
David Joseph²
Jim Denham³

Institution

¹ Edith Cowan University
² Sir Charles Gairdner Hospital
³ University of Newcastle
⁴ Cancer Council Queensland
⁵ Griffith University
⁶ University of Queensland

Funding

$148,759 (Total funding $446,276)

Co-funded with

Cancer Australia

Award type

Priority-driven Collaborative Cancer Research Scheme (PdCCRS)

Project completion year

2015

Project brief

There has been a substantial increase in the use of temporary androgen suppression therapy (AST) as an adjuvant management of prostate cancer. However, AST leads to a range of musculoskeletal toxicities including reduced bone mass and increased skeletal fractures, compounded with rapid metabolic alterations including increased body fat, loss of lean mass, insulin resistance and negative lipoprotein profile. Furthermore, our research suggests an increased incidence of cardiovascular and metabolic morbidity associated with temporary AST, and the researchers have also reported significantly increased distress and reduced quality of life (QoL ).

Preliminary clinical trials by this team have demonstrated high efficacy of exercise for these patients but evidence is limited to only a few studies with men on long-term androgen deprivation. Their recent study published in the Journal of Clinical Oncology proved that a structured exercise program leads to significant and clinically meaningful benefits, including reversal of muscle loss, improved function and QoL in men receiving AST for an average of 14 months.

An NHMRC-funded randomised control trial (RCT) examining different exercise modalities in men on longer term (>three months) AST for prostate cancer, has been conducted by the researchers.

Data for 65 participants with baseline and six-month assessment of lumbar spine (L2-4) BMD, show that the resistance/aerobic exercise and usual care groups experienced a significant reduction of -2.61 per cent (p= 0.019) and -3. 18 per cent (p=0.000) respectively, while bone is preserved in the resistance/high-impact loading exercise intervention with a non-significant change of -0.22 per cent (p=0.839).

This is a world first, demonstrating exercise as arresting bone loss in this patient group and, importantly, that commonly prescribed protocols of aerobic or resistance exercise alone is not as effective as the highly specific, high-impact loading intervention that the researchers have implemented.

The pressing question is whether it is more efficacious to commence exercise therapy at the same time as initiating AST so treatment-induced adverse effects can be immediately attenuated or prevented. 

This project is a RCT with partial crossover to examine the effects of the timing of exercise implementation (immediate or delayed) on preserving long-term skeletal health,  reversing short-  and long-term metabolic  and cardiovascular risk factors and supporting mental health in men receiving AST.

This project is unique as it explores a fundamental question of when exercise implementation will be of most benefit, and addresses both physical and psychological consequences of AST initiation.

The final outcome may be adjunct treatment which will reduce, if not prevent, the toxicities of AST, ultimately resulting in reduced morbidity and mortality for men with prostate cancer.