Prostate cancer is the most commonly diagnosed cancer with 1 in 6 men (1) diagnosed. It is a condition characterised by the uncontrolled rate of cell growth within the prostate, that then has the potential to metastasis (spread) to other parts of the body. The prostate is gland is situated within the pelvis and underneath the bladder. It is responsible for producing the fluid needed for ejaculation. Other conditions that involve the pancreas include prostatis (inflammation of the prostate) and benign prostate hypertrophy (non-cancerous enlargement of the prostate). Throughout this article I discuss the diagnostic process, why exercise is an important adjunct treatment, and what considerations need to be made when designing an exercise program.
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Diagnosis
As an Exercise Physiologist, the diagnostic process of prostate cancer is generally something we are not involved in. With each prostate cancer patient presenting with different stages and aggression levels, being aware of the diagnostic process, and the scores that accompany the various tests, will provide health professionals with a greater understanding of the current state of the patient’s prostate cancer. Below are the 3 tests that patients will go through during their diagnosis.
- PSA (Prostate Specific Antigen): Enzyme found in the blood that is produced by the prostate in which production increases when pancreas cells become cancerous.
- DRE (Digital Rectal Exam): Palpation of the prostate to feel for abnormalities (hardness of the prostate/lumps).
- Prostate Biopsy: Tissue samples of the prostate are taken and examined under a microscope. This helps evaluate the stage of prostate cancer (Gleason Score & ISUP).
The Gleason Score & ISUP are used during the analysis of the tissue biopsy. The Gleason Score is a combination of the most common tissue patterns + second most common tissue patterns seen under a microscope, which helps understand the different tissue types and aggression. ISUP is a grading system used in conjunction with the Gleason score and divides the grades for better understanding of aggressions.
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Common words used during the diagnostic process include:
- Grade: How fast the cancer might grow.
- Stage: How far the cancer has spread.
- Localised: Cancer has not spread beyond prostate.
- Locally advanced: Cancer has extended beyond prostate but still confined in prostate region.
- Advanced: Cancer has spread to organs next to the prostate.
- Metastatic: Cancer spread to different parts of the body.
Exercise as an adjunct treatment
Research supports the notion that exercise is safe and effective in assisting in the treatment of prostate cancer. A study performed by Friedenreich et al showed that prostate cancer patients with higher amounts of energy expenditure reported a lower death rate from prostate cancer and a lower death rate overall (2). PSA doubling time (favourable prognosis) significantly improved along with improvements in overall body composition through a reduction in fat mass and body weight while increases in lean body mass were shown (3). Researchers made the conclusion that PSA doubling time was a direct correlation with improvements in fitness levels. Although not specifically done within prostate cancer, research in breast cancer patients has shown that relative dose intensity of treatment and ability to tolerate these treatments has been higher in groups that have performed exercise during treatment cycles (4). This highlights that exercise may allow for patients to receive and tolerate a greater percentage of their outlined treatment plan.
Outside of these specific benefits, strength & aerobic exercises have been found to:
- Increase physiological processes such as blood flow. An increase in blood flow allows more blood with oxygen to diffuse into the site of the tumour which can offset the current hypoxic environment
- Improvements in immune function through physiological processes, in combination with increased blood flow, allow more of the body’s immune system to flood the infected area
- Help offset the effects of fatigue, sarcopenia, osteoporosis and cardiovascular fitness parameters.
Exercise Program Considerations
There is no “one best program” for prostate cancer patients. Like with any patient, an individualised approach needs to be taken to meet the patient’s needs. Below are some tips I employ to construct the exercise program.
- Exercise screening: A screening not only should outline the stage and grade of the patient’s prostate cancer but should also determine risks for exercise, identify the presence of comorbidities and whether the need for medical clearance needs to be obtained.
- Understand the absolute and relative risk of exercise.
- Understand the patients side effects of their respective treatment e.g. urinary incontinence, cancer related fatigue, changed in body composition via castration treatment, bone pain.
- An assessment that gives the “big picture” e.g. when I take prostate cancer out of the question, what do I see?
- Wellness sheet, RPE scales to establish exercise trends.
- Tracking of blood pressure pre/during exercise to make sure blood pressure matches exercise intensity.
- Having variable intensity and volume of exercise programs planned, for when the patient may present with higher amounts of cancer related fatigue.
- Treatment cycles to know when deload and progressive overload principles can be applied.
Every patient that I see with prostate cancer will be at varying stages through their treatment journey. Understanding the above diagnostic scores, principles of exercise testing and programming will ensure that the exercise modality is suitable and effective for the patient. Furthermore, when working with prostate cancer patients, I have learned the following lessons:
- Understanding their symptoms will vary from day to day so be planned ahead of session for how they come in.
- It’s a learning experience. Every time you program, assess someone with prostate cancer you will learn how to better go about it.
- To monitor their exercise through various tools that helps you establish their response.
To find out more on what you should be doing for your particular case, come on in and see the expert team at Absolute. A multidisciplinary team of highly skilled clinicians here to work alongside your oncology specialist.
Written By Accredited Exercise Physiologist & Performance Coach Adam Luther.
References
- Australian Cancer & Incidence Mortality (2016) – Australian Institute of Health & Welfare
- Friedenreich, C., Qinggang, W., Neilson, H., Kopcuik, K., McGregor, S., & Courneya, K. (2016). Physical activity & survival after prostate cancer. Journal of European Urology. 70(4): 576-585
- Hvid, T., Lindegaard, B., Winding, K., Iversen, P., Brasso, K., Solomon, T., Pedersen, B., & Hojman, P. (2016). Effect of a 2-year home-based endurance training intervention on physiological function and PSA doubling time in prostate cancer patients. 27(2): 165-174.
- Courneya, K., Segal, R., Mackey, J., Gelmon, K., Reid, R., Friedenreich, C., Ladha, A., Proulx, C., Vallance, J., Yasui, Y., & McKenzie, D. (2007). Effects of aerobic and resistance exercise in breast cancer patients receiving adjuvant chemotherapy: a multicenter randomized controlled trial. Journal of Clinical Oncology. 25(28): 4396-4404.
