Kang D-W, Fairey AS, Boulé NG et al: A randomized trial of the effects of exercise on anxiety, fear of cancer progression and quality of life in prostate cancer patients on active surveillance. J Urol 2021; https://doi.org/10.1097/JU.0000000000002334.

Study Need and Importance

Active surveillance (AS) has allowed men with low-risk prostate cancer (PCa) to avoid immediate treatments and their side effects. Unfortunately, some men on AS experience psychosocial distress, which can be associated with poor quality of life and may even prompt some men to opt for radical treatments despite no clinical PCa progression. Exercise has been shown to manage distress in PCa patients during and after treatments; however, no study has examined the role of exercise in the AS setting.

What We Found

We conducted the Exercise during Active Surveillance for Prostate Cancer (ERASE) trial to examine the effects of 12 weeks of high-intensity interval training (HIIT) compared to usual care in 52 PCa patients on AS. We previously reported that the HIIT intervention was feasible (96% adherence), improved cardiovascular fitness and reduced biochemical progression of PCa. In our analyses on psychosocial outcomes, we found that HIIT also significantly improved total prostate cancer-specific anxiety (p=0.024), the fear of progression subscale (p=0.013), hormonal symptoms (p=0.005), perceived stress (p=0.037), fatigue (p=0.029) and self-esteem (p=0.007; see figure).

Figure. A 12-week high-intensity aerobic interval training program significantly reduced total PCa-specific anxiety (left graph) and fear of progression subscale (right graph).

Limitations

The limitations of our study include potential confounding from social interactions that occurred during supervised exercise, the small sample size and limited statistical power, the risk of chance findings due to multiple testing without adjustment, potential recruitment bias and lack of long-term followup.

Interpretation for Patient Care

Our findings suggest that supervised HIIT may improve PCa-specific anxiety, fear of cancer progression, hormonal dysfunction, stress, fatigue and self-esteem in PCa patients on AS. These outcomes may be particularly important for a subgroup of AS patients who show higher anxiety and potentially opt for radical treatment to manage their distress. Larger trials are needed, however, to confirm our findings and to establish the longer-term effects of exercise on patient-reported and treatment outcomes in the AS setting.