High Intensity Interval Training May Be Associated With Reduced PSA Levels

High Intensity Interval Training (HIIT) has been associated with suppressing the progression of prostate cancer, as well as improving cardiorespiratory fitness, in patients under active surveillance.1

In the randomized, single-center, 2-arm, phase 2 ERASE trial (NCT03203460), a cohort of 52 male prostate cancer patients under active surveillance and undergoing 12 weeks of HIIT experienced a significant decrease in l prostate specific antigen (PSA) levels (95% CI, -2.1 to 0.0; P = 0.04) and the rate of prostate specific antigen (PSAV; 95% CI, -2.5 to -0.1; P = .04). The HIIT group also displayed a favorable PSA doubling time (PSADT), compared to the control group, although the results were not statistically significant (17.9 months; 95% CI: -3.8 to 39, 6; P= .10).

In addition, maximal oxygen uptake was significantly improved following exercise, and the growth of the prostate cancer cell line (LNCaP) was inhibited (-0.13 optical density units; IC at 95%, -0.25 to -0.02; P= .02).

“To our knowledge, the ERASE trial was the first randomized clinical trial to examine the effectiveness of HIIT in men with localized prostate cancer under active surveillance,” wrote the senior author, Dong-Woo Kang, PhD, University of Alberta, Edmonton, Alberta, Canada. “These improvements appear to be significant and may translate into better outcomes for prostate cancer patients who are managed with active surveillance.”

A total of 52 patients were randomized into 2 groups. In both groups, the mean age was 63.4 years. Eighty-nine percent self-identified as white individuals. To be eligible to participate, men had to be 18 years of age or older, have a diagnosis of very low to favorable intermediate risk prostate cancer, be under active surveillance and have no plans for immediate treatment, as well as be medically authorized. to participate, and physically able to complete a basic fitness test. Participants could not already engage in vigorous intensity exercise.

Patients in the experimental cohort participated in 12 weeks of supervised aerobic sessions three times per week on a treadmill at 85% to 95% of peak oxygen (VO2). The control group maintained their usual exercise program. All results were evaluated according to the intention-to-treat principle.

The key outcome was cardiorespiratory capacity, which was determined by the peak of VO2, an established surrogate marker for CVD and CVD-related deaths. VO2 was assessed during the initial baseline fitness test and then assessed during the post-intervention period. These tests were carried out on treadmills. The researchers used a modified Bruce protocol to establish the highest oxygen uptake value among 15-second intervals.

The secondary results were evaluated by a blood test 12 hours after the fasting of the patients. This assessment assessed the concentrations and kinetics of PSA, including PSADT and PSAV, sex hormone levels, functional fitness and anthropometry, as well as the proliferation of the prostate cancer cell line in plasma.

Unfortunately, the impact of the COVID-19 outbreak resulted in the success of only 880 of the 918 planned exercises, and post-intervention assessments were carried out 2 weeks earlier than planned due to the closure of public facilities.

A total of 8 participants experienced worsening symptoms that could be related to the exercise regimen. Of these adverse events, 6 reported joint pain, 1 reported chest discomfort, and 1 reported dizziness. One patient had stomach bleeding that was unrelated to HIIT training.

“Ultimately, the ERASE trial [was] well-constructed and demonstrates the power of a lifestyle intervention with far-reaching implications, ”concluded Neha Vapiwala, MD, Department of Radiation Oncology, University of Pennsylvania, in a guest commentary on the study. “While the special focus on patients pursuing AS is technically not unique, it is rare; the demonstration that HIIT alone, without modification of the diet, improved cardiorespiratory condition and biochemical parameters in men with PC located on AS and inhibition of growth at the cellular level is new and remarkable… the ERASE trial enables patients with PC on AS to be in better physical, functional and psychological shape for any future medical intervention they may need. 2

Larger trials are still needed to determine the biophysiological link between exercise and prostate cancer and to identify potential tumor-related biomarkers.

Future trials should seek to expand the sample size by realizing and planning for potential recruitment bias (fit and physically active males) as well as planning long-term follow-up to assess clinical outcomes.

The references:

  • Kang D, Fairey AS, Boulé NG, Field CJ, Wharton SA, Courneya KS. Effects of exercise on cardiorespiratory fitness and biochemical progression in men with localized prostate cancer under active surveillance: the ERASE randomized clinical trial. JAMA Oncol.Published online August 19, 2021. doi: 10.1001 / jamaoncol.2021.3067
  • Vapiwala N. The Power of Exercise to Influence Cardiovascular and Oncology Outcomes – Survival of the Fittest. JAMA Oncol.Published online August 19, 2021. doi: 10.1001 / jamaoncol.2021.3065


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