A phase III clinical trial of exercise modalities on treatment side-effects in men receiving therapy for prostate cancer Long-term Follow-up of a Randomized Trial of Radiation With or Without Androgen Deprivation Therapy for Localized Prostate Cancer. Androgen-deprivation therapy in prostate cancer and cardiovascular risk: a science advisory from the American Heart Association, American Cancer Society, and American Urological Association: endorsed by the American Society for Radiation Oncology. Prospective study of exercise intervention in prostate cancer patients on androgen deprivation therapy. EAU guidelines on prostate cancer. Part 1: screening, diagnosis, and treatment of clinically localised disease. Age and androgen-deprivation therapy on exercise outcomes in men with prostate cancer Comparing eccentric resistance exercise in prostate cancer survivors on and off hormone therapy: a pilot study. Exercise effects on adipokines and the IGF axis in men with prostate cancer treated with androgen deprivation: A randomized study. Cardiovascular mortality following short-term androgen deprivation in clinically localized prostate cancer: An analysis of RTOG 94-08. Cardiovascular mortality following short-term androgen deprivation in clinically localized prostate cancer: An analysis of RTOG 94-08. Lifestyle changes for improving disease-specific quality of life in sedentary men on long-term androgen-deprivation therapy for advanced prostate cancer: a randomised controlled trial. Skeletal response to resistance and impact training in prostate cancer survivors. Effects of Different Exercise Modalities on Fatigue in Prostate Cancer Patients Undergoing Androgen Deprivation Therapy: A Year-long Randomised Controlled Trial. EAU guidelines on prostate cancer. part 1: screening, diagnosis, and local treatment with curative intent-update 2013. Resistance exercise in men receiving androgen deprivation therapy for prostate cancer. Resistance Exercise Reduces Body Fat and Insulin During Androgen-Deprivation Therapy for Prostate Cancer. Resistance training reduces disability in prostate cancer survivors on androgen deprivation therapy: evidence from a randomized controlled trial. A randomized trial of aerobic versus resistance exercise in prostate cancer survivors. Phase III Intergroup Trial of Adjuvant Androgen Deprivation With or Without Mitoxantrone Plus Prednisone in Patients With High-Risk Prostate Cancer After Radical Prostatectomy: SWOG S9921. Effects of a lifestyle intervention on endothelial function in men on long-term androgen deprivation therapy for prostate cancer The Effect on Bone Outcomes of Home-based Exercise Intervention for Prostate Cancer Survivors Receiving Androgen Deprivation Therapy: A Pilot Randomized Controlled Trial Intermittent versus continuous androgen suppression therapy: do we have consensus yet? Role of androgen deprivation therapy for node-positive prostate cancer. Impact of Radiotherapy When Added to Androgen-Deprivation Therapy for Locally Advanced Prostate Cancer: Long-Term Quality-of-Life Outcomes From the NCIC CTG PR3/MRC PR07 Randomized Trial. Obesity and mortality in men with locally advanced prostate cancer
Background And rogen deprivation therapy ( ADT ) is accompanied by a number of adverse side effects including reduced bone mass and increased risk for fracture , reduced lean mass and muscle strength , mood disturbance and increased fat mass compromising physical functioning , independence , and quality of life . The purpose of this investigation is to examine the effects of long term exercise on reversing musculoskeletal-related side effects , and cardiovascular and diabetes risk factors in men receiving and rogen deprivation for their prostate cancer . Specifically , we aim to investigate the effects of a 12-month exercise program design ed to load the musculoskeletal system and reduce cardiovascular and diabetes disease progression on the following primary endpoints : 1 ) bone mineral density ; 2 ) cardiorespiratory function and maximal oxygen capacity ; 3 ) body composition ( lean mass and fat mass ) ; 4 ) blood pressure and cardiovascular function ; 5 ) lipids and glycemic control ; and 6 ) quality of life and psychological distress . Methods / Design Multi-site r and omized controlled trial of 195 men ( 65 subjects per arm ) undergoing treatment for prostate cancer involving ADT in the cities of Perth and Brisbane in Australia . Participants will be r and omized to ( 1 ) resistance/impact loading exercise , ( 2 ) resistance/cardiovascular exercise groups and ( 3 ) usual care/delayed exercise . Participants will then undergo progressive training for 12 months . Measurements for primary and secondary endpoints will take place at baseline , 6 and 12 months ( end of the intervention ) . Discussion The principal outcome of this project will be the determination of the strength of effect of exercise on the well established musculoskeletal , cardiovascular and insulin metabolism side effects of and rogen deprivation in prostate cancer patients . As this project is much longer term than previous investigations in the area of exercise and cancer , we will gain knowledge as to the continuing effects of exercise in this patient population specifically targeting bone density , cardiovascular function , lean and fat mass , physical function and falls risk as primary study endpoints . In terms of advancement of prostate cancer care , we expect dissemination of the knowledge gained from this project to reduce fracture risk , improve physical and functional ability , quality of life and ultimately survival rate in this population . Clinical Trial RegistryA Phase III clinical trial of exercise modalities on treatment side-effects in men receiving therapy for prostate cancer ; No Abstract Editorial Comment : Since r and omized data have supported use of and rogen deprivation therapy ( ADT ) at external beam radiation for men with high risk prostate cancer , the use of ADT has become the st and ard of care for most . There has been considerable controversy regarding duration of use , risk profiles in which benefit could be achieved and timing relative to radiation therapy . Recently demonstration of substantive long-term cardiovascular , metabolic and cognitive toxicity has result ed in more caution in recommending ADT , particularly in elderly patients with preexisting cardiovascular disease . In this study the authors evaluate long-term outcomes among men receiving external beam radiation therapy with or without 6 months of ADT for unfavorable risk prostate cancer . Early analysis of the data indicated that the addition of ADT result ed in improved mortality . However , at the current followup of 16.62 years no reduction in mortality was seen overall for men receiving radiation alone . When segregating men by level of comorbid conditions , improved overall and cancer specific survival was seen with the addition of ADT in men with little to no comorbidity . The opposite effect was seen in men with moderate to high comorbidity . In these men the addition of ADT reduced overall survival , increased cardiac event related mortality and had no effect on cancer specific mortality . The implication s of the findings are broad and suggest , as in many other examples , that individualized application of beneficial therapies likely supersedes level I evidence derived at the population level . One could argue that the duration of ADT may influence effects on cancer specific mortality in the whole group , although the effect of ADT on cardiac mortality in the ADT treated moderate to severe comorbidity group is hard to deflate . In this group 23 of 24 men died , of whom 16 died of cardiac causes and 1 of prostate cancer . In the whole group of men with moderate to severe comorbidity 46 of 49 died , of which only 4 deaths were prostate attributed . The take home message ? Prostate cancer treatment among those with high risk prostate cancer should be approached with caution , and judicious use of ADT in this setting , despite the evidence -based benefit , is warranted And rogen-deprivation therapy ( ADT ) is a widely used treatment for prostate cancer . Recently , several studies have reported an association between ADT and an increased risk of cardiovascular events , including myocardial infa rct ion and cardiovascular mortality.1 - 5 These reports have led to increased interest and discussion regarding the metabolic effects of ADT and its possible association with increased cardiovascular risk . In addition , likely as a result of these reports , internists , endocrinologists , and cardiologists are now being consulted regarding the evaluation and management of patients in whom ADT is being initiated . Most of these physicians are not aware of the possible effects of ADT on cardiovascular risk factors or the issues regarding ADT and cardiovascular disease . Therefore , this multidisciplinary writing group has been commissioned to review and summarize the metabolic effects of ADT , to evaluate the data regarding a possible relation between ADT and cardiovascular events in patients with prostate cancer , and to generate suggestions regarding the evaluation and management of patients , both with and without known cardiac disease , in whom ADT is being initiated ( Table 1 ) . TABLE 1 Prospect i ve Studies of the Effects of ADT on Cardiac Risk Factors  ADT was first used in prostate cancer for patients with overt metastatic disease,7 and it remains the mainstay of therapy for this group . ADT combined with external-beam radiation therapy is a st and ard of care in the treatment of men with high-risk prostate cancer , on the basis of evidence that shows a survival benefit in multiple r and omized controlled trials.8 - 13 However , ADT is also often used for other prostate cancer states ( eg , for prostate volume reduction in men planning to undergo definitive local therapy with brachytherapy , or in the case of rising prostate-specific antigen after definitive local treatment),14,15 and in these cases , its role in prolonging survival is less certain INTRODUCTION And rogen deprivation therapy ( ADT ) is an important component of modern prostate cancer treatment . Survival benefits from neo-adjuvant and adjuvant hormones may take years to manifest , and balancing this with potential morbidity of therapy can be challenging . This study aim ed to assess whether education and short-term combined aerobic and resistance exercises could help to ameliorate the adverse side effects of ADT . METHODS Eight hundred fifty-nine patients with relapsed or metastatic prostate cancer on leuprorelin acetate  were allocated to three interventional streams based on patient preference and medical fitness : supervised group ( Face-to-Face ) exercise sessions , home-based ( At Home ) exercise or a support programme for those incapable of exercising ( Support ) . Patients enrolled onto Face to Face underwent measurement of body composition and cardiorespiratory fitness variables at baseline and programme completion . Patients in the exercise streams were surveyed to determine the programme 's impact on physical fitness and well-being . RESULTS Statistically significant improvements ( p < 0.001 ) were seen in all measured cardiorespiratory fitness and strength variables . Programme attrition rates were low ( 75/859 ; 8.7 % ) , the primary reason for withdrawal being discontinuation of hormones ( 70 % ) . Programme satisfaction was high , with 98 % of surveyed patients reporting a positive impact on fitness and 97 % planning to continue exercising after programme completion . At 6 months , improved physical and emotional well-being was reported by 93 and 79 % of patients , respectively . CONCLUSIONS A short-term structured exercise intervention results in high compliance and significant improvements in muscle strength and cardiorespiratory fitness in prostate cancer patients on ADT OBJECTIVE Our aim was to present a summary of the 2010 version of the European Association of Urology ( EAU ) guidelines on the screening , diagnosis , and treatment of clinical ly localised cancer of the prostate ( PCa ) . METHODS The working panel performed a literature review of the new data emerging from 2007 to 2010 . The guidelines were up date d , and level of evidence and grade of recommendation were added to the text based on a systematic review of the literature , which included a search of online data bases and bibliographic review s. RESULTS A full version is available at the EAU office or Web site ( www.uroweb.org ) . Current evidence is insufficient to warrant widespread population -based screening by prostate-specific antigen ( PSA ) for PCa . A systematic prostate biopsy under ultrasound guidance and local anaesthesia is the preferred diagnostic method . Active surveillance represents a viable option in men with low-risk PCa and a long life expectancy .  PSA doubling time in <3 yr or a biopsy progression indicates the need for active intervention . In men with locally advanced PCa in whom local therapy is not m and atory , watchful waiting ( WW ) is a treatment alternative to and rogen-deprivation therapy ( ADT ) with equivalent oncologic efficacy . Active treatment is mostly recommended for patients with localised disease and a long life expectancy with radical prostatectomy ( RP ) shown to be superior to WW in a prospect i ve r and omised trial . Nerve-sparing RP represents the approach of choice in organ-confined disease ; neoadjuvant and rogen deprivation demonstrates no improvement of outcome variables . Radiation therapy should be performed with at least 74 Gy and 78 Gy in low-risk and intermediate/high-risk PCa , respectively . For locally advanced disease , adjuvant ADT for 3 yr results in superior disease-specific and overall survival rates and represents the treatment of choice . Follow-up after local therapy is largely based on PSA , and a disease-specific history with imaging is indicated only when symptoms occur . CONCLUSIONS The knowledge in the field of PCa is rapidly changing . These EAU guidelines on PCa summarise the most recent findings and put them into clinical practice Purpose The purpose of this study is to examine the effects of age ( ≤65 years or > 65 years ) and and rogen-deprivation therapy ( ADT , presence or absence ) as factors that may predict changes in body composition and fitness following a 24-week exercise program in prostate cancer patients . Methods One hundred twenty-one men were r and omly allocated to either : ( 1 ) aerobic exercise ( AE ) , ( 2 ) resistance exercise ( RE ) , or ( 3 ) usual care ( UC ) . Body composition was assessed by DXA . Aerobic fitness was assessed through a maximal treadmill test  . Muscular strength was assessed by leg extension and bench press using the eight-repetition maximum test . Responses were compared between younger ( ≤65 years ) and older ( > 65 years ) patients with or without ADT  . Results There did not appear to be an interaction between age and ADT on body composition or fitness , nor were there any significant changes in body composition for participants ≤65 years . In participants aged > 65 years , lean mass decreased in AE ( p = 0.013 ) and UC ( p = 0.006 ) , but was preserved in RE . In participants receiving ADT , there was a decrease in lean mass in AE ( p = 0.003 ) and UC ( p < 0.001 ) but not in RE . The non-ADT group did not show any changes in body composition but did show improvements in muscular fitness following resistance training ( p < 0.001 ) . Conclusion Changes in body composition and physical fitness following a 24-week exercise program in men with prostate cancer are not influenced by age and /or ADT . Resistance training appears to attenuate the age-related decrease in lean mass and increase in body fat in older patients with prostate cancer and those  receiving ADT OBJECTIVES To determine the feasibility of an eccentric resistance exercise training protocol in men with prostate cancer and to assess whether men with prostate cancer who are receiving and rogen deprivation therapy ( ADT ) have a blunted effect from the training as compared with prostate cancer survivors not receiving ADT . DESIGN Prospect i ve pilot study . SETTING Academic medical center . PARTICIPANTS Sixteen men with prostate cancer ( Gleason scores 3 + 3 to 4 + 4 ) were initially enrolled . Ten men ( mean age 66 , range 48 - 86 ) completed the study , 5 were currently receiving ADT . Analysis was performed on these 10 men . INTERVENTIONS Subjects were evaluated at baseline . All men underwent a 12-week resistance exercise training protocol using a recumbent , high-force eccentric , leg cycle ergometer 3 times per week at a " somewhat hard " perceived exertion for 12 to 15 minutes . Preexercise and postexercise training changes were examined within and between groups . MAIN OUTCOME MEASURES Quadriceps muscle volume ( magnetic resonance imaging ) , isometric knee extension strength , functional mobility ( Timed Up and Go Test [ TUG ] and 6-minute walk [ 6MW ] ) , health-related quality of life ( FACT-P ) , and fatigue ( FACIT-fatigue scale ) . RESULTS The ADT group demonstrated significant within-group improvements in the 6MW ( P = .01 ) and isometric knee extension strength ( P = .03 ) . This group also demonstrated a clinical ly relevant change in the FACT-P ; however , this did not meet statistical significance . The  non-ADT  group demonstrated significant within-group improvements in the physical subscale of the FACT-P ( P = .03 ) and an increase in muscle volume ( P = .04 ) . Their improvements in the TUG approached significance ( P = .08 ) . No between-group differences existed . CONCLUSIONS Eccentric resistance exercise was well tolerated , and both groups derived some benefits in strength and functional mobility .  Men receiving ADT  did not appear to have a blunted response to the exercise as compared with prostate cancer survivors not receiving ADT BACKGROUND And rogen deprivation therapy ( ADT ) has significant deleterious effects on body composition that may be accompanied by unfavourable changes in adipokine levels . While exercise has been shown to improve a number of side effects associated with ADT for prostate cancer , no studies have assessed the effect of exercise on adiponectin and leptin levels , which have been shown to alter the mitogenic environment . METHODS Twenty-six men with prostate cancer treated with ADT were r and omized to home-based aerobic exercise training or resistance exercise training for 24 weeks . Adiponectin , leptin , insulin-like growth factor 1 ( IGF-1 ) , insulin-like growth factor binding protein 3 ( IGFBP-3 ) were analyzed by ELISA ( enzyme-linked immunosorbent assay ) , in addition to physical activity volume , peak aerobic capacity , and anthropometric measurements , at baseline , 3 months and 6 months . RESULTS Resistance exercise significantly reduced IGF-1 after 3 months ( p = 0.019 ) ; however , this change was not maintained at 6 months . At 6 months , IGFBP-3 was significantly increased compared to baseline for the resistance training group ( p = 0.044 ) . In an exploratory analysis of all exercisers , favourable changes in body composition and aerobic fitness were correlated with favourable levels of leptin , and favourable leptin : adiponectin and IGF-1:IGFBP-3 ratios at 3 and 6 months . CONCLUSIONS Home-based exercise is correlated with positive changes in adipokine levels and the IGF-axis that may be related to healthy changes in physical fitness and body composition . While the improvements of adipokine markers appear to be more apparent with resistance training compared to aerobic exercise , these findings must be considered cautiously and require replication from larger r and omized controlled trials to clarify the role of exercise on adipokines and IGF-axis proteins for men with prostate cancer 18 Background : And rogen deprivation therapy ( ADT ) is associated with greater risk of diabetes and coronary heart disease in men with prostate cancer but there is significant controversy surrounding its potential impact on cardiovascular mortality especially among men with lower rates of cancer-specific death . We assessed the relationship between ADT and mortality in a large r and omized trial of men treated with or without short-course ADT and radiation therapy ( RT ) for clinical ly-localized prostate cancer . METHODS Between 1994 - 2001 , 1979 eligible men ( median age 71 ) with clinical ly-localized ( T1 - 2 , PSA<20 ) prostate cancer were enrolled on a phase III trial ( RTOG 94 - 08 ) and r and omized to RT and 4 months of neoadjuvant/concurrent ADT or RT alone . Fine-Gray proportional hazards model was used to evaluate the relationship between treatment arm and mortality ( disease-specific and cardiovascular ) . Covariates included PSA , Gleason score , T-stage , age , race , weight , prevalent cardiovascular disease ( CVD ) , diabetes ( DM ) , and hypertension . RESULTS After a median follow-up of 8.2 years , use of ADT improved overall and disease-specific survival but there was no ADT-related increase in cardiovascular mortality or non-prostate cancer death . There were a total of 191  cardiovascular-related deaths . At 10-years , cardiovascular mortality for men treated with RT+ADT was 9.8 % vs 10.7 % for men treated with RT alone . In multivariate analyses , treatment arm was not significantly associated with an increased risk of cardiovascular mortality [ adjusted hazard ratio (HR)=0.93 , 95 % confidence interval ( CI ) 0.69 - 1.26 , p=0.64 ] . Traditional cardiac risk factors , including prevalent CVD and DM , were significantly associated with greater cardiovascular mortality . Results were similar when limiting analyses to patient subsets at high risk for cardiovascular mortality and at low risk for disease-specific mortality . CONCLUSIONS Use of short-course ADT improves overall and disease-specific survival but does not appear to increase cardiovascular mortality in men with clinical ly-localized prostate cancer . Supported by RTOG grant U10 CA21661 and CCOP grant U10 CA37422 from NCI 18 Background : And rogen deprivation therapy ( ADT ) is associated with greater risk of diabetes and coronary heart disease in men with prostate cancer but there is significant controversy surrounding its potential impact on cardiovascular mortality especially among men with lower rates of cancer-specific death . We assessed the relationship between ADT and mortality in a large r and omized trial of men treated with or without short-course ADT and radiation therapy ( RT ) for clinical ly-localized prostate cancer . METHODS Between 1994 - 2001 , 1979 eligible men ( median age 71 ) with clinical ly-localized ( T1 - 2 , PSA<20 ) prostate cancer were enrolled on a phase III trial ( RTOG 94 - 08 ) and r and omized to RT and 4 months of neoadjuvant/concurrent ADT or RT alone . Fine-Gray proportional hazards model was used to evaluate the relationship between treatment arm and mortality ( disease-specific and cardiovascular ) . Covariates included PSA , Gleason score , T-stage , age , race , weight , prevalent cardiovascular disease ( CVD ) , diabetes ( DM ) , and hypertension . RESULTS After a median follow-up of 8.2 years , use of ADT improved overall and disease-specific survival but there was no ADT-related increase in cardiovascular mortality or non-prostate cancer death . There were a total of 191  cardiovascular-related deaths . At 10-years , cardiovascular mortality for men treated with RT+ADT was 9.8 % vs 10.7 % for men treated with RT alone . In multivariate analyses , treatment arm was not significantly associated with an increased risk of cardiovascular mortality [ adjusted hazard ratio (HR)=0.93 , 95 % confidence interval ( CI ) 0.69 - 1.26 , p=0.64 ] . Traditional cardiac risk factors , including prevalent CVD and DM , were significantly associated with greater cardiovascular mortality . Results were similar when limiting analyses to patient subsets at high risk for cardiovascular mortality and at low risk for disease-specific mortality . CONCLUSIONS Use of short-course ADT improves overall and disease-specific survival but does not appear to increase cardiovascular mortality in men with clinical ly-localized prostate cancer . Supported by RTOG grant U10 CA21661 and CCOP grant U10 CA37422 from NCI BACKGROUND Prostate cancer is a key driver of cancer-related global disability-adjusted life-years . And rogen-deprivation therapy ( ADT ) for advanced disease is linked to fatigue , reduced physical function , and quality of life ( QoL ) . OBJECTIVE To evaluate the effect of a lifestyle intervention on disease-specific QoL , diastolic blood pressure , and cancer-related fatigue in sedentary men receiving long-term ADT for advanced prostate cancer . DESIGN , SETTING , AND PARTICIPANTS A total of 100 hundred sedentary men with locally advanced or metastatic prostate cancer on long-term ADT were r and omised to an intervention or usual care group . INTERVENTION A 12-wk lifestyle intervention consisting of aerobic and resistance exercise with parallel dietary advice . OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS Disease-specific QoL was measured using the Functional Assessment of Cancer Therapy-Prostate ( FACT-P ) and Functional Assessment of Cancer Therapy-Fatigue ( FACT-F ) question naires at 12 wk postintervention and at 6 mo following withdrawal of support . Analysis of covariance and mixed regression were conducted . RESULTS AND LIMITATIONS Clinical ly relevant improvements in FACT-P were seen at 12 wk in the intervention group compared with controls ( mean difference : 8.9 points ; 95 % confidence interval [ CI ] , 3.7 - 14.2 ; adjusted p=0.001 ) . No difference was apparent at 6 mo ( mean difference : 3.3 points ; 95 % CI , -2.6 to 9.3 ; adjusted p=0.27 ) . No difference in diastolic blood pressure was seen at either follow-up ( all p > 0.05 ) . Clinical ly relevant improvements in FACT-F were seen at 12 wk ( mean difference : 5.3 points ; 95 % CI , 2.7 - 7.9 ; adjusted p<0.001 ) and maintained following withdrawal of supervision ( mean difference : 3.9 points ; 95 % CI , 1.1 - 6.8 ; adjusted p=0.007 ) . Improvements in exercise tolerance and behaviour were maintained at 6 mo ( adjusted p<0.001 and 0.038 ) . CONCLUSIONS A lifestyle intervention result ed in a clinical ly meaningful improvement in disease-specific QoL that was not maintained postintervention . No effect on blood pressure occurred . Durability of response was seen in fatigue and exercise behaviour . Further evaluation of support structures is essential . TRIAL REGISTRATION IS RCT N88605738 INTRODUCTION And rogen deprivation therapy ( ADT ) is associated with significant bone loss and an increase in fracture risk among prostate cancer survivors ( PCS ) . We investigated whether impact + resistance training could stop ADT-related declines in bone mineral density ( BMD ) among PCS on ADT . METHODS We r and omized 51 PCS ( mean age , 70.2 yr ) currently prescribed ADT to participate in 1 yr of impact + resistance training ( Prevent Osteoporosis with Impact + Resistance ( POWIR ) )  or in an exercise placebo program of stretching exercise ( FLEX ) . Outcomes were proximal femur ( total hip , femoral neck , and greater trochanter ) and spine ( L1-L4 ) BMD ( g·cm ) and bone turnover markers ( serum osteocalcin ( ng·mL ) and urinary deoxypyrodinoline cross-links ( nmol·mmol Cr ) ) . RESULTS Retention in the 1-yr study was 84 % and median attendance to supervised classes was 84 % in POWIR and 74 % in FLEX . No study -related injuries were reported . There were no significant differences between groups for average L1-L4 BMD or for BMD at any hip site . When examining individual vertebrae , POWIR has a significant effect on preservation of BMD ( -0.4 % ) at the L4 vertebrae compared with losses ( -3.1 % ) in FLEX ( P = 0.03 ) . CONCLUSION Impact + resistance training was a safe and acceptable form of exercise for older PCS on ADT . Among our limited sample , POWIR did not appear to have a clinical ly meaningful effect on hip or spine BMD , but some evidence of skeletal adaptation to resistance + impact training in an and rogen-deprived state was apparent . Future studies need to be conducted on a larger sample of patients and should consider modifications to POWIR that could further enhance loading across the spine and at the hip to preserve BMD at these clinical ly relevant sites BACKGROUND Physical exercise mitigates fatigue during and rogen deprivation therapy ( ADT ) ; however , the effects of different exercise prescriptions are unknown . OBJECTIVES To determine the long-term effects of different exercise modes on fatigue in prostate cancer patients undergoing ADT . DESIGN , SETTING , AND PARTICIPANTS Between 2009 and 2012 , 163 prostate cancer patients aged 43 - 90 y on ADT were r and omised to exercise targeting the musculoskeletal system ( impact loading+resistance training ; ILRT ; n=58 ) , the cardiovascular and muscular systems ( aerobic+resistance training ; ART ; n=54 ) , or to usual care/delayed exercise ( DEL ; n=51 ) for 12 mo across university-affiliated exercise clinics in Australia . INTERVENTION Supervised ILRT for 12 mo , supervised ART for 6 mo followed by a 6-mo home program , and DEL received a printed booklet on exercise information for 6 mo followed by 6-mo stationary cycling exercise . OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS Fatigue was assessed using the European Organisation for Research and Treatment of Cancer Quality of Life Question naire-Core 36 and vitality using the Short Form-36 . Analysis of variance was used to compare outcomes for groups at 6 mo and 12 mo . RESULTS AND LIMITATIONS Fatigue was reduced ( p=0.005 ) in ILRT at 6 mo and 12 mo ( ∼5 points ) , and in ART ( p=0.005 ) and DEL ( p=0.022 ) at 12 mo . Similarly , vitality increased for all groups ( p≤0.001 ) at 12 mo ( ∼4 points ) . Those with the highest levels of fatigue and lowest vitality improved the most with exercise ( ptrend<0.001 ) . A limitation was inclusion of mostly well-functioning individuals . CONCLUSIONS Different exercise modes have comparable effects on reducing fatigue and enhancing vitality during ADT . Patients with the highest levels of fatigue and lowest vitality had the greatest benefits . PATIENT SUMMARY We compared the effects of different exercise modes on  fatigue in men on and rogen deprivation therapy . All exercise programs  reduced fatigue and enhanced vitality . We conclude that undertaking some form of exercise will help reduce fatigue , especially in those who are the most fatigued CONTEXT The most recent summary of the European Association of Urology ( EAU ) guidelines on prostate cancer ( PCa ) was published in 2011 . OBJECTIVE To present a summary of the 2013 version of the EAU guidelines on screening , diagnosis , and local treatment with curative intent of clinical ly organ-confined PCa . EVIDENCE ACQUISITION A literature review of the new data emerging from 2011 to 2013 has been performed by the EAU PCa guideline group . The guidelines have been up date d , and levels of evidence and grade s of recommendation have been added to the text based on a systematic review of the literature , which included a search of online data bases and bibliographic review s. EVIDENCE SYNTHESIS A full version of the guidelines is available at the EAU office or online ( www.uroweb.org ) . Current evidence is insufficient to warrant widespread population -based screening by prostate-specific antigen ( PSA ) for PCa . Systematic prostate biopsies under ultrasound guidance and local anesthesia are the preferred diagnostic method . Active surveillance represents a viable option in men with low-risk PCa and a long life expectancy . A biopsy progression indicates the need for active intervention , whereas the role of PSA doubling time is controversial . In men with locally advanced PCa for whom local therapy is not m and atory , watchful waiting ( WW ) is a treatment alternative to and rogen-deprivation therapy ( ADT ) , with equivalent oncologic efficacy . Active treatment is recommended mostly for patients with localized disease and a long life expectancy , with radical prostatectomy ( RP ) shown to be superior to WW in prospect i ve r and omized trials . Nerve-sparing RP is the approach of choice in organ-confined disease , while neoadjuvant ADT provides no improvement in outcome variables . Radiation therapy should be performed with ≥ 74 Gy in low-risk PCa and 78 Gy in intermediate- or high-risk PCa . For locally advanced disease , adjuvant ADT for 3 yr results in superior rates for disease-specific and overall survival and is the treatment of choice . Follow-up after local therapy is largely based on PSA and a disease-specific history , with imaging indicated only when symptoms occur . CONCLUSIONS Knowledge in the field of PCa is rapidly changing . These EAU guidelines on PCa summarize the most recent findings and put them into clinical practice . PATIENT SUMMARY A summary is presented of the 2013 EAU guidelines on screening , diagnosis , and local treatment with curative intent of clinical ly organ-confined prostate cancer ( PCa ) . Screening continues to be done on an individual basis , in consultation with a physician . Diagnosis is by prostate biopsy . Active surveillance is an option in low-risk PCa and watchful waiting is an alternative to and rogen-deprivation therapy in locally advanced PCa not requiring immediate local treatment . Radical prostatectomy is the only surgical option . Radiation therapy can be external or delivered by way of prostate implants . Treatment follow-up is based on the PSA level PURPOSE And rogen deprivation therapy is a common treatment in men with prostate cancer that may cause fatigue , functional decline , increased body fatness , and loss of lean body tissue . These physical changes can negatively affect health-related quality of life .  Resistance exercise may help to counter some of these side effects by reducing fatigue , elevating mood , building muscle mass , and reducing body fat . METHODS In a two-site study , 155 men with prostate cancer who were scheduled to receive and rogen deprivation therapy for at least 3 months after recruitment were r and omly assigned to an intervention group that participated in a resistance exercise program three times per week for 12 weeks ( 82 men ) or to a waiting list control group ( 73 men ) . The primary outcomes were fatigue and disease-specific quality of life as assessed by self-reported question naires after 12 weeks . Secondary outcomes were muscular fitness and body composition . RESULTS Men assigned to resistance exercise had less interference from fatigue on activities of daily living ( P = .002 ) and higher quality of life ( P = .001 ) than men in the control group . Men in the intervention group demonstrated higher levels of upper body ( P = .009 ) and lower body ( P < .001 ) muscular fitness than men in the control group . The 12-week resistance exercise intervention did not improve body composition as measured by changes in body weight , body mass index , waist circumference , or subcutaneous skinfolds . CONCLUSION Resistance exercise reduces fatigue and improves quality of life and muscular fitness in men with prostate cancer receiving and rogen deprivation therapy .  This form of exercise can be an important component of supportive care for these patients PURPOSE / OBJECTIVES To determine whether exercise could reduce biomarkers of cancer progression in prostate cancer survivors ( PCSs ) on and rogen-deprivation therapy ( ADT ) . DESIGN R and omized , controlled trial . SETTING Oregon Health and Science University School of Nursing . SAMPLE 51 PCSs r and omized to one year of resistance and impact training  or a stretching control group . METHODS The authors investigated changes in body composition and cancer-related biomarkers , and the influence of age and fat loss on changes in biomarkers . MAIN RESEARCH VARIABLES Body composition ( total fat , trunk fat , and lean mass ) , insulin , insulin-like growth factor-1 , and sex hormone-binding globulin . FINDINGS In the 36 PCSs with baseline and 12-month data , total fat ( p = 0.02 ) and trunk fat ( p = 0.06 ) mass decreased in the training group compared to gains in controls . Loss of total and trunk fat each mediated the relationship between groups and one-year change in insulin ( p < 0.05 ) . Age moderated the insulin response to exercise where insulin reductions were smaller with increasing age ( p = 0.03 ) . CONCLUSIONS Resistance and impact exercise may reduce body fat among PCSs undergoing ADT , in turn exerting an insulin-lowering effect . IMPLICATION S FOR NURSING Nurses should counsel PCSs to exercise to reduce the risk of obesity and associated conditions , including cancer progression OBJECTIVES To investigate whether functionally based resistance exercise could improve strength , physical function , and disability among prostate cancer survivors ( PCS ) on and rogen deprivation therapy ( ADT ) ; and to explore potential mediators of changes in outcomes from exercise . DESIGN R and omized controlled trial . SETTING Academic medical center . PARTICIPANTS PCS ( N=51 ; mean age , 70.2y ) on ADT . INTERVENTION PCS were r and omized to moderate to vigorous intensity resistance training or stretching ( placebo control ) for 1 year . MAIN OUTCOME MEASURES Maximal leg press and bench press strength , objective and self-reported physical function , and self-reported disability . Hierarchical linear modeling was used to test for significant group × time differences adjusting for covariates . RESULTS Retention in the study was 84 % , and median attendance to supervised classes was 84 % in the resistance group . No study -related injuries occurred . Maximal leg strength ( P=.032 ) and bench press strength ( P=.027 ) were improved after 1 year of resistance training , whereas little change occurred from stretching .  Self-reported physical function improved with resistance training , whereas decreases occurred from stretching ( P=.016 ) . Disability lessened more with resistance training than stretching ( P=.018 ) . One-year change in leg press strength mediated the relation between groups ( resistance or stretching ) and 1-year change in self-reported disability ( P<.05 ) . CONCLUSIONS One year of resistance training improved muscle strength in and rogen-deprived PCS . Strengthening muscles using functional movement patterns may be an important feature of exercise programs design ed to improve perceptions of physical function and disability . Findings from this study contribute to the mounting evidence that exercise should become a routine part of clinical care in older men with advanced prostate cancer And rogen-deprivation therapy ( ADT ) for prostate cancer ( PCa ) has side effects that significantly impair health-related quality of life ( HRQOL ) . Exercise ameliorates many side effects of ADT , but different modalities , particularly in the home-based setting , have not been well studied . In this study the authors r and omly assigned 66 PCa survivors receiving ADT to 6 mo of home-based aerobic or resistance training .  Psychosocial well-being and physical fitness were measured at baseline , 3 and 6 mo , and then 6 mo postintervention . Intention-to-treat analyses showed that fatigue and HRQOL were not significantly different between groups ; however , in a per- protocol analysis the resistance-exercise training group demonstrated clinical ly significant improvements in HRQOL . Differential within-group effects on physical fitness were also observed at various time points . At all time points , the aerobic-training group engaged in significantly more physical activity than the resistance-training group , a finding that should be further examined given evidence -based guidelines for activity volume in cancer survivors Purpose Patients with high-risk prostate cancer after radical prostatectomy are at risk for death . Adjuvant and rogen-deprivation therapy ( ADT ) may reduce this risk . We hypothesized that the addition of mitoxantrone and prednisone ( MP ) to adjuvant ADT could reduce mortality compared with adjuvant ADT alone . Methods Eligible patients had cT1 - 3N0 prostate cancer with one or more high-risk factors after radical prostatectomy ( Gleason score [ GS ] ≥ 8 ; pT3b , pT4 , or pN+ disease ; GS 7 and positive margins ; or preoperative prostate-specific antigen [ PSA ] > 15 ng/mL , biopsy GS score > 7 , or PSA > 10 ng/mL plus biopsy GS > 6 . Patients with PSA ≤ 0.2 ng/mL after radical prostatectomy were stratified by pT/N stage , GS , and adjuvant radiation plan and r and omly assigned to ADT ( bicalutamide and goserelin for 2 years ) or ADT plus six cycles of MP . The primary end point was overall survival ( OS ) . Median OS was projected to be 10 years in the ADT arm , requiring 680 patients per arm to detect a hazard ratio of 1.30 with 92 % power and one-sided α = .05 . Results Nine hundred sixty-one eligible intent-to-treat patients were r and omly assigned to ADT or ADT + MP from October 1999 to January 2007 , when the Data Safety Monitoring Committee recommended stopping accrual as a result of higher leukemia incidence with ADT + MP . Median follow-up was 11.2 years . The 10-year OS estimates were 87 % with ADT ( expected 50 % ) and 86 % with ADT + MP ( hazard ratio , 1.06 ; 95 % CI , 0.79 to 1.43 ) . The 10-year estimate for disease-free survival was 72 % for both arms . Prostate cancer was the cause of death in 18 % of patients in the ADT arm and 22 % in the ADT + MP arm . More patients in the MP arm died of other cancers ( 36 % v 18 % in ADT alone arm ) . Conclusion MP did not improve OS and increased deaths from other malignancies . The DFS and 10-year OS in these patients treated with 2 years of ADT were encouraging compared with historical estimates , although a definitive conclusion regarding value of ADT may not be made without a nontreatment control arm Background : Treatment of prostate cancer with and rogen deprivation therapy ( ADT ) is associated with metabolic changes that have been linked to an increase in cardiovascular risk . Methods : This r and omised controlled trial investigated the effects of a 12-week lifestyle intervention that included supervised exercise training and dietary advice on markers of cardiovascular risk in 50 men on long-term ADT recruited to an on-going study investigating the effects of such a lifestyle intervention on quality of life . Participants were r and omly allocated to receive the intervention or usual care . Cardiovascular outcomes included endothelial function ( flow-mediated dilatation ( FMD ) of the brachial artery ) , blood pressure , body composition and serum lipids . Additional outcomes included treadmill walk time and exercise and dietary behaviours . Outcomes were assessed before r and omisation ( baseline ) , and 6 , 12 and 24 weeks after r and omisation . Results : At 12 weeks , the difference in mean relative FMD was 2.2 % ( 95 % confidence interval ( CI ) 0.1–4.3 , P=0.04 ) with an effect size of 0.60 ( 95 % CI < 0.01–1.18 ) favouring the intervention group . Improvements in skeletal muscle mass , treadmill walk time and exercise behaviour also occurred in the intervention group over that duration ( P<0.05 ) . At 24 weeks , only the difference in treadmill walk time was maintained . Conclusions : This study demonstrates that lifestyle changes can improve endothelial function in men on long-term ADT for prostate cancer . The implication s for cardiovascular health need further investigation in larger studies over longer duration Background : Cancer treatment – induced bone loss has important long-term effects in prostate cancer survivors ( PCSs ) receiving and  rogen deprivation therapy ( ADT ) , but little is known about preventive interventions . Objective : The aim of this study was to examine the feasibility and preliminary effectiveness of a 6-month home-based exercise intervention in PCSs . Methods : In this pilot , r and omized controlled trial , 51 men ( mean age , 70.8 years ) were r and omized to a 6-month home-based exercise intervention for preventing osteoporosis group ( n = 26 ) or an exercise placebo intervention of stretching exercise group ( n = 25 ) . Primary outcomes were bone mineral density and bone turnover markers . Secondary outcomes were physical performance ( level of physical activity , muscle strength , and balance ) and health-related quality of life . Results : The patient retention rate for 6 months was 80.4 % . The mean adherence rate was 84.7 % for weight-bearing exercise and 64.8 % for resistance exercise . No adverse events during the study period were reported . Although primary outcomes did not differ significantly between the 2 groups , the home-based exercise intervention for preventing osteoporosis group demonstrated significantly greater increased muscle strength than the stretching exercise group . Conclusions : A home-based exercise program is relatively feasible and safe and may improve muscle strength but not bone outcomes . Implication s for Practice : Given the importance of preventing cancer treatment – induced bone loss among PCSs receiving ADT , a home-based exercise intervention can be considered , but further trials with a larger sample are required to determine its effect for bone outcomes And rogen deprivation therapy ( ADT ) has been a cornerstone in the management of advanced prostate cancer for more than 50 years , but several aspects of the therapy remain controversial . Research since the mid-1980s has looked at the use of intermittent and rogen suppression ( IAS ) as a way to reduce the side effects and costs of continuous and rogen suppression . During that same time , testing for prostate-specific antigen result ed in forward stage migration both at diagnosis and at the time of treatment initiation . Earlier treatment has led to prolonged periods of ADT and increasing recognition of the result ant metabolic complications . With pre clinical evidence suggesting a potential benefit for ias in terms of time to and rogen independence , with phase II and III studies producing optimistic results , and with the potential for reductions in cost and complications , ias has become a popular modality of therapy around the globe . Large prospect i ve r and omized studies , currently ongoing , will ultimately determine the legitimate place of IAS in the treatment of prostate cancer PURPOSE To determine the impact of adjuvant and rogen deprivation therapy ( ADT ) for patients who have node-positive prostate cancer in the prostate-specific antigen ( PSA ) era . PATIENTS AND METHODS We used linked Surveillance , Epidemiology and End Results -Medicare data to construct a cohort of men who underwent radical prostatectomy ( RP ) between 1991 and 1999 and who had positive regional lymph nodes . We classified men as receiving adjuvant ADT if they received ADT within 120 days of RP , and we compared them to the men who had not received adjuvant ADT . We used propensity scores to balance potential confounders of receiving adjuvant ADT ( ie , tumor characteristics , extent of nodal disease , demographics , receipt of radiation therapy ) and Cox proportional hazard methods to measure the impact of adjuvant ADT on overall survival ( OS ) , stratified by propensity score quintile . We conducted a sensitivity analysis that used 90 , 150 , 180 , and 365 days as the definition for adjuvant ADT . RESULTS A total of 731 men were identified , 209 of whom received ADT within 120 days of RP . There was no statistically significant difference in OS between the adjuvant ADT and non-ADT group ( HR , 0.97 ; 95 % CI , 0.71 to 1.27 ) . There was no statistically significant survival difference with 90 , 150 , 180 , and 365 days as the adjuvant ADT definition . CONCLUSION Deferring immediate ADT in men with positive lymph nodes after RP may not significantly compromise survival . Because observational studies should be considered hypothesis-generating studies , these results should be vali date d in a prospect i ve fashion in a similar patient population PURPOSE The NCIC CTG PR3/MRC PR07 r and omized phase III trial compared and rogen-deprivation therapy ( ADT ) alone versus ADT with radiotherapy ( RT ) for patients with locally advanced prostate cancer . This article reports the health-related quality -of-life ( HRQOL ) outcomes of this trial . PATIENTS AND METHODS A total of 1,205 patients were r and omly allocated to either ADT alone or ADT with RT .  HRQOL was assessed at baseline and every 6 months thereafter using the European Organisation for Research and Treatment of Cancer Core Question naire and a prostate cancer-specific checklist or the Functional Assessment of Cancer Therapy-Prostate question naire . Mean changes from baseline scores for five function domains and nine symptom domains were analyzed as those most relevant to ADT and RT . The proportions of patients with improved , stable , or worsened HRQOL scores according to instrument-specific minimal important differences were calculated . RESULTS Baseline question naires were completed by 1,028 patients ( 88 % ) . At 6 months , RT had a statistically significant impact on mean score for bowel symptoms ( P = .02 ) , diarrhea ( P < .001 ) , urinary function ( P = .003 ) , and erectile dysfunction ( P = .008 ) ; by 3 years , however , there were no significant between-group differences in any domain . Generalized linear mixed modeling revealed no significant between-arm differences in any of the function scales but showed significant deterioration in both arms over time for Functional Assessment of Cancer Therapy-Prostate total score , treatment outcome index , and physical and functional well-being . CONCLUSION The addition of RT to ADT for patients with locally advanced prostate cancer significantly improved overall survival and had only modest and transient negative impact on relevant domains of HRQOL Greater body mass index ( BMI ) is associated with shorter time to prostate‐specific antigen ( PSA ) failure following radical prostatectomy and radiation therapy ( RT ) . Whether BMI is associated with prostate cancer‐specific mortality ( PCSM ) was investigated in a large r and omized trial of men treated with RT and and rogen deprivation therapy ( ADT ) for locally advanced prostate cancer
Results The majority of studies demonstrated RE as an effective and safe intervention to improve muscular strength and performance , fatigue and quality of life ( QoL ) in PCaPs , while there is inconclusive evidence concerning cardiovascular performance , body composition , blood lipids , bone mineral density ( BMD ) , and immune response .
Purpose Physical exercise has been shown to be an effective , safe , and quite inexpensive method to reduce cardiovascular and metabolic risk factors and is currently in the process of establishing its relevance for cancer specific morbidity and mortality .
The aim of this systematic review was to focus on specific effects of resistance exercise ( RE ) in the adjuvant therapy and rehabilitation of prostate cancer patients ( PCaPs ) receiving or having received and rogen deprivation therapy ( ADT ) .