Physical Activity for Prostate Cancer - HIIT it up!

Physical activity is one of the many ways in which we can optimize our health before, during and after cancer treatment. Prostate cancer patients undergoing active surveillance can benefit from optimizing their physical activity levels (missed our post on active surveillance? Check it out here)

The Canadian research study Exercise During Active Surveillance for Prostate Cancer (ERASE) trial looked at how exercise during active surveillance in men with prostate cancer influenced their cardiorespiratory fitness [1]. Prostate cancer patients on active surveillance who did a supervised high intensity interval training (HIIT) three times per week for 12 weeks had improved cardiorespiratory fitness levels and reduced PSA levels compared to the control group (prostate cancer patients on active surveillance who did not do the HIIT training) [1]. Although we don’t know the long-term effects of this training, other studies have suggested that improving fitness levels can provide benefits in heart health and weight management and may reduce side effects associated with prostate cancer treatment [2-5].

Quick ways to incorporate more physical activity into your day:

• Take the stairs instead of the elevator/escalator

• Add daily walks on your own or with family/friends

• Get up from your work desk every 20 minutes for a quick stretch and stroll, or get a standing desk

• Do household chores such as snow shovelling, raking the leaves, mowing the lawn, gardening, vacuuming and others

• Dance!

• Enroll in leisurely sporting teams or engage in sports such as golf, tennis or others with friends or family

Talk to your doctor to make sure any high intensity types of exercises are safe for you. 

References:

[1] Kang, D.-W., Fairey, A. S., Boulé, N. G., Field, C. J., Wharton, S. A., & Courneya, K. S. (2021). Effects of Exercise on Cardiorespiratory Fitness and Biochemical Progression in Men With Localized Prostate Cancer Under Active Surveillance: The ERASE Randomized Clinical Trial. JAMA Oncology, 7(10), 1487. https://doi.org/10.1001/jamaoncol.2021.3067

[2] Kim, S. H., Seong, D. H., Yoon, S. M., Choi, Y. D., Choi, E., Song, Y., & Song, H. (2018). The Effect on Bone Outcomes of Home-based Exercise Intervention for Prostate Cancer Survivors Receiving Androgen Deprivation Therapy: A Pilot Randomized Controlled Trial. Cancer Nursing, 41(5), 379–388. https://doi.org/10.1097/NCC.0000000000000530

[3] Galvão, D. A., Taaffe, D. R., Spry, N., Cormie, P., Joseph, D., Chambers, S. K., Chee, R., Peddle-McIntyre, C. J., Hart, N. H., Baumann, F. T., Denham, J., Baker, M., & Newton, R. U. (2018). Exercise Preserves Physical Function in Prostate Cancer Patients with Bone Metastases. Medicine and Science in Sports and Exercise, 50(3), 393–399. https://doi.org/10.1249/MSS.0000000000001454

[4] Bourke, L., Smith, D., Steed, L., Hooper, R., Carter, A., Catto, J., Albertsen, P. C., Tombal, B., Payne, H. A., & Rosario, D. J. (2016). Exercise for Men with Prostate Cancer: A Systematic Review and Meta-analysis. European Urology, 69(4), 693–703. https://doi.org/10.1016/j.eururo.2015.10.047

[5] Keilani, M., Hasenoehrl, T., Baumann, L., Ristl, R., Schwarz, M., Marhold, M., Sedghi Komandj, T., & Crevenna, R. (2017). Effects of resistance exercise in prostate cancer patients: A meta-analysis. Supportive Care in Cancer: Official Journal of the Multinational Association of Supportive Care in Cancer, 25(9), 2953–2968. https://doi.org/10.1007/s00520-017-3771-z

Active Surveillance for Prostate Cancer - How Naturopathic Medicine can help?

Prostate cancers have certain features or qualities that allow clinicians to “grade” or classify the cancer as less aggressive or more aggressive - specifically, they are given a label of risk. There are five different risk groups: very low, low, intermediate, high, and very high. Patients with prostate cancers that are very low and low risk, and in some cases intermediate risk, are usually recommended active surveillance [1].

What is active surveillance?

Many prostate cancers tend to be slow-growing, but they can be diagnosed very quickly with the use of laboratory tests and procedures. Unfortunately, what can happen with a quick diagnosis of a slower-growing cancer is a tendency to over-treat patients. Research has suggested that the outcomes of immediately treating very low to low risk prostate cancer patients are similar to implementing an active surveillance approach; also, treating prostate cancers earlier than necessary can lead to unwanted negative side effects, such as urinary incontinence and erectile dysfunction [2]. Therefore, in an effort to avoid over-treatment, active surveillance has been recommended as the first line for patients with very low and low risk prostate cancer.

Active surveillance involves regular monitoring for cancer progression, through regular testing procedures and visits with an oncologist. When there is a sign of progression is usually when various treatments are implemented. For some individuals, this can be anywhere from months to years [3].

So what can I do during active surveillance?

Understandably, it can be overwhelming and stressful for patients to be given the recommendation of active surveillance; patients often feel anxious about waiting for disease progression or delaying treatment. 

During active surveillance, there are many ways to support your health, and naturopathic medicine can help by:

• Optimizing physical activity levels for improving health and fitness

• Taking a close look at your diet, ensuring you meet optimal nutritional requirements and individualizing dietary recommendations to meet your health goals and reduce risk factors for cancer

• Analyzing environmental risk factors and making recommendations to decrease or eliminate various environmental toxins that can increase risk for cancer

• Using targeted laboratory testing to identify levels of important nutrients, as well as assessing levels of inflammation, assessing immune function and cardiovascular health

• Optimizing lifestyle factors and reducing stress levels

Remember, don’t hesitate to talk to your doctor or oncologist about the pros and cons of active surveillance and what is the best treatment option for you. 

If you are wondering about how naturopathic medicine can help you, call us at 306-664-2150!

References:

[1] Kang, D.-W., Fairey, A. S., Boulé, N. G., Field, C. J., Wharton, S. A., & Courneya, K. S. (2021). Effects of Exercise on Cardiorespiratory Fitness and Biochemical Progression in Men With Localized Prostate Cancer Under Active Surveillance: The ERASE Randomized Clinical Trial. JAMA Oncology, 7(10), 1487. https://doi.org/10.1001/jamaoncol.2021.3067

[2] Romero-Otero, J., García-Gómez, B., Duarte-Ojeda, J. M., Rodríguez-Antolín, A., Vilaseca, A., Carlsson, S. V., & Touijer, K. A. (2016). Active surveillance for prostate cancer. International Journal of Urology: Official Journal of the Japanese Urological Association, 23(3), 211–218. https://doi.org/10.1111/iju.13016

[3] National Comprehensive Cancer Network. (2021). Prostate cancer (version 1.2022). Retrieved from https://www.nccn.org/professionals/physician_gls/pdf/prostate.pdf.

Modifiable Risk Factors for Prostate Cancer

November is Prostate Cancer Awareness Month.

Prostate cancer is the most commonly diagnosed cancer in Canadian men [1].

Starting at age 50, men are screened for prostate cancer regularly via a digital rectal examination (DRE). A DRE may also be done if men (regardless of age) experience urinary symptoms such as urgency, frequency, incontinence, dribbling, weak flow, pain on urination, blood in the urine, and/or other symptoms such as erectile dysfunction, painful ejaculation, swollen lymph nodes, chronic low back or pelvic pain, and weight loss. Laboratory testing of PSA (prostate-specific antigen) can also be used during the screening process and is used to monitor cancer progression; however, PSA is not specific to prostate cancer and can also be high due to benign prostatic hypertrophy, prostate infection and/or inflammation.

If any of the above screening measures are abnormal, a transrectal-guided biopsy of the prostate gland is conducted, and is the standard method of diagnosing prostate cancer. The results of the biopsy, as well as the PSA levels, will be used to determine the stage of disease, which is then used to determine monitoring/treatments.

Prostate cancer, unlike the majority of other cancers common in North America, tends to be slow-growing, with a high five-year survival rate (97.8%) [2]. Patient with low-risk disease are usually recommended to undergo ‘active surveillance’, which is monitoring of changes in symptoms and laboratory markers for cancer progression (ie. PSA, DRE) every 6-12 months before any treatment is recommended. This can be an incredibly stressful time for many, however there are various ways in which patients can take an active role in promoting beneficial changes to their health.

One of the ways in which people can promote healthy changes is understanding modifiable risk factors - these are various factors that influence the risk of developing prostate cancer that can be changed, unlike non-modifiable risk factors (such as age) [3, 4, 5]. Some risk factors for prostate cancer include:

Non-modifiable

• Age (risk of prostate cancer increases as we age)

• Having a first-degree family member with prostate cancer (ie. a father or a brother)

• Ethnicity - black men are more commonly affected compared to white, Hispanic and Asian men

• Various genetic mutations

• Chemical exposures (e.g. Agent Orange)

• A history of sexually transmitted infections

Modifiable

• Being overweight or obese

• A diet high in red meat and saturated fat

• Lack of physical activity/exercise

• Low blood levels of vitamin D3

• Smoking

How can we modify our risk factors? Here’s a few examples:

Exercise: A 2015 study found that men with localized prostate cancer who engaged in walking/bicycling for at least 20 minutes per day had lower overall mortality rates compared to men who were less physically active [6].

Diet: A 2014 study on more than 47000 men found that there was a 22% lower risk of overall mortality in men who ate a Mediterranean-style diet after their prostate cancer diagnosis [7].

Naturopathic medicine can be a useful addition to a person’s health care regimen. Naturopathic doctors (NDs) are well-trained to optimize diet, lifestyle, and nutritional status and implement evidence-based therapies that support overall health and emphasize disease prevention. NDs help guide patients toward making healthy changes and reducing their risk factors for disease.

Book a consultation today to find out how naturopathic medicine can support you!

Written by Dr. Dana Kolenich ND

References:

[1] Canadian Cancer Statistics 2019

[2] https://seer.cancer.gov/statfacts/html/prost.html

[3] http://www.bccancer.bc.ca/health-professionals/clinical-resources/cancer-management-guidelines/genitourinary/prostate#Low-Risk

[4] https://www.ncbi.nlm.nih.gov/books/NBK470550/

[5] https://www.wcrf.org/dietandcancer/prostate-cancer

[6] https://cebp.aacrjournals.org/content/24/1/57

[7] https://pubmed.ncbi.nlm.nih.gov/23962747/