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Guide
It is well known that the goals of cancer treatment include prolonging the life of patients and improving the quality of life (QoL)
of patients.
Health-related quality of life (HRQoL) in prostate cancer (PCa) patients is severely affected
due to disease specificities and treatment-related adverse effects.
Exercise can effectively improve the physical function and quality of life of PCa patients, but because the exercise process is difficult to quantify, its mode, frequency and mechanism are worth exploring
in depth.
Recently, two foreign studies published by Prostate Cancer Prostatic Dis further explore the role of exercise therapy in the field of PCa treatment, which are compiled below for readers
.
Research background
In up to one-third of men, the diagnosis and treatment of PCa is associated with
negative emotions such as anxiety, fear and depression.
Many studies have shown that yoga can improve HRQoL in cancer patients, but there is a lack of evidence that
yoga improves QoL in patients with PCa.
Research methods
In this randomized controlled trial, 29 patients with newly diagnosed localized PCa were randomly assigned to yoga (n=14) or standard care (n=15)
prior to radical prostatectomy (RP).
Patients in the yoga group performed yoga exercises (60 minutes twice a week for 6 weeks) 6 weeks before RP surgery, and again for 6 weeks from 3-6 weeks
after RP.
The primary outcome was patient-reported QoL assessed at baseline, preoperatively, and six weeks postoperatively, and the assessment tools included the Extended Prostate Cancer Composite Index Scale (EPIC), the Prostate Cancer Therapeutic Function Assessment Scale (FACT-P), the Chronic Disease Therapeutic Functional Assessment - Fatigue Scale (FACIT-F), and the Quality of Life Measurement Scale for Cancer Patients (FACT-G).
Secondary outcomes were the effect of
yoga on immune cell status and cytokine levels.
Study results
The improvement of yoga on QoL was reflected in the patient's EPIC sexual function score (MD=8.
5), FACIT fatigue score (MD=6.
3), FACT functional status score (MD=8.
6), FACT-physiological status score (MD=5.
5), and FACT social/family status score (MD=14.
6).
Table 1 Comparison of the scores of yoga group and control group on each scale
Immune cell data analysis showed that the levels of IFN-γ in peripheral blood CD4+ (p=0.
007) and CD8+ (p=0.
004) cells in the yoga group were increased compared with the control group.
The levels of regulatory T cells (p=0.
029) and peripheral myeloid suppressor cells (MDSC) (p=0.
002) decreased, indicating that the antitumor activity was enhanced
in the yoga group.
In addition, the expression of FcγRIII (p=0.
041) and IFN-γ (p=0.
026) in NK cells of patients in the yoga group increased, indicating that their anti-cancer immune response was enhanced
.
In the yoga group, expression of inflammatory cytokines such as granulocyte colony-stimulating factor (G-CSF), monocytes chemokine (MCP-1), and FMS-like tyrosine kinase-3 ligands (Flt-3L) was significantly reduced
.
Figure 1 Cytokine data analysis
Conclusion of the study
Perioperative yoga exercises improve QoL, enhance anti-cancer immune response, and reduce inflammation in patients with PCa
.
Further research is needed on the mechanism of yoga to improve QoL and its effect
on PCa progression and recurrence in the future.
Research background
Androgen deprivation therapy (ADT) can delay the progression of advanced PCa, relieve disease symptoms, and prolong survival, but ADT therapy may cause adverse effects
such as debilitation in patients with PCa.
Supervised exercise therapy appears to improve the negative effects of ADT therapy, defined as physical activity programmes
directed, supervised and monitored by healthcare professionals.
This study aimed to systematically assess the effects
of supervised exercise therapy on PCa patients receiving ADT.
Research methods
The investigators conducted a systematic and comprehensive search of randomized controlled trials (RCTs) relevant to the purpose of the study in English databases such as PubMed, Medline, Embase, and Cochrane Library, and the search date was June 2021
.
Two review authors extracted trial data separately and assessed the risk of bias and the quality of the included studies
.
The primary outcomes of the meta-analysis were disease-specific quality of life and walking performance in patients with PCa after the end of exercise therapy, as assessed
by the FACT-P scale and the 400-metre walk trial, respectively.
Study results
The meta-analysis ultimately included 18 RCTs with a total of 1477 patients
with PCa with T1 to T4 stages.
Patients with PCa who participated in supervised exercise therapy showed clinically relevant improvements
in both disease-specific quality of life (SMD = 0.
43; 95% CI 0.
29 to 0.
58) and walking performance (SMD = -0.
41; 95% CI -0.
60 to -0.
22) compared with patients who did not participate in exercise therapy.
Figure 2 Forest map: disease-specific quality of life
Figure 3 Forest chart: walking performance
Conclusion of the study
Moderate-quality evidence suggests that supervised exercise therapy improves disease-specific quality of life and walking performance in PCa patients treated with ADT compared with no exercise therapy, independent of
the patient's cancer stage.
The findings strongly recommend that patients with PCa receive supervised exercise therapy to control the negative effects
of ADT therapy.
References:
[1] Kaushik D, Shah PK, Mukherjee N, et al.
Effects of yoga in men with prostate cancer on quality of life and immune response: a pilot randomized controlled trial.
Prostate Cancer Prostatic Dis.
2022 Sep; 25(3):531-538.
doi: 10.
1038/s41391-021-00470-w.
Epub 2021 Nov 23.
PMID: 34815548; PMCID: PMC9124736.
[2] Ussing A, Mikkelsen MK, Villumsen BR, et al.
Supervised exercise therapy compared with no exercise therapy to reverse debilitating effects of androgen deprivation therapy in patients with prostate cancer: a systematic review and meta-analysis.
Prostate Cancer Prostatic Dis.
2022 Sep; 25(3):491-506.
doi: 10.
1038/s41391-021-00450-0.
Epub 2021 Sep 6.
PMID: 34489536; PMCID: PMC9385477.
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