AUA 2021: A Phase II Randomized Clinical Trial Of Yoga In Men With Prostate Cancer

( In this study by Kaushik and colleagues, the authors explored the impact of yoga on men with newly diagnosed prostate cancer before and after prostatectomy. They found that yoga has important effects on quality of life (QoL), antitumor immune response, and inflammatory response.

The authors introduced the topic by indicating that yoga is an established exercise that focuses on isometric exercise, breath control and mindfulness. It is established that it improves health-related quality of life (QoL) in patients with several types of cancer, but also note that its benefits have not been studied in prostate cancer. To address this deficiency, they performed a phase II clinical trial to evaluate the impact of yoga on QoL and its effects on immune cell status and cytokine levels in men undergoing radical prostatectomy.

They recruited 30 men with newly diagnosed localized prostate cancer who were scheduled to undergo radical prostatectomy. These men were then randomized to yoga (n=15) or standard-of-care (n=15) before prostatectomy. Men randomized to yoga performed sixty minutes of yoga twice weekly for 6 weeks before surgery and for 3–6 weeks after surgery ***.

The primary outcome was self-reported QoL, assessed by the Expanded Prostate Index Composite (EPIC), Functional Assessment of Cancer Therapy-Prostate (FACT-P), Functional Assessment of Chronic Illness Therapy-Fatigue (FACIT–F), Functional Assessment of Cancer Therapy-General (FACT-G) at baseline, preoperatively, and 6 weeks postoperatively. Secondary outcomes were immune cell status and cytokine levels in blood specimens collected at the same assessment times.

They found that the greatest benefit of yoga on QoL was seen in EPIC-sexual, FACIT-F (fatigue), FACT-Functional wellbeing, FACT-physical wellbeing, and FACT-Social wellbeing (Figure 1).



 On secondary subgroup analysis, they found that sexual, physical and social wellbeing in men who underwent yoga.


From a secondary analysis standpoint, men in the yoga group showed increased numbers of circulating CD4+ and CD8+ T-cells and increased Fc receptor III expression and interferon-gamma in natural killer cells, decreased numbers of regulatory T-cells and myeloid-derived suppressor cells, indicating antitumor activity (Figure 2). Yoga reduced inflammatory cytokine levels (granulocyte colony-stimulating factor monocyte chemoattractant protein and FMS-like tyrosine kinase-3 ligand. 

Based on the above, they conclude that perioperative yoga improved QoL, promoted an antitumor immune response, and attenuated inflammation in men undergoing prostatectomy. Yoga is feasible in this setting and has benefits that require further investigation. *** 

Presented by: Dharam Kaushik, MD, Urologic Oncologist, UT San Antonio

Written by: Thenappan (Thenu) Chandrasekar, MD – Urologic Oncologist, Assistant Professor of Urology, Sidney Kimmel Cancer Center, Thomas Jefferson University, @tchandra_uromd on Twitter during the 2021 American Urological Association, (AUA) Annual Meeting, Fri, Sep 10, 2021 – Mon, Sep 13, 2021.