Role of Physical Activity and Its Link with Lower Rates of Progression in Men on Active Surveillance - Editorial

“Eat right and exercise”. As a prostate cancer provider, I can’t count how many times I have given this advice to my patients. I am always afraid when they ask back, “Will it actually help”? The truth is, we don’t know. While increasing data suggest that diet and exercise may modulate prostate cancer risk and even progression in some studies, the totality of the evidence remains weak. Into this void, steps an important paper exploring the role of physical activity (i.e. exercise) and its link with lower rates of progression in men on active surveillance.

In this study, the authors assessed 85 men with low-risk prostate cancer being managed by active surveillance. All men completed a physical activity questionnaire at baseline and were categorized as sedentary (n=24), moderately active (n=46), or active (n=15). The authors then assessed the risk of grade reclassification, commonly used criteria for “progression” among men on active surveillance. The authors found that those who progressed were less physically active (p=0.056). Importantly, over time, the level of physical activity was significantly predictive of who progressed (p=0.033). Indeed, on multivariable analysis, the level of physical activity was the only significant predictor of progression (p=0.016). The authors concluded that physical activity may influence prostate cancer evolution.


stephen j freedland

Stephen J. Freedland, MD

Stephen J. Freedland, MD, is director of the Center for Integrated Research in Cancer and Lifestyle and co-director of the Cancer Genetics and Prevention Program and Associate Director for Faculty Development at the Cedars-Sinai Samuel Oschin Comprehensive Cancer Institute. He is also a faculty physician in the Division of Urology within the Department of Surgery at Cedars-Sinai. He has served on numerous American Urological Association guideline panels for prostate cancer and co-chaired a prostate cancer guideline panel for the American Society of Clinical Oncology.

Dr. Freedland's clinical area of expertise focuses on urological diseases, particularly benign prostatic hyperplasia and prostate cancer. His approach toward cancer prevention and awareness focuses on treating the whole patient, not just the disease, by combining traditional Western medicine with complementary holistic interventions. His research interests include investigations on urological diseases and the role of diet, lifestyle and obesity in prostate cancer development and progression, as well as prostate cancer among racial groups and risk stratification for men with prostate cancer.

PCAN: January 2022

Physical Activity Decreases the Risk of Cancer Reclassification in Patients on Active Surveillance: A Multicenter Retrospective Study - Full-Text Article

Background: Physical activity (PA) is associated with favorable outcomes in prostate cancer (PCa) patients. We assessed its effect on the risk of PCa reclassification (PCaR) during active surveillance.

Methods: Anthropometric, demographic, and clinical data concerning men diagnosed with a low-risk PCa and initially managed with active surveillance at the two participating institutions were retrospectively collected. The Physical Activity Scale for the Elderly (PASE) was used for patients’ self-assessment of their daily exercise and their consequent stratification into three groups: sedentary (PASE ≤ 65), moderately active (65 < PASE < 125), active (PASE ≥ 125). Kaplan–Meier model was used to evaluate the predictive role of PA on PCaR, computed at 2, 5, 10 years after diagnosis; differences between lifestyle groups were assessed using the log-rank and uni-/multivariable Cox analyses applied to identify predictors of reclassification.
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PCAN: December 2021

PSA Response to Antiandrogen Withdrawal: A Systematic Review and Meta-Analysis - Full-Text Article

Background: Antiandrogen withdrawal (AAW) response is the paradoxical decrease in prostate-specific antigen (PSA) following the withdrawal of antiandrogen in patients with advanced prostate cancer. Currently, the reported literature on the proportion of patients exhibiting AAW response and the differences in PSA response between the types of antiandrogens is unclear.

Methods: This review aimed to explore the PSA response to AAW and to identify if the response depends on the type of antiandrogens. A literature search was performed using databases PubMed, Cochrane and EMBASE with a cut-off date of 23rd of November 2020. Studies reporting on outcomes of AAW and prostate cancer were included. Studies were screened by two reviewers and relevant data extracted. Meta-analysis of outcomes was reported using random-effects and fixed-effects model. A subgroup analysis was performed for type of antiandrogen.
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PCAN: November 2021

Impact of Decipher Biopsy Testing on Clinical Outcomes in Localized Prostate Cancer in a Prospective Statewide Collaborative - Full-Text Article

BACKGROUND: Decipher Biopsy is a commercially available gene expression classifier used in risk stratification of newly diagnosed prostate cancer (PCa). Currently, there are no prospective data evaluating its clinical utility. We seek to assess the clinical utility of Decipher Biopsy in localized PCa patients.

METHODS: A multi-institutional study of 855 men who underwent Decipher Biopsy testing between February 2015 and October 2019. All patients were tracked through the prospective Michigan Urological Surgery Improvement Collaborative and linked to the Decipher Genomics Resource Information Database (GRID® ; NCT02609269). Patient matching was performed by an independent third-party (ArborMetrix Inc.) using two or more unique identifiers.
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PCAN: October 2021

Diagnostic Accuracy of Magnetic Resonance Imaging Targeted Biopsy Techniques Compared to Transrectal Ultrasound Guided Biopsy of the Prostate: A Systematic Review and Meta-Analysis - Full Text

BACKGROUND: Multiparametric MRI localizes cancer in the prostate, allowing for MRI guided biopsy (MRI-GB) 43 alongside transrectal ultrasound-guided systematic biopsy (TRUS-GB). Three MRI-GB approaches exist; visual estimation (COG-TB); fusion software-assisted (FUS-TB) and MRI ‘in-bore’ biopsy (IB-TB). It is unknown whether any of these are superior.We conducted a systematic review and meta-analysis to address three questions. First, whether MRI-GB is superior to TRUS-GB at detecting clinically significant PCa (csPCa). Second, whether MRI-GB is superior to TRUS-GB at avoiding detection of insignificant PCa. Third, whether any MRI-GB strategy is superior at detecting csPCa.
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PCAN: September 2021

What Is the Minimal Dose for Resistance Exercise Effectiveness in Prostate Cancer Patients? Systematic Review and Meta-Analysis on Patient-Reported Outcomes - Full-Text Article

Background: Active treatments for prostate cancer are well known to result in several adverse effects such as fatigue, depression and anxiety symptoms, impacting the overall quality of life (QoL) and wellbeing of a considerable proportion of patients. Resistance-based exercise interventions have shown positive effects to reduce or mitigate these treatment-related side effects. However, the minimal dosage required to derive these benefits is unknown. We systematically reviewed the resistance training effects in prostate cancer patients to determine the minimal dosage regarding the exercise components (mode, duration, volume and intensity) on fatigue, QoL, depression and anxiety.
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PCAN: July 2021

Bone Targeted Therapy and Skeletal Related Events in the Era of Enzalutamide and Abiraterone Acetate for Castration Resistant Prostate Cancer With Bone Metastases – Full Text Article

Background In an era of multiple life-prolonging therapies for metastatic castration-resistant prostate cancer (mCRPC), the optimal timing of initiation and duration of antiresorptive bone-targeted therapy (BTT) to prevent skeletal-related events (SREs) is unknown.

Methods To assess practice patterns of BTT use and its associations with clinical outcomes in a high-volume center in the modern era of metastatic CRPC management, a retrospective cohort of patients treated for mCRPC with BM between 2007 and 2017 was identified from a single institutions clinical research database.
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