Intense exercise safe for men with metastatic prostate cancer

Patients with metastatic prostate cancer can safely engage in intense exercise training to improve survival outcomes, suggests a study presented at AACR 2024.

“Exercise training was feasible and safe in men with metastatic prostate cancer with no difference observed in exercise session adherence by disease status,” said lead study author Dr SA Kenfield from the University of California San Francisco, San Francisco, US. “Survey completion was high, while in-person completion rates were affected by the COVID-19 pandemic.”

Previous observational studies reported a 30‒60-percent reduction in all-cause and cancer-related mortality in men with prostate cancer undertaking moderate-to-vigorous exercise, according to the authors. In 2016, the INTERVAL-GAP4* was carried out to establish the efficacy of supervised exercise in improving overall survival in metastatic prostate cancer patients.

INTERVAL-GAP4 is a multicentre, randomized, controlled phase III trial that assessed the demographic characteristics, completion rates, exercise adherence, and safety of 12-month intense exercise in 240 men with prostate cancer at Edith Cowan University in Perth, Australia.

Kenfield and colleagues randomized participants to a high-intensity combined resistance and aerobic exercise supervised program for 1 year tapering to self-management in year 2 (intervention) or a self-directed unsupervised exercise with print materials (control).

Patients were then stratified by site and disease/treatment status (metastatic hormone-sensitive prostate cancer [mHSPC] or metastatic castration-resistant prostate cancer [mCRPC]; if the latter, treatment modality). Unfortunately, the study failed to meet its recruitment goals and ceased further enrolment in February 2023.

Feasible

Of the 240 participants assessed between April 2016 and February 2023, 60 consented to the study, 52 met the eligibility criteria, and two did not receive the allocation. As a result, 50 patients were included in the final analysis: 27 in the intervention arm and 23 in the control arm. [AACR 2024, abstract CT232/3]

Eligible participants had a median age of 72 years at randomization, a median BMI of 31.7 kg/m², and were mostly White (94 percent). Thirteen patients (26 percent) had mHSPC, and 37 (74 percent) mCRPC. Those excluded from the study did not meet the clinical criteria (n=81), could not commit their time (n=24), were unable to be contacted (n=22), uninterested (n=19), or had poor physical function (n=13).

At 6 months, 84 percent of the participants completed the surveys, 62 percent completed the exercise testing, and 66 percent had biological samples. Forty-two patients survived after 1 year, of whom 85 percent completed the surveys, 73 percent completed testing, and 73 percent had biological samples.

Median exercise adherence for the first 12 months of the study was 90 percent. Adherence did not differ significantly between patients with mCRPC and those with mHSPC.

In terms of safety, 10 serious adverse events were recorded in the first 12 months, but all of these were deemed unrelated to the exercise intervention.

“Additional analysis of the entire study population (N=145) is ongoing and will be compared with the pilot site,” Kenfield said.

*Intense Exercise for Survival among Men with Metastatic Prostate Cancer