Neoadjuvant exercise therapy safe, feasible in prostate cancer

Neoadjuvant exercise therapy may be beneficial in the treatment of men with prostate cancer, with a dose of 225 min per week showing a promising activity against the disease, as shown in the results of a phase Ia nonrandomized, dose-finding study.

The single-centre study included 53 inactive men (median age 61 years) with treatment-naïve localized prostate cancer who were scheduled to undergo surgical resection. These men were assigned to undergo exercise therapy presurgery at one of six dose levels, which ranged from 90 to 450 min per week. The therapy involved individualized moderate-intensity treadmill walking. All exercise therapy sessions were conducted remotely with real-time monitoring.

Researchers evaluated the feasibility of exercise therapy using relative exercise dose intensity (REDI). An exercise dose level was considered feasible if at least 70 percent of men achieved a REDI of 75 percent or greater. Outcomes included changes in tumour cell proliferation (Ki67) and plasma prostate-specific antigen levels. Safety and changes in patient physiology were also evaluated.

All exercise doses were feasible. After the intervention, mean Ki67 increased by 5.0 percent with 90 min of exercise per week, increased by 2.4 percent with 150 min of exercise per week, decreased by 1.3 percent with 225 min of exercise per week, decreased by 0.2 percent with 300 min of exercise per week, decreased by 2.6 percent with 375 min of exercise per week, and increased by 2.2 percent with 450 min of exercise per week.

Meanwhile, prostate-specific antigen levels increased by 1.0 ng/mL with the 90-min/wk regimen, increased by 0.2 ng/mL with the 150-min/wk regimen, decreased by 0.5 ng/mL the 225-min/wk regimen, decreased by –0.2 with the 300-min/wk regimen, decreased by –0.7 ng/mL with the 375-min/wk regimen, and decreased by –0.9 ng/mL with the 450-min/wk regimen.

None of the participants reported any serious adverse events.

A weekly exercise dose of 225 min was chosen for phase 2.