In a Canadian single-institution phase II study (ERASE) reported in JAMA Oncology, Kang et al found that increased exercise in the form of high-intensity interval training was associated with increased cardiorespiratory fitness and reductions in prostate-specific antigen (PSA) level, PSA velocity, and prostate cancer cell growth in men with localized prostate cancer under active surveillance.
Study Details
In the trial, 52 patients (mean age = 63.4 years) at the University of Alberta were randomly assigned between July 2018 and February 2020 to undergo 12 weeks of thrice-weekly supervised aerobic sessions on a treadmill at 85% to 95% of peak oxygen consumption (high-intensity interval training [HIIT] group, n = 26) or usual care (usual exercise levels, n = 26).
The primary outcome measure was peak oxygen consumption defined as the highest value of oxygen uptake during a graded exercise test using a modified Bruce protocol. Biochemical disease variables and cell proliferation in the prostate cancer cell line LNCaP were secondary outcome measures.
Key Findings
Overall, 46 (88%) of 52 patients completed the post-intervention peak oxygen consumption assessment and 49 (94%) of 52 provided blood samples. Adherence to HIIT was 96%.
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Mean peak oxygen consumption increased by 0.9 mL/kg/min in the HIIT group and decreased by 0.5 mL/kg/min in the usual care group (adjusted between-group mean difference = 1.6 mL/kg/min, 95% confidence interval [CI] = 0.3–2.9 mL/kg/min, P = .01).
Mean changes in disease variables significantly favoring the HIIT vs usual care group were observed for PSA level (-0.4 vs +0.3 µg/L, adjusted mean difference = -1.1 µg/L, 95% CI = -2.1–0.0 µg/L, P = .04), PSA velocity (-1.0 vs -0.1 μg /L/y, adjusted mean difference = -1.3 μg /L/y, 95% CI = -2.5 to -0.1 μg /L/y, P = .04), and growth of prostate cancer cell line LNCaP (-0.02 vs 0.00 optical density units [ODU], adjusted mean difference = -0.13 ODU, 95% CI = -0.25 to -0.02 ODU, P = .02).
No statistically significant differences were found for PSA doubling time (adjusted mean difference = +17.9 months, 95% CI = -3.8 to +39.6 months, P = .10) or testosterone level (adjusted mean difference = 1.0 nmol/L, 95% CI = -0.7 to +2.6 nmol/L, P = .24).
The investigators concluded, “The ERASE trial demonstrated that HIIT increased cardiorespiratory fitness levels and decreased PSA levels, PSA velocity, and prostate cancer cell growth in men with localized prostate cancer who were under active surveillance. Larger trials are warranted to determine whether such improvement translates to better longer-term clinical outcomes in this setting.”
Kerry S. Courneya, PhD, of the Faculty of Kinesiology, Sport, and Recreation, University of Alberta, Edmonton, is the corresponding author for the JAMA Oncology article.
Disclosure: The study was supported by the Canadian Institutes of Health Research and Prostate Cancer Canada. For full disclosures of the study authors, visit jamanetwork.com.
