Prostate cancer is the second most common cancer diagnosed in men. 1 in 6 men will be diagnosed with prostate cancer before the age of 85. In addition, it is the third most common cause of cancer related deaths! This form of cancer is most common in older men, with 63% of cases diagnosed in those over the age of 65.
This year alone, an estimated 16,754 males will be diagnosed with prostate cancer resulting in an as many as 3,152 deaths! The news is not all bad the 5 year survival rate for prostate cancer is certainly something to smile about. Of the men diagnosed with prostate cancer between 2012 and 2016 95% have survived at least 5 years!
Like all forms of cancer, prostate cancer is a very serious condition and is life threatening if it is not treated. However, the statistics indicate that the majority of men will survive – the treatment works! The downside? The treatments can have major side effects that can reduce overall function, physical capabilities and quality of life. Luckily, exercise is a fantastic way of reducing these side effects and, in some cases, preventing them completely! This is what we will explore in this post, but first let’s start by understanding exactly what prostate cancer is.
What is Prostate Cancer?
Our bodies are made up of billions of cells that reproduce and multiply in a controlled and purposeful way. Cancer occurs when these cells become abnormal and grow uncontrollably to form tumours. Specifically, prostate cancer occurs when these tumours form within the prostate gland.
Certain factors can increase your risk of prostate cancer. These include age (especially above 50 y.o.), family history of cancer and a father or brother diagnosed with prostate cancer before the age of 60. In addition, research suggests that there is a link between high testosterone levels and prostate cancer.
How is prostate cancer classified?
There are three different classifications of Prostate Cancer:
- Early (or localised) Prostate Cancer: Cancer cells have grown, but do not appear to have spread beyond the prostate
- Locally Advanced Prostate Cancer: Cancer cells have spread to parts of the body outside, but close to the prostate
- Metastatic Prostate Cancer: Cancer cells have spread to distant parts of the body
Treatment of Prostate Cancer
As we mentioned earlier, the survival rate for prostate cancer is high, indicating that the treatment is effective!
Prostate cancer treatment is influenced by the TNM staging system. This system uses five key pieces of information:
- The extent of the primary tumour (T)
- Has the cancer spread to the nearby lymph nodes? (N)
- Has the cancer metastasised (spread) to other parts of the body (M)
- The PSA level at the time of diagnosis
- The Gleason Score, which measures how likely the cancer is to grow and spread
The importance of PSA testing!
A PSA blood test measures the amount of a protein know as prostate-specific antigen in your blood. This test does not determine if you have prostate cancer or not. Simply put it informs us of overactivity within the prostate, this over activity may or may not be related to cancerous cells.
It is important to stress that only one-third of individuals with increased PSA levels have prostate cancer! This test is used as an indicator and for the purpose of early detection. As we know, the earlier we can identify it the greater our chances of recovery and survival. If you are a male over 50 years old it is recommended that you discuss having a PSA test with your GP, that way you and your GP can monitor any changes in your PSA.
In this phase, the prostate cancer is monitored as it is not causing symptoms and is considered low risk. Because there are minimal or no associated symptoms, the treatment may do more harm than good. Due to this, monitoring the prostate cancer to ensure it is not progressing is the optimal approach.
Those with slightly more progressed cancer go into this form of active surveillance. Progression of the cancer is still considered low risk, however more frequent PSA testing and check ups are completed to closely monitor the situation and ensure it is not worsening. Some men may move in and out of this phase depending on the success of other treatments.
A prostatectomy is performed which, to put it simply, removing the affected prostate and therefore the cancerous cells. The aim of this is to remove it before it spreads to the rest of the body.
Beams of radiation are used to target the affected areas in an attempt to damage or destroy the cancerous cells. This would prevent them from multiplying to spread or create larger tumours.
This treatment is a form of hormone therapy. Prostate cancer requires testosterone in order to grow and spread. Hence, an implant is inserted with the aim to suppress the production of testosterone and therefore slow down the spread of the cancer.
This method is commonly used alongside other treatments and can be applied successfully for many years.
During Chemotherapy, anti-cancer drugs are used to prevent the cancer from growing and spreading. This can be done using oral tablets, injections or an intravenous drip.
This form of treatment typically occurs in cycles, and treatment can occur for as long as six months, a year or for as long as it works.
The Affects of Treatment
As is the case with any treatment, cancer treatments can have negative side effects. These side effects can include (but are not limited to):
- Fatigue or lack of energy
- Compromised immune system
- Muscle weakness or atrophy
- Reduced bone mineral density
- Hair loss
- Easily bruising or bleeding
- Nausea, vomiting or appetite changes
- Peripheral Neuropathy or other nerve problems
- Changes in weight (loss or gain)
- Digestive problems
- Decreased concentration and focus
- Mood changes
- Changes in libido and sexual function
- Increased risk of:
- Heart Disease
What is the role of physical activity?
Individuals living with prostate cancer have been shown to gain tremendous benefits from regular exercise training. Evidence shows that exercise can help prostate cancer patients in many ways. Exercise has been proven to reduce the impact of the side effects of cancer treatments, enable patients to undergo more treatment cycles, and return to physical function faster post-treatment.
Managing Side Effects
Prostate cancer treatment can result in many side effects, as discussed earlier. Both aerobic and resistance training have been shown to help reduce or completely prevent these side effects. In particular, exercise training helps prostate cancer patients by:
- Reducing fatigue and increasing energy levels
- Maintaining and in some cases improving muscular strength and endurance
- Improving aerobic fitness
- Maintaining bone minerals density
- Limiting gains in adipose tissue (body fat)
- Reducing incontinence symptoms
- Improving quality of life
- Boosting the immune system function
- Improving mood, focus and concentration
- Aiding in prevention of:
- Heart Disease
Returning to Physical Health
The improvements from exercise training mentioned above can be obtained either during and after prostate cancer treatment. As such, exercise is a great ally not only during the fight against cancer but also on the recovery path after the war has been won!
The goal of exercise during treatment is to maintain and try to limit the loss of physical function. This is with a particular focus on fatigue (or energy levels) and maintaining a healthy body composition including minimising muscle atrophy. By minimising these changes the road to recovery after treatment will be that bit easier. However, if have completed your treatment and are now looking to regain what you may have lost exercise is there for you too. This is especially important in regaining independence in completing our daily activities and returning to work. Prostate cancer survivors have been able to improve their overall physical fitness and capabilities through regular exercise training. As such, exercise is an important tool in improving independence, ability to complete daily tasks and return to work.
Where to begin?
This is a very good question! and a tough one to answer. The ideal exercises (and the safest) vary from situation to situation, depending on the stage of the cancer and overall physical capabilities after treatment. Not to mention that many people over the age of 50 are likely to have other injuries or illnesses to be considered when prescribing exercise. As such, it is important to seek advice from an expert before beginning. This is where exercise professionals, such as our expert Exercise Physiologists join the party. They are able to assess your individual needs and circumstances and provide the exercises best for you!
In addition, we also have some previous posts that provide more detail on various exercises that can be a good starting point. I would recommend starting with “No gym? No problem! Effective ways to exercise outside the gym!“, as it provides fantastic options for exercise within the comfort of your own home.
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Exercise Physiologists specialise in helping people identify the type of exercise that will help them achieve their goals – not just in a gym with weights, but to include in your everyday life! If you would like some assistance in determining the best type fo exercise for you to help you achieve your goals, contact us to organise an appointment to see one of our Exercise Physiologists.
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References and useful resources
American Cancer Society, Prostate cancer stages and other ways to assess risk, viewed 15/09/20. https://www.cancer.org/cancer/prostate-cancer/detection-diagnosis-staging/staging.html
Australian Government – Cancer Australia, Prostate Cancer in Australia Statistics, viewed 15/09/2020. https://www.canceraustralia.gov.au/affected-cancer/cancer-types/prostate-cancer/statistics
Baumann, F.T., Zopf, E.M. and Bloch, W., 2012. Clinical exercise interventions in prostate cancer patients—a systematic review of randomized controlled trials. Supportive Care in Cancer, 20(2), pp.221-233.
Cancer Council, Early detection of prostate cancer, viewed 15/09/2020. https://www.cancer.org.au/cancer-information/causes-and-prevention/early-detection-and-screening/early-detection-of-prostate-cancer
Cancer Council Victoria, Prostate Cancer, viewed 11/09/2020. https://www.cancervic.org.au/cancer-information/types-of-cancer/prostate_cancer/prostate-cancer-overview.html
Photos provided by Curtis MacNewton, Emily Morter, Marcelo Leal and National Cancer Institute via Unsplash.com
Prostate Cancer Foundation of Australia, https://www.prostate.org.au/
Segakm R.J., Reid, R.D., Courneya, K.S., Malone, S.C., Parliament, M.B., Scott, C.G., Venner, P.M., Quinney, H.A., Jones, L.W., Slovinec D’Angelo, M.E. and Wells, G.A., 2003, Resistance exercise in men receiving androgen deprivation therapy for prostate cancer. Journal of Clinical Oncology, 21(9), pp. 1653-1659.
Segal, R.J., Reid, R.D., Courneya, K.S., Sigal, R.J., Kenny, G.P., Prud’Homme, D.G., Malone, S.C., Wells, G.A., Scott, C.G. and Slovinec D’Angelo, M.E., 2009. Randomized controlled trial of resistance or aerobic exercise in men receiving radiation therapy for prostate cancer. Journal of clinical oncology, 27(3), pp.344-351.