Abstract
BackgroundStudies indicate that strength training has beneficial effects on clinical health outcomes in prostate cancer patients during androgen deprivation therapy. However, randomized controlled trials are needed to scientifically determine the effectiveness of strength training on the muscle cell level. Furthermore, close examination of the feasibility of a high-load strength training program is warranted. The Physical Exercise and Prostate Cancer (PEPC) trial is designed to determine the effectiveness of strength training on clinical and muscle cellular outcomes in non-metastatic prostate cancer patients after high-dose radiotherapy and during ongoing androgen deprivation therapy.Methods/designPatients receiving androgen deprivation therapy for 9-36 months combined with external high-dose radiotherapy for locally advanced prostate cancer are randomized to an exercise intervention group that receives a 16 week high-load strength training program or a control group that is encouraged to maintain their habitual activity level. In both arms, androgen deprivation therapy is continued until the end of the intervention period.Clinical outcomes are body composition (lean body mass, bone mineral density and fat mass) measured by Dual-energy X-ray Absorptiometry, serological outcomes, physical functioning (muscle strength and cardio-respiratory fitness) assessed with physical tests and psycho-social functioning (mental health, fatigue and health-related quality of life) assessed by questionnaires. Muscle cellular outcomes are a) muscle fiber size b) regulators of muscle fiber size (number of myonuclei per muscle fiber, number of satellite cells per muscle fiber, number of satellite cells and myonuclei positive for androgen receptors and proteins involved in muscle protein degradation and muscle hypertrophy) and c) regulators of muscle fiber function such as proteins involved in cellular stress and mitochondrial function. Muscle cellular outcomes are measured on muscle cross sections and muscle homogenate from muscle biopsies obtained from muscle vastus lateralis.DiscussionThe findings from the PEPC trial will provide new knowledge on the effects of high-load strength training on clinical and muscle cellular outcomes in prostate cancer patients during androgen deprivation therapy.Trial registrationClinicalTrials.gov: NCT00658229
Highlights
Studies indicate that strength training has beneficial effects on clinical health outcomes in prostate cancer patients during androgen deprivation therapy
The effects of strength training on the same regulators are of particular interest during androgen deprivation therapy (ADT), and as far as we know they have not previously been explored in Prostate Cancer (PC) patients
Whereas reduced levels of testosterone during ADT negatively affect the regulation of muscle mass, strength training might counteract these detrimental effects on muscle fibres (Figure 2)
Summary
Previous research has examined the effect of physical exercise on clinical outcomes such as body composition, physical function, mental health, fatigue and quality of life in PC patients [3,4,5]. Studies investigating the effects of ADT and exercise at the muscle cell level are still lacking Expanded knowledge in this field among PC patients is required. The results on the cellular effects of ADT in muscle tissue will provide novel understandings of muscle mass regulation by testosterone. Such knowledge will improve our understanding on how aging in general and reduced testosterone production during ADT induces loss of muscle mass (sarcopenia). The PEPC trial focuses on the effect on a high-load strength training program on both clinical and muscle cellular outcomes in PC patients during ADT.
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