Abstract
Alternative management strategies for localised prostate cancer are required to reduce morbidity and overtreatment. The aim of this study was to evaluate the feasibility, safety and acceptability of exercise training (ET) with behavioural support as a primary therapy for low/intermediate risk localised prostate cancer. Men with low/intermediate-risk prostate cancer were randomised to 12 months of ET or usual care with physical activity advice (UCwA) in a multi-site open label RCT. Feasibility included acceptability, recruitment, retention, adherence, adverse events and disease progression. Secondary outcomes included quality of life and cardiovascular health indices. Of the 50 men randomised to ET (n = 25) or UCwA (n = 25), 92% (n = 46) completed 12 month assessments. Three men progressed to invasive therapy (two in UCwA). In the ET group, men completed mean: 140 mins per week for 12 months (95% CI 129,152 mins) (94% of target dose) at 75% Hrmax. Men in the ET group demonstrated improved body mass (mean reduction: 2.0 kg; 95% CI −2.9,−1.1), reduced systolic (mean: 13 mmHg; 95%CI 7,19) and diastolic blood pressure (mean:8 mmHg; 95% CI 5,12) and improved quality of life (EQ.5D mean:13 points; 95% CI 7,18). There were no serious adverse events. ET in men with low/intermediate risk prostate cancer is feasible and acceptable with a low progression rate to radical treatment. Early signals on clinically relevant markers were found which warrant further investigation.
Highlights
Selecting clinical management strategies for men with localised prostate cancer is a balancing act
As demonstrated in the largest RCT far comparing treatment options, men with localised prostate cancer are nine times more likely to die of other causes rather than prostate cancer - CVD mortality being nearly three times more likely[1]
The aim of the Prostate Cancer Novel Therapy (PANTERA) trial was to assess the feasibility and acceptability of delivering exercise training (ET) as a novel primary therapy to men with low and intermediate risk localised prostate cancer with a view to informing a subsequent definitive trial evaluating the effect on progression to invasive therapy
Summary
Selecting clinical management strategies for men with localised prostate cancer is a balancing act. Developing exercise training (ET) as a novel primary treatment option for prostate cancer could fundamentally change the way the disease is managed and offer cancer specific and other health advantages for men affected. The challenge with exercise programmes is to support men in starting to become physically active and maintain exercise over the long-term, whilst providing objective data to confirm behaviour change[13]. Such therapies need to be integrated with clinical practice, if they are ever to be considered a realistic treatment option in the health services. The aim of the Prostate Cancer Novel Therapy (PANTERA) trial was to assess the feasibility and acceptability of delivering ET as a novel primary therapy to men with low and intermediate risk localised prostate cancer with a view to informing a subsequent definitive trial evaluating the effect on progression to invasive therapy
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