Effects of Exercise on Cardiorespiratory Fitness and Biochemical Progression in Men With Localized Prostate Cancer Under Active Surveillance: The ERASE Randomized Clinical Trial.
Level 2 - randomized trial
Individual randomized controlled trial
PubMed 34410322 · doi:10.1001/jamaoncol.2021.3067
What was done
A single-center phase 2 randomized clinical trial (ERASE) evaluated 52 men (mean age 63.4 years) with localized very low-risk to favorable intermediate-risk prostate cancer undergoing active surveillance. Participants were randomized to 12 weeks of thrice-weekly supervised high-intensity interval training (HIIT) on a treadmill at 85% to 95% peak VO2 (n = 26) or usual care (n = 26). The primary outcome was peak VO2 from a graded exercise test using a modified Bruce protocol. Secondary and exploratory outcomes included PSA level, PSA kinetics, testosterone, and in vitro growth of the LNCaP prostate cancer cell line.
What was found
Adherence to HIIT was 96%, with 46/52 (88%) completing peak VO2 assessment and 49/52 (94%) providing blood samples. Peak VO2 increased by 0.9 mL/kg/min with HIIT and decreased by 0.5 mL/kg/min with usual care (adjusted between-group difference 1.6 mL/kg/min; 95% CI, 0.3 to 2.9; P = .01). Compared to usual care, the HIIT group had significant reductions in PSA level (-1.1 μg/L; 95% CI, -2.1 to 0.0; P = .04), PSA velocity (-1.3 μg/L/y; 95% CI, -2.5 to -0.1; P = .04), and LNCaP cell growth (-0.13 optical density unit; 95% CI, -0.25 to -0.02; P = .02). There were no statistically significant differences in PSA doubling time or testosterone.
Why it matters
This trial provides randomized evidence that high-intensity interval training improves cardiorespiratory fitness and slows biochemical and cellular markers of prostate cancer progression in men managed with active surveillance.
Limits
The study had a small sample size (n = 52), single-center design, and short intervention period (12 weeks). It assessed surrogate biochemical and cellular markers rather than long-term clinical endpoints such as disease progression, transition to definitive treatment, metastasis, or mortality.
Cited by
- supports High-intensity interval training in men with prostate cancer undergoing active surveillance lowers prostate-specific antigen (PSA) levels.
- supports In vitro exposure of prostate cancer cells to serum from men who underwent high-intensity interval training suppresses prostate cancer cell growth compared to serum from non-exercising controls.