Exercise Oncology...what say you?

"whether exercise actually delays cancer progression or not is irrelevant to the decision"...that's a "bridge too far"...and I MUST disagree.

For men diagnosed with low risk PCa, slowing cancer progression is a HUGE DEAL.

I understand where you are coming from, and you can be skeptical with your own opinions, but please do not minimize what the science has already demonstrated.

No. Darolutamide has the ability to work to suppress testosterone so a lot of testosterone can be there and Darolutamide will still be effective. It doesn’t reduce testosterone. It works around testosterone, You might say.

PSAV = PSA velocity.

PSA velocity focuses on the absolute change in PSA per unit of time (ng/mL/year).
PSA doubling time focuses on the time required for PSA to double, reflecting more of the "growth rate" of PSA levels.

From what I understand PSA velocity is used more in detecting early trends in PSA changes, for example when screening or monitoring low-risk prostate cancer. PSA doubling time is used more after treatment (e.g., prostatectomy or radiation) to assess a cancer's recurrence or aggressiveness.

PSA Velocity

I understand where you're coming from too, and I realise that this sounds like splitting hairs, but what science has demonstrated is that in a single large RAT, the median overall survival (the point when half of participants had died) was 7 months later for people who exercised more.

That's a very important step towards demonstrating causality — I'm not dismissing the science at all — but it's not enough to get us to reasonable certainty. Despite all the best efforts in an RAT, I'm sure the researchers themselves would be the first to admit that there's still a significant risk that they're seeing correlation more than causality. Repeating the result in at least a couple more large scale RATs will be needed to be confident of causality.

My point is that there's no need to wait for that additional research, because exercise brings other demonstrated benefits regardless, so it's a win for those, and also a potential win for the future if additional studies bear out the first findings.

What I've been referring to all along is the ERASE randomized clinical trial (published August 2021), reference cited below.
https://jamanetwork.com/journals/jamaoncology/fullarticle/2783273
Its conclusion was:

“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.“

My personal exercise oncology experience (see next post for detail), after implementing the ERASE protocol is EXACTLY what was demonstrated in its conclusion, so it was not an "irrelevant" conclusion (to say the least) regarding my own experience....you may continue with skepticism, but in my book, when something works for you, as described, it's hard to argue it was irrelevant.

I have no idea about the study you referred to in your last post, please site a reference and its conclusion.

My clinical/genomic data is summarized below:

May 2023: PSA was 7.8

October 2023: mpMRI showed 3, 4 & 5 PIRADS lesions and a MRI targeted TRUS biopsy indicated 7/15 cores positive, five 3+3 (5-10%) & two 3+4 (10-20%), my Decipher GRID Clinical-Model rated my tumor “Low Risk" @ 0.22 (attached)

November 2023: Initiated a running program involving 8-10 miles a week and occasional HIIT and also began a whole plant food diet (WPFD). Garmin VO2 Max was 40

February 2024: Lost 25 lbs (BMI=22.5) and stopped the WPFD, reintroducing salmon, chicken and beef, my first post-biopsy PSA dropped to 5.95

Between Feb '24 - Jul '25: Weight was constant at 162 lbs +/- 2 lbs and PSA fluctuated between 5.76 - 6.60

October 2024: 12 month follow-up mpMRI shows that the PIRADS 3 & 4 lesions were no longer visible and the PIRADS 5 lesion had shrunk and its T2 & DWI/ADC signals were reduced from “moderate” to “mild”

March 2025: Increased running to 12-15 miles/week and increase HIIT to 2-3x/week. VO2 Max fluctuates between 48 - 50

May 2025: PSA dropped to 5.76, lowest level since biopsy

So, 21 months after being diagnosed with Gleason 3+4 PCA, my VO2 max has increased 20-25%, my PSA has dropped 2.04 units (down 26%, demonstrating a negative PSA velocity) and my 12 month follow-up mpMRI (same MRI machine and same radiologist's interpretation) demonstrated lesion reversal.

Some may say that it is mere coincidence that after 21 months on active surveillance for my localized PCa that my VO2 Max would increase 20-25%, my PSA level decrease 26% and my PSA velocity and prostate cancer cell growth reverse (based on a comparative 12 month follow-up mpMRI)...well let's see what the science says:

"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."

Well isn't science magical! 🙂

I'm not skeptical at all — I think it's very promising. And thanks for sharing the link to the lit review. They're a little more cautious than you, but do think the research trends are very promising (and I agree; we're really not disagreeing here, except on the level of confidence which we apply to a causal link):

"the clinical studies included in this review have yielded conflicting results. Some authors have found no correlation between engaging in physical exercise and the risk of tumor progression. Specifically, two RCTs failed to demonstrate a link between PA and PSA kinetics. However, after observing the participants of the Prostate Cancer Lifestyle Trial for two years, it was noted that the rate of definitive treatment was significantly lower among active men compared to the control group (5% vs. 27%, p = 0.005). "

… and …

"To accurately assess the impact of exercise on the risk of PCa progression in patients managed with AS, further randomized clinical trials with extended follow-up periods, incorporating the use of wearable devices for daily PA measurement, are warranted."

In other words, it looks like we're onto something here, so let's tighten up the methodologies and keep pushing ahead. If I were betting, I'd bet that the evidence will keep accumulating until they decide to make physical activity a core part of cancer treatment rather than a secondary recommendation.

...well I guess I just have to chalk up my amazing clinical data to magic (see above for details)....how could I have been so naive to believe, and actually implement, the protocol of a randomized clinical trial and obtain the exact results that they demonstrated 🙂

Not at all. Anecdotal evidence is important. I also attribute my progress (diagnosed with stage 4b in 2021 but still NED and PSA < 0.01 after almost 4 years) partly to staying physically active, and expect that there will be even more evidence to back that up in the future.

If nothing else, being fit helps me to tolerate the side effects of my treatment better, and ecouraged my onco team to go all out with some strong therapies (so I've been able to stay on them), and also encouraged my onco team to use strong, "curative" treatments rather than milder, palliative ones. But like you, I think there's likely more to it than just that.