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Active Surveillance- Systematic Review of Interventions
Prostate Cancer | Last Active: May 26 7:21am | Replies (36)Comment receiving replies
Paul, I wanted to ask you this.
I used to exercise a lot, testosterone levels were constantly rising. Everything was leading up to my doctor saying that if my testosterone kept rising, I'd have to have my balls amputated.
I decided to take a rather unusual approach. I actually stopped moving a lot and reduced my exercise to almost nothing. After that, my testosterone levels dropped again.
What do you think about what I wrote about the connection between testosterone levels and exercise?
I read about IGF on your website. Is it scientifically proven that it reduces the progression of prostate cancer?
Thank you, I await your reply!
Replies to "@paulsweeney Paul, I wanted to ask you this. I used to exercise a lot, testosterone levels..."
@denis76
While Exercise provides vital muscle-preserving benefits, it cannot override the biochemical mechanism of ADT. It can’t keep your testosterone up for more than a very short time.
Are you on the agonist version of ADT (Lupron) or the antagonist version (Firmagon, Orgovyx). Switching to the other version may be what you need to keep the testosterone down.
Connect
Thank you for the question — it's a really important one and I want to be careful with my answer because I'm not a doctor.
On the testosterone and exercise connection: it's true that intense exercise can cause temporary spikes in testosterone. But the relationship between testosterone and prostate cancer is more complicated than "higher testosterone = worse cancer." The evidence on this has actually shifted significantly in recent years. The ERASE trial — a randomised controlled trial specifically in men on active surveillance — showed that HIIT exercise decreased PSA, decreased PSA velocity, and inhibited prostate cancer cell growth. Those men were exercising intensely three times a week. If exercise-induced testosterone was driving their cancer, you'd expect the opposite result.
The concern your doctor raised about testosterone may be specific to your clinical situation — particularly if you're being considered for androgen deprivation therapy (ADT). In that context, the goal is to suppress testosterone as low as possible, and your doctor may have been concerned about anything that works against that suppression. That's a very different situation from a man on active surveillance where the goal is to monitor, not suppress.
Stopping exercise to control testosterone worries me, because the overall evidence strongly favours exercise for men with prostate cancer — not just for cancer-specific outcomes, but for cardiovascular health, mental health, bone density (especially important if you're on ADT, which causes bone loss), and overall survival. I'd really encourage you to discuss this with your oncologist and ask specifically whether the exercise benefits outweigh the testosterone concern in your case. I suspect they will.
On IGF — you're right that evidence.zone mentions it. Insulin-like growth factor (IGF-1) is associated with prostate cancer progression in observational studies, and it's one of the reasons obesity and high-insulin diets are flagged as risk factors. But "associated with" is not the same as "proven to cause." The evidence that lowering IGF-1 through diet or lifestyle slows prostate cancer progression in humans is not yet proven in clinical trials — it's biologically plausible and supported by population-level data, but we don't have an RCT showing "lower your IGF-1 and your cancer progresses more slowly." What we do know is that the things that lower IGF-1 — plant-rich diets, healthy weight, moderate exercise, reduced dairy — are the same things that show up across the evidence base as beneficial for men with prostate cancer.
Paul