Exercise Oncology...what say you?

You bring up a great point that needs some explanation.

Many observational studies have found NO association with vigorous exercise and a reduced risk of being diagnosed with prostate cancer.

A comprehensive 2018 meta-analysis of 48 cohort and 24 case-control studies (151,748 prostate cancer cases) found no association between total physical activity and prostate cancer incidence.

However, a subgroup analysis, in that meta-analysis, showed that vigorous physical activity was associated with a 25% reduced risk of advanced prostate cancer.

A 2004 Harvard Health Professionals Follow-Up Study followed 47,620 men over 14 years. Men aged 65 or older who engaged in ≥3 hours per week of vigorous physical activity (e.g., activities such as running, cycling, or swimming) had a 67% lower risk of advanced prostate cancer, as compared to those with no vigorous activity.

However, no significant association was found between vigorous exercise and total prostate cancer incidence.

This suggests vigorous exercise may specifically reduce the risk of aggressive forms of prostate cancer but not its initial diagnosis.

The ERASE trial was particularly important, because it addressed men already diagnosed with localized PCa.

As odd as it sounds, the science indicates that men diagnosed with PCa are the beneficiaries of a ramped up vigorous exercise treatment program….. however, vigorous exercise does not prevent one from acquiring PCa.

…a very important difference to understand.

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, as mentioned earlier, there was a conclusion in the ERASE randomized clinical trial (published August 2021), cited below:

“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.“
https://jamanetwork.com/journals/jamaoncology/fullarticle/2783273
One can choose not to believe it or have another reason to be skeptical regarding its clear conclusion, but its implementation is working in my case and that's good enough for me.

I was diagnosed with low risk Gleason 3+4 in October 2023.

I'm not saying it will work for everyone (or even the majority of low risk PCa men)...everyone chooses the treatment for which they are most comfortable implementing...and I'm completely comfortable (as is my urologist) with my exercise oncology protocol. I plan to stick with it.

I didn’t see that study… I am sticking with the exercise as well for a number of reasons… My PSA numbers have been creeping up slowly but my blood cancer oncologist concurs not to treat the Pca unless there is a major spike up.. In my case surgery, ADT and and/or radiation could complicate things with my blood cancer which could lead to a deadly leukemia. I’ll take a hard pass on that…

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! 🙂

Very interesting but you may want to conceal your private information on the lab report. It's a long shot but you never know who is lurking.

Yep… biopsy, MRI, PSMA Pet scan back in 2022… Decipher score was bad…high risk.. Cancer center graded 4 + 3… John Hopkins 2nd opinion graded 3 + 4. PSMA negative for metastasis… PSA was 7.95 in December 2021 and now is 12.2 … There is much more to this story, but for now the prostate cancer is not the priority…
I have minimal symptoms from the chemo pills I am taking and actually feel really good… People have no idea that I am fighting 2 cancers among other things… In that regard, I consider myself lucky…

Wow…that’s rough!

As your blood cancer oncologist is agreeing to hold off on PCa treatment and the PCa still appears to be localized I’d encourage you (as one PCa patient to another) to consider putting the ERASE protocol to the test.

There are definitely no guarantees and it’s not easy, but there is good science behind it and who knows???

In this thread I haven’t even mentioned all the non-PCa benefits I’ve received since starting.

Just yesterday my wife found, while rummaging through old files for other reasons, a 5k race I ran (my only one) when I was 37 years old (32 years ago).

I couldn’t believe it, but my best 5K time, at 68 years old a few months ago, is only 6 seconds slower than my 37 year old self! I couldn’t believe it….and that’s just the tip of the benefit iceberg.

Anyway, if you’re up for it DM me and I’ll can set you up into our “Runners Group”….not all of us run, but we encourage each other in whatever exercise we enjoy.

Whatever you decide, all the best to you!

Just as an FYI, I will be 71 in a few weeks… I used to run many 5K’s but another one of my medical problems is that I have osteonecrosis of my left knee… I can bike, swim, and walk with no issues, but I can’t pivot at all and have been advised not to run…
I certainly will look into ERASE to see what else I can do.. I never swam laps before last September and am not a great swimmer, but now I can knock off 2000 yards relatively easily… As I mentioned in an earlier post, I have a PSMA Pet scan coming up to see if there has been any worsening of the PCa.. Hoping for no metastasis as that would complicate everything..
I really appreciate your input..
Thanks and have a great day..