- Reply to L. Bourke et al and K.M. Winters-Stone et al. July 07, 2014
DOI: 10.1200/JCO.2014.55.1879 Journal of Clinical Oncology - published online before print July 7, 2014
Progress Toward Embracing Exercise Training As an Integral Part of Prostate Cancer Treatment
University of Florida; and Malcom Randall Veterans Affairs Medical Center, Gainesville, FL
Royal Hallamshire Hospital, University of Sheffield, Sheffield, United Kingdom
We were encouraged to read the recently published systematic review by Gardner et al1 concerning the beneficial effects of exercise training interventions on physical function and fatigue in men undergoing androgen-deprivation therapy (ADT) for prostate cancer. Although we share the author's general conclusion, several important issues deserve the readers' attention.
First, through no fault of the authors, but given the time lapse between the latest literature update (June 2013) and the date of publication (December 2013), two recent randomized controlled trials2,3 (RCTs) that were published in October 2013 were not evaluated. This is unfortunate, given the general rarity of RCTs in this arena, because the finding of clinically relevant improvements in prostate cancer–specific quality of life in one of the studies was noteworthy, particularly because that study has been the only RCT to explicitly include sedentary men with documented metastatic disease receiving long-term ADT.2 Second, the relatively uncritical side-by-side presentation of evidence that was derived from experimental and observational study designs and the failure to rate the quality of evidence on an outcome-specific basis are concerns.4 Finally, efforts toward a meta-analysis of RCT data using standardized effect size measures for select outcomes could have greatly improved the practical value of this important review.5 A Cochrane systematic review using a rigorous peer-reviewed methodology, which will also evaluate any available non-English–language manuscripts, is ongoing and is expected to address these issues later this year.
Many in the field are particularly excited about the potential benefit of exercise training in regard to the effect on disease progression. The editorial by Parsons6 that accompanied the study by Gardner et al1 highlighted this but suggested that there are no planned randomized trials in the field to address this issue. We are pleased to announce the Prostate Cancer Novel Therapy (PANTERA) trial has recently been granted support by Cancer Research United Kingdom. This study will evaluate the effect of 12 months of aerobic exercise training on disease progression and time to invasive therapy in men with low- and intermediate-risk localized prostate cancer undergoing active surveillance, with the first phase focusing on feasibility of the intervention.
We look forward to seeing treating urologists and oncologists begin to embrace the growing evidence for the beneficial effects of exercise training in men with prostate cancer, and we also eagerly anticipate a commitment from health care providers to support the integration of such interventions as the standard in cancer treatment.
The author(s) indicated no potential conflicts of interest.
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