It seems that exercise is good for almost everything, including prostate cancer. In fact, exercise had a positive effect on sexual function and enjoyment in men with prostate cancer, according to a recent study presented at the 2023 ASCO Breakthrough meeting by lead study author Daniel Galvão, PhD, of the Exercise Medicine Research Institute at Edith Cowan University, Perth, Australia.1
The study showed that exercise, in the form of supervised resistance and aerobic exercises, improved erectile function and intercourse satisfaction in men with prostate cancer. However, self-managed psychosexual therapy did not lead to additional improvements in sexual function. According to the study authors, further research is needed to establish the long-term outcomes of exercise on sexual health in men with prostate cancer.
“Sexual dysfunction is a common, upsetting, and chronic side effect of prostate cancer treatment. Nearly half of patients with prostate cancer report having unmet sexual health care needs, highlighting the lack of current health-care services to adequately address the demand for management of sexual dysfunction after prostate cancer treatment. Our study shows that these patients can immediately benefit from supervised exercise interventions to improve their sexual health and that exercise should be considered an integral part of treatment for prostate cancer,” said Dr. Galvão. “Men with prostate cancer concerned about sexual dysfunction should be encouraged to undertake exercise as a potential countermeasure,” he added.
Men with prostate cancer concerned about sexual dysfunction should be encouraged to undertake exercise as a potential countermeasure.— Daniel Galvão, PhD
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Prostate cancer itself as well as treatments such as surgery, radiation therapy, and chemotherapy may cause or exacerbate sexual dysfunction. Although sexual dysfunction is a common, distressing, and persistent adverse effect of prostate cancer treatment, current strategies are largely inadequate in improving the physical and psychological effects on sexuality.
“Exercise is emerging as a potential therapy in the management of sexual health,” explained Dr. Galvão.
Evidence shows that exercise may counteract many prostate cancer–specific treatment-related adverse effects, including musculoskeletal toxicity (eg, muscle loss) that impairs physical function and quality of life, as well as fatigue.2-4
“Exercise has also been associated with lower overall and prostate cancer mortality, and it has also been shown to suppress prostate cancer tumor biology via the release of exercise-induced myokines,” Dr. Galvão told The ASCO Post in an e-mail.
Study Details
The three-arm, parallel-group, multicenter, randomized trial (from 2014–2018) was designed to explore the effects of supervised, clinic-based, resistance and aerobic exercises—with and without psychosexual therapy self-management—on the sexual health of men with prostate cancer. The study was conducted at university-affiliated exercise clinics.
A total of 112 eligible participants were men with prostate cancer previously or currently undergoing treatment who expressed concerns about sexual dysfunction. At baseline, groups were stratified by age (< 60 years and ≥ 60 years), previous prostatectomy (yes/no), previous radiation therapy (yes/no), and previous or current androgen-deprivation therapy (yes/no).
Groups were well balanced for demographic factors, disease characteristics, and type of treatment. Mean patient age was about 66 years; the majority had Gleason scores of 7 to 8; about 55% had undergone prostatectomy and 30% radiation therapy within the past 12 months; and 40% were still on androgen-deprivation therapy.
Participants were randomly assigned to one of three groups: 6 months of supervised, group-based resistance and aerobic exercises (n = 39); the same exercise program plus psychosexual therapy (n = 36); or usual care (n = 37). Exercise was undertaken 3 days per week at university-affiliated exercise clinics. Psychosexual therapy consisted of a brief self-management intervention that addressed psychological and sexual well-being.
The primary outcome measure was sexual health, as measured by the International Index of Erectile Function. Secondary outcomes included body composition, physical function, and muscle strength. Results were analyzed according to intention to treat.
Key Findings
Exercise increased erectile function by 5.1 points, whereas usual care led to an increase of 1.0 point (P interaction = .010). Intercourse satisfaction, as measured by the International Index of Erectile Function, increased by 2.2 points with exercise and 0.2 points with usual care (P interaction = .026). Compared with usual care, exercise prevented an increase in fat mass (P interaction = .028) and improved physical function outcomes, as well as upper and lower body muscle strength.
“Overall sexual satisfaction did not differ between those who exercised and controls, although the direction of change clearly favored exercise [P interaction = 0.067]. The lack of significance for overall satisfaction likely reflects that sexual relationships are multifaceted,” Dr. Galvão commented.
Self-managed psychosexual therapy did not appear to result in additional improvements.
“The acute issue these men face is erectile dysfunction as a treatment side effect, and men report this as a primary concern. Our study shows a positive effect on erectile function. In the broader sense, we also know self-reliance, physical strength, and well-being are important to men’s health, and an exercise program speaks directly to strength and well-being, both also important in the context of an aging patient group prone to comorbid chronic illness,” he stated.
Comment on the Study
“Exercise has previously been shown to improve some side effects of prostate cancer treatment. These data extend the benefits of exercise for patients with prostate cancer to include sexual dysfunction, furthering the importance of physical activity for these patients,” said ASCO Expert Peter Paul Yu, MD, FACP, FASCO. Dr. Yu is Senior Vice President and Physician-in-Chief at Hartford HealthCare Cancer Institute, Hartford, Connecticut.
DISCLOSURE: This study was funded by the National Health and Medical Research Council in Australia. Dr. Galvão reported no conflicts of interest. Dr. Yu owns stock in Google, Apple, Microsoft, Amazon, and Danaher.
REFERENCES
1. Galvão DA, Chambers SK, Taaffe DR, et al: Effects of supervised exercise and self-managed psychosexual therapy on sexual health in men with prostate cancer: A randomized clinical trial. 2023 ASCO Breakthrough meeting. Abstract 71. Presented August 3, 2023.
2. Galvão DA, Taaffe DR, Spry N, et al: Combined resistance and aerobic exercise program reverses muscle loss in men undergoing androgen suppression therapy for prostate cancer without bone metastases: A randomized controlled trial. J Clin Oncol 28:340-347, 2010.
3. Schumacher O, Galvão DA, Taaffe DR, et al: Nationwide industry-led community exercise program for men with locally advanced, relapsed, or metastatic prostate cancer on androgen-deprivation therapy. JCO Oncol Pract 18:e1334-e1341, 2022.
4. Taaffe DR, Newton RU, Spry N, et al: Effects of different exercise modalities on fatigue in prostate cancer patients undergoing androgen deprivation therapy: A year-long randomised controlled trial. Eur Urol 72:293-299, 2017.
