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Can Exercise Adaptations Be Maintained in Men with Prostate Cancer Following Supervised Programmes? Implications to the COVID-19 Landscape of Urology and Clinical Exercise.

ABSTRACT: In this brief correspondence, we evaluate the potential impact of pivoting from face-to-face supervised to unsupervised home-based exercise programmes to contextualise the coronavirus disease 2019 (COVID-19) pandemic in prostate cancer patients. A meta-analysis was undertaken in fatigue, quality of life, and lean and fat mass outcomes in the four studies included. Our analysis indicates that unsupervised home-based exercise maintains patient-reported outcomes, except for fat mass. In summary, changing to unsupervised exercise is unlikely to provide further benefits on patient-reported and body composition outcomes, but may help maintain initial gains during physical distancing restrictions.

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We discuss the potential impacts of transitioning from face-to-face supervised to unsupervised home-based exercise programmes in prostate cancer patients during the coronavirus disease 2019 (COVID-19) pandemic. Our analysis suggests that patients are likely to maintain patient-reported and body composition benefits from current nonsupervised programmes; however, evolution of exercise delivery to prostate cancer patients is required to continue health and fitness improvement in this group.

SUBMITTER: Lopez P

PROVIDER: S-EPMC7531928 | biostudies-literature | 2020 Oct

REPOSITORIES: biostudies-literature

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Can Exercise Adaptations Be Maintained in Men with Prostate Cancer Following Supervised Programmes? Implications to the COVID-19 Landscape of Urology and Clinical Exercise.

Lopez Pedro P Taaffe Dennis R DR Newton Robert U RU Spry Nigel N Shannon Tom T Frydenberg Mark M Saad Fred F Galvão Daniel A DA

European urology open science 20201002

In this brief correspondence, we evaluate the potential impact of pivoting from face-to-face supervised to unsupervised home-based exercise programmes to contextualise the coronavirus disease 2019 (COVID-19) pandemic in prostate cancer patients. A meta-analysis was undertaken in fatigue, quality of life, and lean and fat mass outcomes in the four studies included. Our analysis indicates that unsupervised home-based exercise maintains patient-reported outcomes, except for fat mass. In summary, ch ...[more]

PMID: 33043309

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Project description:BackgroundThe andropause is associated with declines in serum testosterone (T), loss of muscle mass (sarcopenia), and frailty. Two major interventions purported to offset sarcopenia are anabolic steroid therapies and resistance exercise training (RET). Nonetheless, the efficacy and physiological and molecular impacts of T therapy adjuvant to short-term RET remain poorly defined.MethodsEighteen non-hypogonadal healthy older men, 65-75 years, were assigned in a random double-blinded fashion to receive, biweekly, either placebo (P, saline, n = 9) or T (Sustanon 250 mg, n = 9) injections over 6 week whole-body RET (three sets of 8-10 repetitions at 80% one-repetition maximum). Subjects underwent dual-energy X-ray absorptiometry, ultrasound of vastus lateralis (VL) muscle architecture, and knee extensor isometric muscle force tests; VL muscle biopsies were taken to quantify myogenic/anabolic gene expression, anabolic signalling, muscle protein synthesis (D2 O), and breakdown (extrapolated).ResultsTestosterone adjuvant to RET augmented total fat-free mass (P=0.007), legs fat-free mass (P=0.02), and appendicular fat-free mass (P=0.001) gains while decreasing total fat mass (P=0.02). Augmentations in VL muscle thickness, fascicle length, and quadriceps cross-section area with RET occured to a greater extent in T (P < 0.05). Sum strength (P=0.0009) and maximal voluntary contract (e.g. knee extension at 70°) (P=0.002) increased significantly more in the T group. Mechanistically, both muscle protein synthesis rates (T: 2.13 ± 0.21%·day-1 vs. P: 1.34 ± 0.13%·day-1 , P=0.0009) and absolute breakdown rates (T: 140.2 ± 15.8 g·day-1 vs. P: 90.2 ± 11.7 g·day-1 , P=0.02) were elevated with T therapy, which led to higher net turnover and protein accretion in the T group (T: 8.3 ± 1.4 g·day-1 vs. P: 1.9 ± 1.2 g·day-1 , P=0.004). Increases in ribosomal biogenesis (RNA:DNA ratio); mRNA expression relating to T metabolism (androgen receptor: 1.4-fold; Srd5a1: 1.6-fold; AKR1C3: 2.1-fold; and HSD17β3: two-fold); insulin-like growth factor (IGF)-1 signalling [IGF-1Ea (3.5-fold) and IGF-1Ec (three-fold)] and myogenic regulatory factors; and the activity of anabolic signalling (e.g. mTOR, AKT, and RPS6; P < 0.05) were all up-regulated with T therapy. Only T up-regulated mitochondrial citrate synthase activity (P=0.03) and transcription factor A (1.41 ± 0.2-fold, P=0.0002), in addition to peroxisome proliferator-activated receptor-γ co-activator 1-α mRNA (1.19 ± 0.21-fold, P=0.037).ConclusionsAdministration of T adjuvant to RET enhanced skeletal muscle mass and performance, while up-regulating myogenic gene programming, myocellular translational efficiency and capacity, collectively resulting in higher protein turnover, and net protein accretion. T coupled with RET is an effective short-term intervention to improve muscle mass/function in older non-hypogonadal men.

Project description:The 2021 European Association of Urology recommendations for early prostate cancer detection included a risk-based algorithm. Risk assessment methods are proposed to prevent excessive use of prostate magnetic resonance imaging (MRI) and biopsy, simultaneously reducing overdiagnosis and overtreatment. However, the clinical implications of sequential use of risk assessment tests have not yet been properly assessed. We provide an appraisal of the recommended algorithm and evaluate its outcomes in a contemporary prospective study population of biopsy-naïve men. To increase the effectiveness in cases of limited MRI capacity, we show that use of the Rotterdam Prostate Cancer Risk Calculator-3 for pre-MRI risk stratification could avoid more than one-third of MRI examinations. After prostate MRI, use of either the Prostate Imaging-Reporting and Data System (PI-RADS) score or a risk model including MRI outcome as a variable could avoid six out of ten prostate biopsies while maintaining high sensitivity. However, implementation in health care systems requires due consideration of the access to and quality of diagnostic resources, as well as cost-effectiveness.Patient summaryWe evaluated the European Association of Urology risk-based strategy for early prostate cancer detection. Risk assessment before magnetic resonance imaging (MRI) using a risk calculator or prostate-specific antigen (PSA) density could reduce MRI demands and overdiagnosis of insignificant cancers. Risk assessment using prostate MRI results could avoid 60% of prostate biopsies while maintaining prostate cancer detection rates.The European Association of Urology (EAU) recently published its current position and recommendations on prostate-specific antigen (PSA) testing [1]. On the basis of the literature and expert opinion, a risk-based algorithm for early detection of prostate cancer (PCa) was proposed. The guideline recommends stratifying men with PSA ≥3 ng/ml as either "low risk", for whom magnetic resonance imaging (MRI) can be avoided, or "intermediate and high risk", for whom prostate MRI should be performed as a basis for further diagnostic decisions. Strategies must be developed to use health care resources efficiently and to reduce unnecessary morbidity, anxiety, and costs of diagnostics. However, any paradigm shift inevitably leads to a paucity of research data. As a result, there is still debate regarding which men can safely avoid an initial MRI but are subjected to clinical follow-up, and which men must undergo an immediate MRI. The authors proposed four methods for risk assessment: (1) family history; (2) PSA velocity; (3) PSA density; and (4) risk calculators. It must be stressed that the availability and quality of prostate MRI in each situation should be considered when using these pre-MRI risk assessment tools. We discuss in brief the proposed risk assessment methods including MRI and assess potential outcomes in a contemporary population.

Dataset Information

Can Exercise Adaptations Be Maintained in Men with Prostate Cancer Following Supervised Programmes? Implications to the COVID-19 Landscape of Urology and Clinical Exercise.

Patient summary

Publications

Can Exercise Adaptations Be Maintained in Men with Prostate Cancer Following Supervised Programmes? Implications to the COVID-19 Landscape of Urology and Clinical Exercise.

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