Prostate cancer elder alert. Living with treatment choices and outcomes

Comparing eccentric resistance exercise in prostate cancer survivors on and off hormone therapy: a pilot study

OBJECTIVES

To determine the feasibility of an eccentric resistance exercise training protocol in men with prostate cancer and to assess whether men with prostate cancer who are receiving androgen deprivation therapy (ADT) have a blunted effect from the training as compared with prostate cancer survivors not receiving ADT.

DESIGN

Prospective pilot study.

SETTING

Academic medical center.

PARTICIPANTS

Sixteen men with prostate cancer (Gleason scores 3+3 to 4+4) were initially enrolled. Ten men (mean age 66, range 48-86) completed the study, 5 were currently receiving ADT. Analysis was performed on these 10 men.

INTERVENTIONS

Subjects were evaluated at baseline. All men underwent a 12-week resistance exercise training protocol using a recumbent, high-force eccentric, leg cycle ergometer 3 times per week at a "somewhat hard" perceived exertion for 12 to 15 minutes. Preexercise and postexercise training changes were examined within and between groups.

MAIN OUTCOME MEASURES

Quadriceps muscle volume (magnetic resonance imaging), isometric knee extension strength, functional mobility (Timed Up and Go Test [TUG] and 6-minute walk [6MW]), health-related quality of life (FACT-P), and fatigue (FACIT-fatigue scale).

RESULTS

The ADT group demonstrated significant within-group improvements in the 6MW (P = .01) and isometric knee extension strength (P = .03). This group also demonstrated a clinically relevant change in the FACT-P; however, this did not meet statistical significance. The non-ADT group demonstrated significant within-group improvements in the physical subscale of the FACT-P (P = .03) and an increase in muscle volume (P = .04). Their improvements in the TUG approached significance (P = .08). No between-group differences existed.

CONCLUSIONS

Eccentric resistance exercise was well tolerated, and both groups derived some benefits in strength and functional mobility. Men receiving ADT did not appear to have a blunted response to the exercise as compared with prostate cancer survivors not receiving ADT.

Impairment of the DNA repair and growth arrest pathways by p53R2 silencing enhances DNA damage-induced apoptosis in a p53-dependent manner in prostate cancer cells

p53R2 is a p53-inducible ribonucleotide reductase that contributes to DNA repair by supplying deoxynucleotide triphosphate pools in response to DNA damage. In this study, we found that p53R2 was overexpressed in prostate tumor cell lines compared with immortalized prostatic epithelial cells and that the protein was induced upon DNA damage. We investigated the effects of p53R2 silencing on DNA damage in LNCaP cells (wild-type p53). Silencing p53R2 potentiated the apoptotic effects of ionizing radiation and doxorubicin treatment as shown by increased sub-G(1) content and decreased colony formation. This sensitizing effect was specific to DNA-damaging agents. Comet assay and gamma-H2AX phosphorylation status showed that the decreased p53R2 levels inhibited DNA repair. Silencing p53R2 also reduced the levels of p21(WAF1/CIP1) at the posttranscriptional level, suggesting links between the p53-dependent DNA repair and cell cycle arrest pathways. Using LNCaP sublines stably expressing dominant-negative mutant p53, we found that the sensitizing effect of p53R2 silencing is mediated by p53-dependent apoptosis pathways. In the LNCaP sublines (R273H, R248W, and G245S) that have defects in inducing p53-dependent apoptosis, p53R2 silencing did not potentiate DNA damage-induced apoptosis, whereas p53R2 silencing was effective in a LNCaP subline (P151S) which retains the ability to induce p53-dependent apoptosis. This study shows that p53R2 is a potential therapeutic target that could be used to enhance the effectiveness of ionizing radiation or DNA-damaging chemotherapy in a subset of patients with prostate cancer.

Review of exercise intervention studies in cancer patients

PURPOSE

To present an overview of exercise interventions in cancer patients during and after treatment and evaluate dose-training response considering type, frequency, volume, and intensity of training along with expected physiological outcomes.

METHODS

The review is divided into studies that incorporated cardiovascular training, combination of cardiovascular, resistance, and flexibility training, and resistance training alone during and after cancer management. Criteria for inclusion were based on studies sourced from electronic and nonelectronic databases and that incorporated preintervention and postintervention assessment with statistical analysis of data.

RESULTS

Twenty-six published studies were summarized. The majority of the studies demonstrate physiological and psychological benefits. However, most of these studies suffer limitations because they are not randomized controlled trials and/or use small sample sizes. Predominantly, studies have been conducted with breast cancer patients using cardiovascular training rather than resistance exercise as the exercise modality. Recent evidence supports use of resistance exercise or "anabolic exercise" during cancer management as an exercise mode to counteract side effects of the disease and treatment.

CONCLUSION

Evidence underlines the preliminary positive physiological and psychological benefits from exercise when undertaken during or after traditional cancer treatment. As such, other cancer groups, in addition to those with breast cancer, should also be included in clinical trials to address more specifically dose-response training for this population. Contemporary resistance training designs that provide strong anabolic effects for muscle and bone may have an impact on counteracting some of the side effects of cancer management assisting patients to improve physical function and quality of life.

Resistance exercise in men receiving androgen deprivation therapy for prostate cancer

PURPOSE

Androgen deprivation therapy is a common treatment in men with prostate cancer that may cause fatigue, functional decline, increased body fatness, and loss of lean body tissue. These physical changes can negatively affect health-related quality of life. Resistance exercise may help to counter some of these side effects by reducing fatigue, elevating mood, building muscle mass, and reducing body fat.

METHODS

In a two-site study, 155 men with prostate cancer who were scheduled to receive androgen deprivation therapy for at least 3 months after recruitment were randomly assigned to an intervention group that participated in a resistance exercise program three times per week for 12 weeks (82 men) or to a waiting list control group (73 men). The primary outcomes were fatigue and disease-specific quality of life as assessed by self-reported questionnaires after 12 weeks. Secondary outcomes were muscular fitness and body composition.

RESULTS

Men assigned to resistance exercise had less interference from fatigue on activities of daily living (P =.002) and higher quality of life (P =.001) than men in the control group. Men in the intervention group demonstrated higher levels of upper body (P =.009) and lower body (P <.001) muscular fitness than men in the control group. The 12-week resistance exercise intervention did not improve body composition as measured by changes in body weight, body mass index, waist circumference, or subcutaneous skinfolds.

CONCLUSION

Resistance exercise reduces fatigue and improves quality of life and muscular fitness in men with prostate cancer receiving androgen deprivation therapy. This form of exercise can be an important component of supportive care for these patients.

An e-learning caregiving program for prostate cancer patients and family members

e-health interventions have the potential to augment caregiving training for management of chronic disease. Instruction on caregiving functions often key to patients and families' well being is time consuming but not reimbursable in our current health care system. A theoretically defined interactive multimedia program is described which would assess patient and family member's level of preparedness for specific caregiving functions for prostate cancer and provide tailored skill building vignettes on caregiving techniques. Maximizing today's technology, this program is best designed for a hybrid delivery utilizing both web-based resources and a CD-ROM. Feedback from 45 prostate patients and family members from a Midwest cancer center on perceived needs for caregiving training underscores the potential value of a computer supported intervention for some patients and families. Implementation of the software, marketing, and distribution will be guided in part by recent e-health experiences that leave many health professionals appropriately skeptical about the utility of such products.

Indwelling catheter treatment and health-related quality of life in men with prostate cancer in comparison with men with benign prostatic hyperplasia

Experiences from indwelling urinary catheter treatment periods were studied. Little is known of what is felt from a male perspective although catheter treatment is a common pre- and postoperative measure for men with prostate cancer and benign prostatic hyperplasia (BPH). Also studied were health-related quality of life (HRQOL) and sense of coherence (SOC). Men with catheter experience (prostate cancer n = 71, BPH n = 37) were selected from a larger questionnaire study. Assessment was made with study-specific questions together with the QLQ C-30 assessing HRQOL and the SOC questionnaire measuring sense of coherence. Data reduction method was applied to study specific variables to determine problem patterns. Correlation between HRQOL and SOC was determined. Results showed similar problem patterns in men with prostate cancer and BPH: discomfort in wearing catheter (e.g. uneasiness 48.2%), practical and psychosocial difficulties in handling and wearing catheter (e.g. attaching catheter 32.4%) and discomfort at installation (e.g. pain 29.7%). There was lack of knowledge about wearing and practical handling of the catheter. Having a cancer diagnosis did not add to uneasiness or practical problems. Life quality was correlated to SOC (p <or= 0.001).

Beyond sexual assessment: lessons learned from couples post radical prostatectomy

PURPOSE

To share selected experiences of advanced practice nurses (APNs) who implemented a home-based nursing protocol related to psychosexual function for couples following radical surgery for prostate cancer.

DATA SOURCES

Selected research-based articles, the PLISSIT Model for sexual rehabilitation counseling, and the authors' experiences.

CONCLUSIONS

Five lessons related to communicating about sexuality and intimacy were synthesized from the experience, including examining knowledge and self-awareness regularly, using a structured interview guide to facilitate the process, developing a trusting relationship with the couple, attending to verbal and nonverbal cues, and providing information about the full range of sexual expression.

IMPLICATIONS FOR PRACTICE

Include an assessment of sexual health as an integral part of a general health assessment. Patients do not generally volunteer information about their sexual concerns unless the subject is introduced by the APN.