Progress Toward Embracing Exercise Training As an Integral Part of Prostate Cancer Treatment TO THE EDITOR: 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 outcomespecific 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.

Liam Bourke Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, United Kingdom

Phillip K. Dahm University of Florida; and Malcom Randall Veterans Affairs Medical Center, Gainesville, FL

Derek J. Rosario Royal Hallamshire Hospital, University of Sheffield, Sheffield, United Kingdom


The author(s) indicated no potential conflicts of interest. REFERENCES 1. Gardner JR, Livingston PM, Fraser SF: Effects of exercise on treatmentrelated adverse effects for patients with prostate cancer receiving androgendeprivation therapy: A systematic review. J Clin Oncol 32:335-346, 2014 2. Bourke L, Gilbert S, Hooper R, et al: Lifestyle changes for improving disease-specific quality of life in men on long-term androgen deprivation therapy for advanced prostate cancer: A randomized controlled trial. Eur Urol 65:865-872, 2014 3. Galva¨o DA, Spry N, Denham J, et al: A multicentre year-long randomised controlled trial of exercise training targeting physical functioning in men with prostate cancer previously treated with androgen suppression and radiation from TROG 03.04 RADAR. Eur Urol 65:856-864, 2014 4. Guyatt GH, Oxman AD, Vist GE, et al: GRADE: An emerging consensus on rating quality of evidence and strength of recommendations. BMJ 336:924-926, 2008 5. The Cochrane Collaboration: Cochrane Handbook for Systematic Reviews of Interventions, Version 5.1.0. Oxford, United Kingdom, The Cochrane Collaboration, 2011. http://www.cochrane.org/handbook 6. Parsons JK: Prostate cancer and the therapeutic benefits of structured exercise. J Clin Oncol 32:271-272, 2014

DOI: 10.1200/JCO.2014.55.1879; published online ahead of print at www.jco.org on July 7, 2014

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Journal of Clinical Oncology, Vol 32, No 23 (August 10), 2014: pp 2517

© 2014 by American Society of Clinical Oncology

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Progress toward embracing exercise training as an integral part of prostate cancer treatment.

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