“According to Dr. Robert Newton and a 2025 paper on the effects of lean muscle mass as it relates to inhibiting metabolic syndrome and exciting T-cells. I wanted to share this with you because as your painfully aware, I’ve been against treating my prostate with ADT drugs from very early on and my feelings haven’t deterred much. I’m hopeful through AI advancements and patient advocates like myself we can discover a less barbaric way for advanced PC patients to live a better quality life with dignity and self esteem. Anyways, I wanted to share this video with you and get your thoughts as well as possibly push the industry towards better treatment options for us. ”
Thanks for sharing. I read some of the papers on exercise and metastatic prostate cancer by Dr Newton a few years ago. They are a primary inspiration for my efforts to exercise. I'm part way through listening to this interview and it's very interesting. The host of this interview is Dr. Geo Espinosa, Assistant Professor of Urology at NYU. He's quite popular but also somewhat notorious for his integrative and holistic and functional medicine approaches.
A friend of mine, an IFBB professional bodybuilder, was diagnosed in 2018 with Gleason 9, T3 prostate cancer and had a PSA over 900. Remarkably, he never underwent androgen deprivation therapy (ADT), chemotherapy, or radiation therapy. As of now, he is HSPC, his PSA is down to 2, and he has no detectable metastases. His medical oncologist speculates that his rigorous exercise regimen may have contributed to this outcome.
I was also diagnosed in 2018 with Gleason 9, T3 prostate cancer, but my PSA was only 13 at diagnosis. Seven years later, I remain HSPC with a PSA of 0.4.
1. ERASE Trial (NCT03203460)
• Population: 52 men with localized PCa on active surveillance
• Intervention: 12 weeks of supervised high-intensity interval training (HIIT) vs. usual care
• Findings:
• Significant improvements in cardiorespiratory fitness (VO₂ peak)
• Decreased PSA levels and PSA velocity
• Reduced in vitro growth of LNCaP prostate cancer cells
• Conclusion: HIIT improved fitness and suppressed biochemical progression markers in localized PCa.
2. PRESTO-1 Trial (JAMA Oncol 2024, NCT05751434)
• Population: 53 non-exercising men with localized PCa, pre-surgery
• Intervention: Dose-finding study of endurance exercise (90–450 min/week treadmill walking)
• Findings:
• 225–375 min/week was feasible and biologically active
• Decreased plasma PSA and tumor cell proliferation (Ki67)
• No serious adverse events
• Conclusion: 225 min/week is the recommended phase II dose for future efficacy trials.
3. Erectile Function Trial (JAMA Netw Open 2025)
• Population: 112 men with PCa, mixed treatments (RT, ADT, prostatectomy)
• Intervention: 6 months supervised resistance + aerobic exercise vs. usual care
• Findings:
• Significant improvement in erectile function (mean IIEF difference 5.1 vs. 1.0, p=0.04)
• Improved muscle strength, reduced fat mass
• Conclusion: Exercise improves sexual function, especially after RT or ADT.
4. POWER Trial (ASCO GU 2025)
• Population: Men with advanced PCa on ADT, reporting significant fatigue
• Intervention: 12-week supervised exercise program (aerobic + resistance)
• Findings:
• Clinically significant reduction in fatigue (PROMIS fatigue T-score)
• Improved peak aerobic capacity
• Conclusion: Exercise should be routinely recommended for symptom management in advanced PCa.
5. ExPeCT Trial (NCT02453139)
• Population: Men with high-burden metastatic PCa
• Intervention: 6 months of aerobic exercise vs. usual care
• Findings:
• Safe, but no significant change in quality of life
• Conclusion: Exercise is safe in advanced PCa, but more research is needed on efficacy for QOL.
• Post-exercise serum from exercisers inhibited DU145 PCa cell growth in vitro
• Conclusion: Exercise may promote systemic adaptations that suppress tumor growth in mCRPC.
7. Notable Ongoing Trials
• PRESTO-2 (NCT05751434): Phase II RCT of 225 min/week exercise in localized PCa, measuring clinical and tumor endpoints.
• INTERVAL-GAP4: International phase III RCT of HIIT + resistance training vs. self-directed exercise in men with mCRPC. Primary endpoint: overall survival. Interim analyses suggest increased myokines and tumor inhibition, but full results pending.
8. Systematic Reviews & Meta-Analyses
• Prehabilitation Systematic Review (2022):
• 10 studies + 2 post hoc analyses
• Findings: Exercise prehabilitation is safe, feasible, improves QOL and physical function in surgical PCa patients.
• Meta-analysis of 18 RCTs:
• Findings: Supervised exercise during ADT improves disease-specific QOL and physical performance, but impact on cancer control is unclear.
Summary Table
Trial/Study Population Exercise Type Key Outcomes/Findings
1. Androgen Receptor (AR) Sensitization and Signaling
• pBAT Mechanism: The periodic supraphysiologic testosterone exposures in pBAT aim to overwhelm and destabilize AR signaling in prostate cancer cells, exploiting their adaptive response to androgen deprivation.
• Exercise Link: Resistance and BFR training upregulate AR expression and increase androgen sensitivity in muscle tissue. This may enhance the anabolic effects of testosterone during the high phase of pBAT, potentially improving patient outcomes like sarcopenia mitigation and quality of life.
________________________________________
2. mTOR Pathway and Anabolism
• Both pBAT (via testosterone surges) and resistance/BFR exercise activate the mTOR pathway—a key driver of muscle protein synthesis.
• This dual stimulation may enhance lean body mass accrual, which is often a goal in cancer care for preserving physical function and metabolic health.
________________________________________
3. Metabolic and Insulin Sensitivity Benefits
• Exercise improves insulin sensitivity, reduces fat mass, and supports metabolic health—factors that could counteract metabolic side effects of hormonal therapy.
• Testosterone in pBAT also has favorable effects on insulin sensitivity and body composition during its high phase.
________________________________________
4. Tumor Microenvironment Effects
• Exercise can reduce systemic inflammation, modulate immune function, and improve vascular perfusion—all of which may contribute to a less favorable environment for tumor growth.
• These systemic shifts could potentially amplify the stress placed on prostate cancer cells during androgen cycling.
________________________________________
5. Myokine and Cytokine Signaling
• Exercise induces myokine release (e.g., IL-6, irisin) which may have systemic anti-tumor effects or influence androgen signaling pathways.
• There may be crosstalk between exercise-induced cytokine changes and the stress-response mechanisms exploited by BAT.
________________________________________
Caveats
• Safety first: In metastatic disease, especially with bone involvement, any resistance training must be carefully supervised.
• Hormonal fluctuations: The exercise response may vary depending on whether the patient is in the high- or low-testosterone phase of the pBAT cycle.
• No direct clinical studies on BAT/pBAT + exercise synergy in prostate cancer.
I am in no way diminishing the positive impacts of exercise for those of us with PC not for anyone else, either ill in other ways or for those who are healthy. But- your post requires me to ask- was your body builder friend a body builder when initially diagnosed?
Yes. I looked into that once and didn't find any good data. I was a bodybuilder in my twenties. Maybe if I had never gave it up I wouldn't have gotten PCa. Or maybe if I had continued it would have been G10 instead of G9.
And maybe it's playing with timing. Perhaps intense exercise is a negative for PCa risk but a positive, according to most governments, once you have PCa.
Or maybe it doesn't make much difference. I don't know if we're ever going to have solid answers to these questions.
I've been doing weight training since I was 17 - I like it a lot (or convinced myself I do 😉)
I also do all-out HIIT on an indoor bike once a week.
During RT and while on ADT I just continued and I would often go to the gym next to the hospital before or after and RT session to avoid traffic. I have had zero fatigue and very limited symptoms on Orgovyx + Abi .
Anecdotal of course but the exercise could explain it.
Based on the video I plan to tweak my workout a bit, emphasising eccentric (I already use periodization and different reps per set: 5, 10 and 15)
Same here. I never did not go to the gym after my radiation treatments, In fact, I planned the radiation schedule around my gym visits. My radiation nurses were concerned about me training before the treatments because they did not want me to dehydrate and when I drank the necessary water for my treatment, the water would go to other areas of my body instead of the bladder which needed to be full for the treatment. I have been going to the gym for years so it was already embedded into my daily schedule. When my oncologist warned me about the loss of muscle mass I would incur on the Zytiga/Lupron regimen. I told him "Doc you don't know me, I have been training for cancer for 50 years". He laughed and has since been amazed by my retention of muscle mass.
It's evident we share a similar passion for serious fitness. It's so encouraging to read the comments in this posting from you and others. This is considerably better than I had anticipated.
I will start radiation and ADT in May and quality of life potential issues have concerned me. But perhaps fitness may ultimately save the day for this Gleason 4+3 63-year old.
Thanks to all for their insightful and personal contributions to this posting.
Good luck in your treatments. I am 62 years old and my Gleason was 3 + 4. I had two pelvic lymph nodes in the equation with the prostate. They were not in a place to be resected. As long as I keep going, I am good. Once I lay down to watch TV in the evening, I am out cold. You will be fatigued but battle through it. The key is to keep moving until you have accomplished all of your goals for the day.
Again, best wishes to you and all of our "brothers".
I was diagnosed in my early fifties as a Gleason 9, 5+4, and given little chance by my urologist. At the time I was a triathlete, nationally ranked. I ended up going to Dr. Myers and under his excellent care am still alive at 80. At the time I told him that my physical condition didn't help much. His reply was to the contrary, you probably would not be here if you weren't in great physical shape. So work out as hard as you can. Once on hormone treatment it is hard but try to do as much as possible. If nothing else, it helps your mental attitude.
I hit the gym 3 times a week. My urologist commented that my cancer "is certainly not aggressive". Now I am upping my game by going after sugar and just generally refraining from all the snacking I've been in the habit of doing. I've lost 7 lbs in the last three weeks or so but I've got another 15 to go to lose this gut I've been sporting. I am borderline type 2 diabetic. I don't need to add that on top of prostate cancer.
Sharing 'just the facts'. Soon to be 68. Following my RP nine years ago I 'retired early' and embarked on full time fitness/active RV lifestyle. Eight months traveling Rockies hiking and biking, etc. Winters were hard physical work renovating a farm house and skiing. Four years ago I introduced upper body work taking TRX straps and bar and weights on road. Winters at family home base with trainers to maximize my upper body and leg work.
Here is my uPSA history post third treatment, salvage ePLND, no ADT, beginning March 2018.
<0.010 twenty-three months
0.01X range eight months
0.02X range seven months
0.03X range since June 2021 with last four month dips back into 0.02X range
September 2024 diagnosed with metastatic liver melanoma, began immunotherapy. Stepped up fitness training. February 2025 imaging and liquid blood biopsy testing indicate NED, for both diseases.
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