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  • Exercise – Aerobic and Weight Bearing – Countermeasures to Some ADT Side Effects

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    Old 06-12-2021, 03:39 PM   #1
    IADT3since2000
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    Lightbulb Exercise – Aerobic and Weight Bearing – Countermeasures to Some ADT Side Effects

    The role of exercise in countering side effects of ADT was recently raised in the thread https://www.healthboards.com/boards/cancer-prostate/1052272-how-dire-path-report-gleason-5-4-a.html to john ct1, post #37 and other posts.
    Being physically active is very important (if possible) in my opinion. As the research described below indicates, it helps with many potential side effects, including energy, muscle strength, fatigue, weight gain, metabolic syndrome, cognitive sharpness and depression; that's just what immediately comes to mind. As a very important side benefit, an exercise program is also heart healthy, and cardiovascular disease is an even greater threat than prostate cancer for most of us.

    I'm speaking from experience. I was physically active before diagnosis and throughout my fourteen years on intermittent ADT. My main exercise prior to that was racewalking, and I kept that up, though at lower speeds - still a lot faster than most people are able to walk. It's a great aerobic and weight-bearing exercise, but walking at a slower, even a normal or slow pace is also very good for maintaining fitness, and there's research to prove it.

    Back at the start for me, around early 2000 there was not a great appreciation for weight/resistance exercise for prostate cancer patients, but that soon changed as research accumulated. Now it is seen as important. If you are up to it, intense weight/resistance exercise would probably be best, but any such exercise would probably be good – that’s what I did, moderately intense resistance exercise with weight machines.

    It is true that ADT with drugs that reduce testosterone (not all ADT drugs do) will reduce muscle mass and thereby decrease strength unless countered. However, my own experience proved that it can be countered, which matches published research findings. I did not know this for my first round of 31 months of ADT with Lupron, and I lost some muscle mass and strength. But in my second or third round, having learned about the importance of weight work, I deliberately tried to maintain my strength, mainly by regular gym work - not frequent, but once or twice a week with workouts of one to two hours. I logged the weight I could lift (mostly resistance machines) with a regular routine. I was actually able to increase the total weight somewhat while on ADT! (Not by much, but it’s like the proverbial singing pig: he may not sing well, but it’s a miracle that he can sing at all.) Benefits for me while on ADT included energy, physical strength (though not what it would have been with no ADT), less weight gain (and later actual weight loss and excellent control), continued great blood pressure, perhaps greater mental alertness, perhaps better sleep, and likely other benefits.

    Not all of us will be able to do that, either because we are not up to the exercise physically (which I appreciate ever more as I approach my 78th birthday), or because we just lack the motivation. But if you are up to it, I'm convinced you will find the effort rewarding. Patients do not have to be athletes to do exercise programs. They can find a program that works for them in their current condition.

    To me, the best program focuses on both aerobic and weight/resistance exercise but also includes elements for flexibility and balance.

    Dr. Stacey A. Kenfield, ScD, presented on exercise for prostate cancer patients at the recent 2021 Patient Conference for Prostate Cancer by the UCSF and California Prostate Cancer Coalition. Her talk will be online, hopefully soon. She made many important points. While much of the talk was on the overall benefit of exercise for prostate cancer patients, and none of it specifically related to ADT, she did an excellent job describing what exercise involved, how to gauge intensity of exercise, and several exercise programs.

    There is an abundance of research on exercise related to ADT side effects. I used the following search string on www.pubmed.gov - prostate cancer AND (ADT OR androgen deprivation therapy) side effects AND physical activity – and got a list of 206 medical research publications, virtually all with abstracts describing key points and 83 with links to free copies of complete papers. While no papers in the list were published before 2000, the subject of side effects of ADT and countermeasures that include physical activity has received a great deal more attention in recent years, with papers in the list published after 2011 more than doubling annually the numbers of papers annually up through that point. Fifty four of the studies still show up when the filter for clinical trials is applied. I took a look at the first few abstracts, and they confirmed what I expected to see: exercise makes a substantial, favorable difference in reducing side effects of ADT. If you want more detail, check out some of the abstracts. Much of these abstracts is written in plain English, but for the technical and statistical parts, I or others on this Board can help answer questions. As a real quick primer, the “p” value indicates the odds that the result is due to chance rather than a real result; the p value should be very low, the lower the better, with .05 and below desirable before the effect is considered likely real.

    ….Jim

    - - - - - - - - - - - - - - - - - - - - - - - -
    21 years as a survivor. Doing well. Diagnosis Dec 1999 PSA 113.6 (first ever), age 56
    Gleason 4+3=7 (J. Epstein, JHU), all cores +, most 100%; "rock hard" prostate with ECE - stage 3, PNI, PSADT determined later 3-4 months; technetium bone scan and CT scan negative; prognosis 5 years.
    Later ProstaScint scan negative except for one suspicious small area in an unlikely location. ADT Lupron as first therapy, in Dec 1999, then + Casodex in March 2000, then + Proscar and Fosamax in Sep 2000. Rejected for surgery January 2000; offered radiation but told success odds were low; switched to ADT only vice radiation in May 2000, betting on holding the fort for improved technology; PSA gradual decline to <0.01 May 2002. Commenced intermittent ADT3 (IADT3) with first vacation from Lupron & Casodex. Negative advanced scans in 2011 (NaF18 PET/CT for bone) and 2012 (Feraheme USPIO for nodes and soft tissue). With improved technology, tried TomoTherapy RT, 39 sessions, in early 2013, plus ADT 3 in support for 18 months (fourth round of IADT3), ended April 2014. Continuing with Avodart as anti-recurrence shield. Current PSA remarkably low and stable at <0.01; apparently cured (Current PSA as of 12/2/2020). (Current T 93 12/2/2020.) Supportive diet/nutrition, exercise, supportive medications during this journey, as well as switches in antiandrogen, 5-ARI, and bone drugs. Barely noticeable side effects from radiation; continuing low T, likely do to long use of ADT, but good energy and adequate strength. I have a lot of School of Hard Knocks knowledge, and have followed research, which has made me an empowered and savvy patient, but I have had no enrolled medical education. What I experienced is not a guarantee for all but shows what is possible.

    Last edited by IADT3since2000; 06-13-2021 at 04:35 AM. Reason: Added bulb icon,

     
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    Old 07-18-2021, 05:36 AM   #2
    IADT3since2000
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    Re: Exercise – Aerobic and Weight Bearing – Countermeasures to Some ADT Side Effects

    "85% Reduction in ADT Side Effects"

    In mid-July "john ct1" posted about his apparently successful use of exercise in posts #29 and #31 on the thread https://www.healthboards.com/boards/cancer-prostate/1052262-39yo-gleason-9-updates.html . He relayed an opinion by Dr. Mark Scholz, MD, the primary author of "The Key to Prostate Cancer," that resistance training (aka weight training) reduces the side effects of ADT by 85%. I had not seen that before from Dr. Scholz, but it's in line with what I've heard him say or write previously, believable to me at least for some of the main side effects based on my own experience, and very encouraging! Perhaps the hard part is getting to the gym or doing a vigorous workout at home.

    Thank you John!

    ….Jim

    - - - - - - - - - - - - - - - - - - - - - - - -
    21 years as a survivor. Doing well. Diagnosis Dec 1999 PSA 113.6 (first ever), age 56
    Gleason 4+3=7 (J. Epstein, JHU), all cores +, most 100%; "rock hard" prostate with ECE - stage 3, PNI, PSADT determined later 3-4 months; technetium bone scan and CT scan negative; prognosis 5 years.
    Later ProstaScint scan negative except for one suspicious small area in an unlikely location. ADT Lupron as first therapy, in Dec 1999, then + Casodex in March 2000, then + Proscar and Fosamax in Sep 2000. Rejected for surgery January 2000; offered radiation but told success odds were low; switched to ADT only vice radiation in May 2000, betting on holding the fort for improved technology; PSA gradual decline to <0.01 May 2002. Commenced intermittent ADT3 (IADT3) with first vacation from Lupron & Casodex. Negative advanced scans in 2011 (NaF18 PET/CT for bone) and 2012 (Feraheme USPIO for nodes and soft tissue). With improved technology, tried TomoTherapy RT, 39 sessions, in early 2013, plus ADT 3 in support for 18 months (fourth round of IADT3), ended April 2014. Continuing with Avodart as anti-recurrence shield. Current PSA remarkably low and stable at <0.01; apparently cured (Current PSA as of 12/2/2020). (Current T 93 12/2/2020.) Supportive diet/nutrition, exercise, supportive medications during this journey, as well as switches in antiandrogen, 5-ARI, and bone drugs. Barely noticeable side effects from radiation; continuing low T, likely do to long use of ADT, but good energy and adequate strength. I have a lot of School of Hard Knocks knowledge, and have followed research, which has made me an empowered and savvy patient, but I have had no enrolled medical education. What I experienced is not a guarantee for all but shows what is possible.

     
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    Old 07-19-2021, 06:56 AM   #3
    john_ct1
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    Re: Exercise – Aerobic and Weight Bearing – Countermeasures to Some ADT Side Effects

    Quote:
    Originally Posted by IADT3since2000 View Post
    "85% Reduction in ADT Side Effects"

    In mid-July "john ct1" posted about his apparently successful use of exercise in posts #29 and #31 on the thread https://www.healthboards.com/boards/cancer-prostate/1052262-39yo-gleason-9-updates.html . He relayed an opinion by Dr. Mark Scholz, MD, the primary author of "The Key to Prostate Cancer," that resistance training (aka weight training) reduces the side effects of ADT by 85%. I had not seen that before from Dr. Scholz, but it's in line with what I've heard him say or write previously, believable to me at least for some of the main side effects based on my own experience, and very encouraging! Perhaps the hard part is getting to the gym or doing a vigorous workout at home.

    Thank you John!

    ….Jim
    From the horses month. He states "80%" in the first video but I've heard him state "80-85%" elsewhere.

    https://youtu.be/_xELWgutrdE
    https://youtu.be/YE61HSAsFb0

    -John
    __________________
    57 yo, family history of PCa, PSA 5.7, Free PSA 8.43%, DRE Neg, 5/26/21 Biopsy: Gleason 9, Grade 5, 16 of 20 cores positive mix of 5+4 and 4+5. Stage IIIc, cT2NxMx, CT shows a 3 cm x 2 cm diseased pelvic lymph node, Bone scan neg, 6/16/20 1st Firmagon injection.

     
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    IADT3since2000 (07-19-2021)
    Old 07-19-2021, 12:34 PM   #4
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    Re: Exercise – Aerobic and Weight Bearing – Countermeasures to Some ADT Side Effects

    This is the advice given to counter the effects of aging.

    Everyone of us can be an advocate for exercise in lieu of using testosterone therapy to counter the effects of aging in men at a time they are at risk for prostate cancer and BPH. Testosterone supplements can not only impact prostate cancer they can impact BPH as well.
    __________________
    Born 1953; family w/PCa-grandfather, 3 brothers
    7-12-04 PSA 1.9; 7-10-06 PSA 2.0; 8-30-07 PSA 3.2; 12-1-11 PSA 5.7; 5-16-12 PSA 4.76; 12-11-12 PSA 5.2; 3-7-16 PSA 7.2
    3-14-16 TRUS biopsy, PCa 1%-60% across 8 of 12 samples, G3+3
    5-4-16 DaVinci RP, Path-65g, lymph nodes, seminal vesicles, capsule, margin all neg G3+4, T vol 35%, +pT2c, No Incontinence-6mos, Erections-14 months
    7-9-21 PSA less than 0.02; zero club 5yrs

     
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