Although prostate cancer is the second leading cause of cancer death (and 11% of all male cancer deaths) in the United States, the most common cause of death among men is still cardiovascular, or heart, disease. This means that even if you are diagnosed with prostate cancer, your physical health is still of utmost importance. Physical activity decreases your cardiovascular risk factors and improves your overall physical health. In addition to managing your weight, maintaining bone and muscle strength, and helping with potential side effects of prostate cancer treatment, it also improves your emotional health.

Several studies have suggested that men with prostate cancer who lead an active lifestyle have improved survival rates compared to sedentary patients. Additionally, men who walk 1-3 hours per week have been shown to cut their risk of aggressive prostate cancer almost in half. And men who vigorously exercise more than 3 hours per week have a 61% reduced risk of prostate cancer death. Physical activity comes in many forms, including traditional ways such as weight lifting, walking, jogging, cycling, and swimming. But you can also enjoy other less traditional ways such as walking 18 holes of golf, mowing the grass, ballroom dancing, and yoga, to name a few.

Physical Health and Treatment for Localized Prostate Cancer

Physical health is important when preparing for a radical prostatectomy (surgery to remove the prostate) as a treatment of localized prostate cancer. Getting aerobic exercise in the weeks leading up to a radical prostatectomy can improve pulmonary (lung) function. This helps with reducing the risk of complications with general anesthesia (i.e., “going to sleep”) during the operation. At the same time, men that quit smoking even weeks before surgery can decrease their risks of cardiopulmonary complications from anesthesia after a radical prostatectomy.

Strengthening the pelvic floor muscles can decrease the incidence and severity of side effects of treatment for localized prostate cancer — specifically urinary incontinence among men undergoing surgery. These muscles run from your pubic bone in the front to your tailbone in the back and support the bladder, prostate, and rectum. Strengthening the pelvic floor muscles before and after surgery can be accomplished by contracting the muscles as if you were holding in your urine stream (these are called Kegel exercises). Prior to surgery, contract these muscles for 10 seconds, followed by a 10-second rest, for a total of five reps three times a day. Following surgery, and after the Foley catheter is removed, you should consult with your surgeon as to when to begin Kegel exercises. To start, less vigorous contractions (contract for 3 seconds followed by a 15-second rest, for a total of five reps three times a day) is likely enough, followed by more strenuous contractions with continued recovery. Additionally, strengthening of the pelvic floor muscles through Kegel exercises can also be done by men undergoing radiation therapy.

Following surgery, it is normal to have fatigue and decreased appetite. Indeed, it may take weeks before you feel back to how you felt before surgery, which is not unexpected. During this time period, it is important to remain as active as possible (most importantly by walking). However, avoid lifting heavy objects more than 10 pounds (or the about the weight of a gallon of milk) for 6 weeks after surgery. This allows the incisions beneath your skin to adequately heal and helps you to avoid a hernia (intestines poking through the abdominal wall).

While waiting for your appetite to return, eating frequent (about 6) small meals of several bites is usually better tolerated compared to three “regular” meals. However, it is important to remember that even when you do not have an appetite, drink enough fluids to remain hydrated (about 2 liters of urine per day). This helps to avoid dehydration, which may cause you to need to be readmitted to the hospital.

Physical Health and Treatment for Advanced Prostate Cancer

The backbone of treatment for advanced prostate cancer therapy is androgen deprivation therapy (ADT). This treatment lowers the testosterone level to very low levels, thus cutting off the “fuel” for prostate cancer cells. However, this very low level of testosterone often also affects many aspects of a man’s quality of life. It can cause fatigue, loss of muscle mass, bone breakdown, and loss of sexual drive (low libido). Although no one wants to exercise when they are tired, maintaining an exercise routine while on hormone therapy is extremely important. Exercise helps to combat many if not all of the side effects of treatment (muscle wasting, bone breakdown, depression, etc.). If it is financially possible for you, joining a gym or hiring a personal trainer may help you stay on track with a workout plan, particularly in the early weeks and months of hormone therapy.

A prostate cancer diagnosis is likely to have a large impact on a man’s life. However, the importance of physical health during the initial diagnosis, preparing for and going through treatment, and combating the side effects of treatment cannot be overstated. A weekly exercise routine is important during this period of your prostate cancer journey. At the same time, it helps to decrease your risk factors for heart disease, which is the most common cause of death among American men.

Zachary Klaassen, MD, MSc
Urologic Oncologist, Georgia Cancer Center, Augusta University, Augusta, GA, USA