Phillip Koo: 

Alright, so the last item or presentation we're going to talk about is a study on exercise and colon cancer, and it was published in the New England Journal of Medicine. Can you sort of give us a brief overview about that, and we'll get into some questions about exercise?

Zachary Klaassen: 

Yeah, absolutely. So, for the listeners, the New England Journal of Medicine is sort of the holy grail of publications when we're talking about, you know, when we do a randomized trial and we're looking at where we want it to get into, it's the Lancet, which is European, it's New England Journal of Medicine. So, this is a big deal when anything, a phase three trial, gets published in New England Journals. So, it means it's been rigorously reviewed. It's one of the top journals for publishing our research.

So, it automatically, when you get the table of contents emailed every Wednesday, as a provider, you flip through and you're looking through it, when something in cancer hits that journal - because this is all medicine, it's not just cancer for that journal. When it hits that journal, it immediately is something that you're clicking on just to see what was published, even if it's not in the prostate cancer or bladder or kidney cancer space.

And so this was a colon cancer trial where, and neither of us are colon cancer surgeons or physicians, but, the concept is very interesting because it was a colon cancer trial where patients had surgery, they had treatment after their surgery, but what they did in this study was they randomized these people to a very intensive three-year exercise regimen versus standard of care and support for the patients that were in the sort of control arm.

And what they found was this three-year exercise regimen improved colon cancer-specific survival as well as improved overall survival. Compared to those that did not have the intensive exercise regimen. So, to my knowledge, this is the first very structured exercise, prolonged, you know, three years, a long time, the first structured long exercise regimen in any cancer that has shown not only benefits in overall survival, which we would kind of expect it's going to be better for your heart, everything else, but also improve cancer-specific survival as well. So, not specific to prostate, but very interesting to see them hit both of those endpoints in this trial.

Phillip Koo: 

And that's great. I think sometimes purists always want to say, you know, that it has to be studied in a very specific state. And yes, for drugs and whatnot, that makes a lot of sense. For exercise, I think, you know, we all in our gut and conventional wisdom know that exercise is good. Eating well is good.

And then why are we investing all this time and energy into this three-year-long study that requires a lot of resources? In some ways, we're holding something that we know is so good for patients away from patients. So, what's sort of our takeaway when it comes to prostate? Do we just kind of assume it works?

Zachary Klaassen: 

Yeah, it's a great point. I think you're right; we know that it works for overall health for sure. I have a couple of patients on the webinar tonight. They hear me talk about cardiovascular health as much as I talk about prostate cancer, because at the end of the day, the number one cause of mortality in the US is cardiovascular disease. And I think we're all at risk of that. And so, I think to your point about do we need a prostate cancer trial to tell us that exercise helps. It'd be nice to have it, but it's a big lift.

It's a five-to-ten-year trial. To get the three years of exercise, plus you wait for the long-term follow-up to see if those endpoints are beneficial. But I think if the take-home tonight, in my opinion, is if we are regimented about exercise, it's no question going to help our overall health, and it probably will help our overall survival like we saw in that trial, because it's going to help out heart, it's going to help our mental health, it's going to help everything. 

And if we're lucky, it may help our prostate cancer survival as well. And that's the question we don't know until we have a trial. I don't if there will be a trial, but I know that if we're exercising, it can't hurt the prostate cancer, and it certainly will help our overall health as well.

Phillip Koo: 

That's great, you know, I've heard this before, but heart healthy is cancer healthy, regardless. So that's great. Well, thank you very much.