Centre for Applied Health Economics, Griffith University, Brisbane, Australia.
Menzies Health Institute Queensland, Griffith University, Gold Coast, Australia.
Support Care Cancer. 2020 Dec;28(12):5661-5671. doi: 10.1007/s00520-020-05637-0. Epub 2020 Jul 22.
Prostate cancer (PCa) is the most commonly diagnosed cancer in Australia, accounting for one quarter of all new cancer diagnoses for males. Androgen deprivation therapy (ADT) is the standard first-line therapy for metastatic PCa but is also used across much of the spectrum of disease. Unfortunately, debilitating adverse effects are a significant and largely unavoidable feature of ADT. A recent systematic review of adverse effects of ADT identified 19 sub-groups classified according to the Common Terminology Criteria for Adverse Events (CTCAE) Version 5.0. The potential for multiple simultaneous adverse effects, their associated management and the impact of adverse effects on cancer outcomes and quality of life are important considerations in the treatment and supportive care of men with PCa. Exercise is increasingly being recognized as an efficacious strategy in managing these adverse effects.
A rapid review was undertaken to examine the role of exercise in the management of the most commonly reported ADT adverse effects classified according to the CTCAE sub-groups. A systematic search was conducted in Medline, PsycINFO, Google Scholar and Google for the years 2010 to September 2019 to identify the benefits of exercise in managing the adverse effects of ADT for PCa.
There is strong evidence for exercise as medicine in addressing several of the adverse effects of PCa such as loss of muscle mass and strength, fatigue and declining physical function. Moderate level evidence for PCa exists for exercise-induced improvements in depression and anxiety, bone loss, and sexual dysfunction. While evidence of the effectiveness of exercise is lacking for many adverse effects of ADT for PCa, evidence in the cancer population as a whole or other clinical populations is strong, and many clinical guidelines recommend exercise as a fundamental part of their clinical management. With the exception of gynaecomastia and breast pain, there is increasing evidence (PCa, cancer or other clinical populations) to suggest that exercise has the potential to reduce and even prevent many of the adverse effects of ADT, thus improving survivorship outcomes for men with PCa.
Exercise has the potential to reduce and even prevent many of the adverse effects of ADT, thus improving survivorship outcomes for men with PCa. The use of exercise for PCa management has the potential to translate into health and economic benefits in improved quality of life and fewer complications, resulting in savings to the health care system, enhanced productivity and reduced patient and carer burden. Exercise thus has the potential to improve quality of life for this population as well as generate significant cost savings.
前列腺癌（PCa）是澳大利亚最常见的癌症，占男性所有新发癌症诊断的四分之一。去势治疗（ADT）是转移性 PCa 的标准一线治疗方法，但也广泛应用于疾病的大部分阶段。不幸的是，衰弱的不良反应是 ADT 的一个显著且在很大程度上不可避免的特征。最近对 ADT 不良反应的系统评价确定了 19 个子组，根据不良反应通用术语标准（CTCAE）第 5.0 版进行分类。在治疗和支持性护理患有 PCa 的男性时，需要考虑同时发生多种不良反应的可能性、其相关管理以及不良反应对癌症结局和生活质量的影响。运动越来越被认为是管理这些不良反应的有效策略。
进行了快速审查，以检查根据 CTCAE 子组分类的最常报告的 ADT 不良反应管理中运动的作用。在 Medline、PsycINFO、Google Scholar 和 Google 中进行了系统搜索，以确定运动在管理 PCa 患者 ADT 不良反应方面的益处。
有强有力的证据表明，运动作为一种药物，可以治疗几种 PCa 不良反应，如肌肉质量和力量丧失、疲劳和身体功能下降。对于运动对 PCa 引起的抑郁和焦虑、骨丢失和性功能障碍的改善，有中等水平的证据。虽然缺乏运动对 PCa 患者 ADT 许多不良反应的有效性证据，但在癌症人群或其他临床人群中证据很强，许多临床指南建议将运动作为其临床管理的基本组成部分。除了女性型乳房和乳房疼痛外，越来越多的证据（PCa、癌症或其他临床人群）表明，运动有可能减轻甚至预防许多 ADT 的不良反应，从而改善 PCa 患者的生存结果。
运动有可能减轻甚至预防许多 ADT 的不良反应，从而改善 PCa 患者的生存结果。运动在 PCa 管理中的应用有可能通过提高生活质量和减少并发症转化为健康和经济效益，从而为医疗保健系统节省资金、提高生产力并减轻患者和照顾者的负担。因此，运动有可能改善这一人群的生活质量并产生巨大的成本节约。
