Physical activity after diagnosis and risk of prostate cancer progression: data from the cancer of the prostate strategic urologic research endeavor

Abstract

Vigorous activity after diagnosis was recently reported to be inversely associated with prostate cancer-specific mortality. However, men with metastatic disease may decrease their activity due to their disease; thus, a causal interpretation is uncertain. We therefore prospectively examined vigorous activity and brisk walking after diagnosis in relation to risk of prostate cancer progression, an outcome less susceptible to reverse causation, among 1,455 men diagnosed with clinically localized prostate cancer. Cox proportional hazards regression was used to examine vigorous activity, nonvigorous activity, walking duration, and walking pace after diagnosis and risk of prostate cancer progression. We observed 117 events (45 biochemical recurrences, 66 secondary treatments, 3 bone metastases, 3 prostate cancer deaths) during 2,750 person-years. Walking accounted for nearly half of all activity. Men who walked briskly for 3 h/wk or more had a 57% lower rate of progression than men who walked at an easy pace for less than 3 h/wk (HR = 0.43; 95% CI: 0.21-0.91; P = 0.03). Walking pace was associated with decreased risk of progression independent of duration (HR brisk vs. easy pace = 0.52; 95% CI: 0.29-0.91; P(trend) = 0.01). Few men engaged in vigorous activity, but there was a suggestive inverse association (HR ≥3 h/wk vs. none = 0.63; 95% CI: 0.32-1.23; P(trend) = 0.17). Walking duration and total nonvigorous activity were not associated with risk of progression independent of pace or vigorous activity, respectively. Brisk walking after diagnosis may inhibit or delay prostate cancer progression among men diagnosed with clinically localized prostate cancer.

Figure 1

Post–diagnostic walking duration, walking pace, and risk of prostate cancer progression among 1,455 men diagnosed with clinically localized prostate cancer. Abbreviations: CI, confidence interval; MPH, miles per hour. Adjusted for age at diagnosis (continuous), days from diagnosis to questionnaire (continuous), primary treatment (radical prostatectomy, radiation, other/watchful waiting, hormone), biopsy Gleason sum (<7, 7, >7), and prostate–specific antigen at diagnosis (tertiles). Events/person-years: <3 MPH, <3 hours/week = 66/1289; <3 MPH, 3+ hours/week = 23/471; 3+ MPH, <3 hours/week = 18/569; 3+ MPH, 3+ hours/week = 8/396. Ten participants (0.7%) who reported being unable to walk and reported no time spent walking were excluded.