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Randomized Controlled Trial
. 2024 Jun 15;130(12):2108-2119.
doi: 10.1002/cncr.35241. Epub 2024 Feb 14.

The Prostate Cancer Active Lifestyle Study (PALS): A randomized controlled trial of diet and exercise in overweight and obese men on active surveillance

Jonathan L Wright  1   2   3 , Jeannette M Schenk  2 , Roman Gulati  2 , Sarah J Beatty  2 , Matthew VanDoren  2 , Daniel W Lin  1   2 , Michael P Porter  1   3 , Colm Morrissey  1 , Atreya Dash  1   3 , John L Gore  1   2 , Ruth Etzioni  2 , Stephen R Plymate  3   4 , Marian L Neuhouser  2
Affiliations
Randomized Controlled Trial

The Prostate Cancer Active Lifestyle Study (PALS): A randomized controlled trial of diet and exercise in overweight and obese men on active surveillance

Jonathan L Wright et al. Cancer. .

Abstract

Background: Active surveillance (AS) is increasingly used to monitor patients with lower risk prostate cancer (PCa). The Prostate Cancer Active Lifestyle Study (PALS) was a randomized controlled trial to determine whether weight loss improves obesity biomarkers on the causal pathway to progression in patients with PCa on AS.

Methods: Overweight/obese men (body mass index >25 kg/m2) diagnosed with PCa who elected AS were recruited. The intervention was a 6-month, individually delivered, structured diet and exercise program adapted from the Diabetes Prevention Program with a 7% weight loss goal from baseline. Control participants attended one session reviewing the US Dietary and Physical Activity Guidelines. The primary outcome was change in glucose regulation from baseline to the end of the 6-month intervention, which was measured by fasting plasma glucose, C-peptide, insulin, insulin-like growth factor 1, insulin-like growth factor binding protein-3, adiponectin, and homeostatic model assessment for insulin resistance.

Results: Among 117 men who were randomized, 100 completed the trial. The mean percentage weight loss was 7.1% and 1.8% in the intervention and control arms, respectively (adjusted between-group mean difference, -6.0 kg; 95% confidence interval, -8.0, -4.0). Mean percentage changes from baseline for insulin, C-peptide, and homeostatic model assessment for insulin resistance in the intervention arm were -23%, -16%, and -25%, respectively, compared with +6.9%, +7.5%, and +6.4%, respectively, in the control arm (all p for intervention effects ≤ .003). No significant between-arm differences were detected for the other biomarkers.

Conclusions: Overweight/obese men with PCa undergoing AS who participated in a lifestyle-based weight loss intervention successfully met weight loss goals with this reproducible lifestyle intervention and experienced improvements in glucose-regulation biomarkers associated with PCa progression.

Keywords: active surveillance; insulin; obesity; prostate cancer; randomized controlled trial; weight loss.

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Conflict of interest statement

Conflict of Interest: The authors declare no potential conflicts of interest.

Figures

Figure 1:
Figure 1:
The PALS study CONSORT Flow Diagram
Figure 2:
Figure 2:
Mean Anthropometric and Serum measurements by PALS Study Arm during the intervention. Bars represent 95% Confidence Intervals
See this image and copyright information in PMC

References

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