Cancer, Prostate

Overview of Prostate Cancer

Prostate cancer is usually an adenocarcinoma that initially affects the outer prostate gland and then spreads inward with metastases in advanced stages. Risk factors include age greater than 50 years, African American race, and a family history of prostate cancer. Common treatments for prostate cancer include radical prostatectomy and radiation. Individuals in the advance stages of the disease may also receive androgen deprivation therapy to inhibit testosterone production. Individuals with prostate cancer may receive treatments that depress testosterone production, resulting in decreased physical function and fatigue.^1,2,3 Older men with early stages of the disease may not need treatment for this condition.³ Those with advanced stages of this cancer or have undergone surgical procedures may experience back and pelvic pains with standing and walking activities, which may limit their daily activity levels.

Comorbidities to Consider

• Clients experiencing urinary incontinence with physical exertions may self-limit activities to avoid this problem.

• Symptoms of fatigue, weight loss, and dyspnea associated with physical activities have also been associated with symptoms for metastasis of the tumor.

Client Examination

Keys to Examination of Clients

• Ask your clients if they have had a recent test for their prostate antigen assay and prostatic acid phosphatase levels.

• Assess if your clients have symptoms of depression that may limit their preparedness to participate in exercise activities.^1,2 Screen clients in their 7th or 8th decade for cardiopulmonary conditions.

Recommended Baseline Testing of Fitness Levels

• Perform the 6-minute walk test to assess aerobic capacity and exercise tolerance.

• Measure upper and lower extremity strength levels to determine a baseline for resistive exercises.

• Measure fatigue using the Brief Fatigue Inventory or the Functional Assessment of Cancer Therapy for Fatigue.^4,5

Exercise Prescription

Type: Walking, cycle ergometer, aquatic exercise^6,7

Intensity: Start at 60%–70% of maximum heart rate

Duration: 20–30 minutes

Frequency: Three to four times per week.

Getting Started

Individuals experiencing urinary incontinence will benefit from pelvic floor exercises to improve the control of the external and internal sphincter muscles.⁸ Clients with prostate cancer will have no restrictions for exercise directly related to this condition. Resistance training using a circuit of exercise for the upper and lower extremities has been beneficial for these clients.^7,9 Walking distance can be progressed to 45–60 minutes over a 12-week period. Resistance exercises for the upper and lower extremities can begin at 60%–70% of a one-rep maximum, with two sets of 8 to 12 repetitions.⁶ Clients can return to previous recreational activities when their overall fitness levels have returned to pre-treatment levels.