Pioneering study could improve life for prostate cancer sufferers
Professor Derek Rosario, consultant urological surgeon at Sheffield Teaching Hospitals, has been named the chief investigator of a brand new £2.5m National Institute for Health Research study investigating whether a new exercise programme could improve the lives of men suffering with prostate cancer.
The unique STAMINA (Supported exercise training for men with prostate cancer on androgen deprivation therapy) trial is one of the largest studies of its kind anywhere in the world and will look to investigate whether a longer-term supported exercise programme – embedded in NHS cancer care and delivered via expert commercial partners in the community – can counter the problems caused by androgen deprivation therapy (ADT).
ADT is the standard treatment for men with advanced prostate cancer but it is associated with significant side effects including: fatigue, depression, sexual dysfunction, cognitive dysfunction (impairment of memory and concentration), increased fat mass and loss of muscle strength. ADT also increases the risk of developing bone fractures, diabetes and heart and circulatory problems.
Previous research has shown that short-term exercise can help tackle some of these side effects, with current treatment guidelines from the National Institute for Health and Care Excellence (NICE) recommend 12 weeks of supervised exercise for men having ADT to help boost their quality of life. But the benefits of exercise decline without ongoing support, and very few treatment centres are able to offer exercise as a core part of the NHS service for men with prostate cancer.
If found to be clinically effective, STAMINA will be the first evidence-based service of its kind for improving the lives of those living with prostate cancer, with findings applicable across other countries where prostate cancer is prevalent.
Professor Derek Rosario said: “We have been working in this area for over 10 years now. We have shown that specific targeted exercise training significantly reduces many of the adverse effects caused by ADT as well as improving quality of life in these men. Unless the intervention is embedded within the cancer care of the man and ongoing support is provided though, participation dwindles and the benefits are lost.
"So finding cost-effective ways of ensuring men on ADT continue with their training programme is essential if we are to reduce the side effects and provide sustained benefits. The NIHR-funded STAMINA study is a novel approach and if the model is successful, it could be applied to a number of long-term health conditions."
Academic lead, Professor Liam Bourke from Sheffield Hallam University, said: "This is one of the largest studies of its kind anywhere in the world - it is designed to test fundamentally new ideas about reducing the treatment burden in men with prostate cancer. It's very ambitious but if the results are positive it could offer new ways of looking at treatment across several cancers including breast and colorectal."
The STAMINA study will involve around 1000 men being treated with ADT, split randomly into two groups. One group will receive a 12-month individually tailored exercise programme delivered free of charge by Nuffield Health through their national network of Fitness and Wellbeing Clubs. The other group will receive NHS best practice treatment based on the NICE guidance. The study will take place at around 40 NHS sites.
STAMINA will also explore ways to optimise communication between clinical and exercise teams so that men receive the support they need to stick with exercise training for the full prescribed duration.
Dr Davina Deniszczyc, Charity Director and Primary Medical Director at Nuffield Health said: “STAMINA aims to generate robust ‘real-world’ evidence that is required to define best practice. We can test whether supported exercise delivered in our clubs can provide value for money in comparison to other community-based exercise interventions.”
The study involves Sheffield Teaching Hospitals, Sheffield Hallam University and not-for-profit healthcare provider by Nuffield Health.
Chris Allen, 68, who was diagnosed with prostate cancer 18 years ago and was on ADT for two and a half years before taking a nine month break and then starting the treatment again in November, believes a 12-month exercise programme would benefit prostate cancer sufferers who are noticing the effects ADT has on their bodies, “It’s important to know how far to push your body with exercise, especially when you’re experiencing muscle soreness, noticing weight gain and loss of muscle mass. I hope the STAMINA programme will give me more knowledge about how to best work with my body, rather than against it while on ADT.”
To find out more about the project and how patients or treatment centres can get involved, visit www.stamina.org.uk or tweet the STAMINA team @STAMINA_Sheff.
CASE STUDY: CHRIS ALLEN’S STORY OF LIFE ON ANDROGEN DEPRIVATION THERAPY
Following his prostate cancer diagnosis 18 years ago, 68-year old Chris Allen from Chesterfield is hoping to take part in a unique 12-month study to investigate the role of exercise in combatting the debilitating side effects of advanced prostate cancer treatment.
Androgen deprivation therapy (ADT) is the standard treatment for advanced prostate cancer, but while effective, it’s associated with significant side effects including: severe fatigue, depression, loss of libido and impotence, impairment of memory and concentration, increased fat mass and loss of muscle strength.
ADT also increases the risk of developing bone fractures, diabetes and heart and circulatory problems.
Chris was diagnosed after his wife persuaded him to have a PSA (prostate-specific antigen) test – a blood test to help detect prostate cancer - following the death of Chris’ own father from prostate cancer.
The first test showed his levels were slightly above a normal result of 4ng/mL. Three months later they had gone up significantly and an irregular lump was found on his prostate: an MRI scan confirmed aggressive prostate cancer. Surgery wasn’t an option due to the location of the lump.
Chris was on ADT for two and a half years before taking a nine month break and then starting the treatment again in November. Speaking of the side effects he experienced, Chris said: “I have been living with a variety of symptoms as a result of ADT. The worst ones are hot flushes, muscle aches, weight gain and a loss of libido.”
“My wife sadly passed away two years ago following a battle with breast cancer. I met my new partner during my nine month break from ADT so when we got together I wasn’t experiencing any treatment side effects so was able to have a sexual relationship. Once I went back on ADT my libido vanished – which is a common symptom of treatment.”
Chris experiences an average of four hot flushes per day which can cause embarrassment and discomfort, “My hot flushes don’t make me turn red but I become very sweaty which can make me feel uncomfortable in public. A hot flush in the night can lead to me waking up soaking wet and cold and interrupts my sleep. I get up around four times a night to go to toilet as well and then my tiredness exacerbates my muscle soreness and leads to more hot flushes, so it’s a vicious circle.”
“I’m also an active person so the muscle soreness has been a frustration, but rather than letting it hold me back I have found ways to lessen the impact. As a keen cyclist I have always enjoyed getting out on my bike, but on ADT I get tired halfway through my regular route. Rather than stop cycling I decided to buy an electric bike with a pedal assist option for when I became too tired to pedal. That means I never have to worry about feeling too tired to get back home when I am out.”
Chris believes a 12-month exercise programme would benefit prostate cancer sufferers who are noticing the effects ADT has on their bodies, “It’s important to know how far to push your body with exercise, especially when you’re experiencing muscle soreness, noticing weight gain and loss of muscle mass. I hope the STAMINA programme will give me more knowledge about how to best work with my body, rather than against it while on ADT.”