The impact of physical activity on the outcomes of active surveillance in prostate cancer patients: a scoping review

Simple Summary: The present review explores the impact of physical activity (PA) on patients with prostate cancer (PCa) managed through active surveillance (AS). Specifically, the correlation between the duration, frequency, and intensity of physical exercise and the risk of tumor reclassification has been investigated. We pointed out inconsistencies in PA assessment and conflicting findings regarding its association with AS outcomes. Nevertheless, several studies suggest that active individuals may experience reduced risk of PCa progression. This renders PA a cost-effective approach for minimizing the need for definitive treatment, thereby classifying it within tertiary prevention strategies. Given the increasing number of patients diagnosed with PCa, this strategy may assume significant relevance for the public health in the coming years.Abstract Introduction: Active surveillance has emerged as a valid therapeutic option in patients with low-risk prostate cancer, allowing for the deferral of definitive treatment until the time of possible disease progression. Although it is known that physical activity plays a protective role in the onset and progression of this tumor, its impact on patients with low-risk disease who are managed with active surveillance remains unclear. Our scoping review aims to summarize the existing evidence on this subject. Evidence Acquisition: On 9 April 2023, a systematic search was conducted using the PubMed and Scopus databases. The search employed the combination of the following terms: ("prostate cancer" OR "prostate tumor") AND ("active surveillance") AND ("physical activity" OR "physical exercise" OR "physical intensive activity" OR "intensive exercise") AND ("lifestyle"). Out of the 506 identified articles, 9 were used for the present scoping review, and their results were reported according to the PRISMA-ScR statement. Evidence Synthesis: We discovered a lack of uniformity in the assessment of PA and its stratification by intensity. There was no consensus regarding what constitutes cancer progression in patients choosing expectant management. In terms of the impact of PA on AS outcomes, conflicting results were reported: some authors found no correlation, while others (six of total studies included) revealed that active men experience smaller increases in PSA levels compared to their sedentary counterparts. Additionally, higher levels of exercise were associated with a significantly reduced risk of PCa reclassification. Conclusion: Due to the heterogeneity of the methodologies used in the available studies and the conflicting results reported, it is not possible to draw definitive conclusions concerning the role physical activity may play in the risk of prostate cancer progression in men managed with active surveillance.