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By Karen Alexander, Oncology Wellness Specialist


How to Manage Fatigue During Prostate Cancer Treatment

Prostate cancer is the second-most common cancer in men in the United States, after skin cancer. About 1 in 7 men will be diagnosed with prostate cancer during his lifetime. Signs of prostate cancer include a weak flow of urine and frequent urination, and cancer-related fatigue (CRF) is a very common side effect for all cancer patients. Assessment for prostate cancer may include medical history, digital rectal exam, prostate-specific antigen (PSA) test, transrectal ultrasound, transrectal magnetic resonance imaging, and biopsy. A transrectal biopsy is used to diagnose prostate cancer. 

Prostate cancer treatment may include radiotherapy, chemotherapy, surgery and androgen deprivation therapy. Sometimes, medical castration and surgical castration are considered to reduce androgen levels. However, androgens are used by many other organs besides the prostate, so medical or surgical castration can have a wide range of side effects including weight gain, increased fat mass, loss of muscle mass and physical strength, fatigue and a state of chronic inflammation. These side effects may explain CRF, one of the most common side effects of prostate cancer. Since both physical activity and nutrition may impact healthy body weight, muscle maintenance, reduction of fat mass and chronic inflammation, making a lifestyle change regarding your physical activity or nutrition may reduce CRF.

Physical Activity
Approximately 70% of prostate cancer survivors are overweight or obese, and just 12–50% of the entire prostate cancer population currently meets the exercise oncology guidelines. The guidelines recommend a combination of moderate-intensity aerobic and resistance training for 20 to 30 minutes, 3 to 5 times per week. This is recommended for all cancer patients, not just those with prostate cancer.

It should be noted that recent studies have shown that supervised moderate to hard resistance training (weights) with or without moderate to vigorous aerobic exercise appears to improve both CRF and quality of life.

The American Institute for Cancer Research has a list of diet and nutrition recommendations to prevent cancer, reduce the risk of recurrence of certain cancers, and reduce the risk of other chronic diseases such as diabetes and heart disease. For more information about the AICR guidelines for cancer prevention, please click here.

How nutrition therapy can reduce CRF:

  • Adequate protein intake has shown to significantly reduce CRF in some cancer populations. 
  • Modifying your diet to include high intake of fruits, vegetables, whole grains, and oily fish (with omega 3) may significantly reduce CRF levels.
  • A Mediterranean diet reduces pro-inflammatory markers and may prevent CRF.
  • A diet low in sugar seems to reduce tiredness.
  • Maintaining a healthy weight leads to lower levels of CRF.
  • Weight loss, in particular reduction of fat mass, abdominal visceral fat and BMI reduce pro-inflammatory markers associated with CRF. On the other hand, high levels of abdominal visceral fat and a BMI classification of ‘obese’ are known to create a pro-inflammatory state.

As we have discussed in previous bulletins, the Mediterranean diet (high intake of fruits and vegetables, cereals and whole grain breads, nuts and seeds, olive oil as a main source of fat, a moderate amount of cheese and yogurt, low qualities of red meat, and a moderate amount of fish) offers anti-inflammatory properties and may reduce CRF. For more information on the Mediterranean diet please click here

Ackerman Cancer Center is committed to the health of our patients and employees. We encourage all of our patients and staff to be physically active and to follow a healthy diet. Please come see me if you would like more information on healthy food choices and ACC physical activity programs.


Best regards,

Karen Ambrosio, MSCN, BSND

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