What is the clinical evidence from this study?

Study design: RCT. Population: localized prostate cancer (n=29). Intervention: Yoga vs. Standard-of-care. Primary outcome: EPIC-sexual score change (MD 8.5, 95% CI -1.7, 18.8, p=0.098).

What does this research mean for the field?

Perioperative yoga exercise improves quality of life, promotes an anti-tumor immune response, and attenuates inflammation in men with prostate cancer. Novelty: ClaimNovelty.CONFIRMATORY. Consensus alignment: ConsensusAlignment.NEUTRAL.

November 23, 2021Open Access

Effects of yoga in men with prostate cancer on quality of life and immune response: a pilot randomized controlled trial

Key Result

Perioperative yoga exercise improved quality of life, promoted an immune response, and attenuated inflammation in men with prostate cancer.

Study Design

Type

RCT (n=29)

Blinding

Open-label

Randomization

block randomized

Multicenter

Structured PICO

Does a perioperative yoga program improve quality of life and immune response in men with localized prostate cancer scheduled for radical prostatectomy?

Population

29 men aged 30-80 years with newly diagnosed localized prostate cancer scheduled for radical prostatectomy, median age 56-60, ~23% Hispanic.

Intervention

Hatha yoga program consisting of 60 minutes twice weekly for 6 weeks preoperatively and 6 weeks postoperatively.

Comparator

Standard-of-care only (no yoga intervention prior to surgery).

Outcome

Self-reported quality of life assessed by EPIC, FACT-P, FACIT-F, and FACT-G at baseline, preoperatively, and 6 weeks postoperatively.patient reported

Perioperative yoga exercise improved quality of life, promoted an immune response, and attenuated inflammation in men with newly diagnosed prostate cancer.

Main Result

Effect estimate: MD 8.5 (95% CI -1.7, 18.8)

Absolute Event Rate: 9.1% vs 0.6%

p-value: p=0.098

Limitations

Small study cohort
Assessments were performed at only two time points and adherence rates are not available
Significance level was not adjusted for multiple comparisons

Abstract

BACKGROUND: Diagnosis and treatment of prostate cancer is associated with anxiety, fear, and depression in up to one-third of men. Yoga improves health-related quality of life (QoL) in patients with several types of cancer, but evidence of its efficacy in enhancing QoL is lacking in prostate cancer. METHODS: In this randomized controlled study, 29 men newly diagnosed with localized prostate cancer were randomized to yoga for 6 weeks (n = 14) or standard-of-care (n = 15) before radical prostatectomy. The primary outcome was self-reported QoL, assessed by the Expanded Prostate Index Composite (EPIC), Functional Assessment of Cancer Therapy-Prostate (FACT-P), Functional Assessment of Chronic Illness Therapy-Fatigue (FACIT-F), Functional Assessment of Cancer Therapy-General (FACT-G) at baseline, preoperatively, and 6 weeks postoperatively. Secondary outcomes were changes in immune cell status and cytokine levels with yoga. RESULTS: The greatest benefit of yoga on QoL was seen in EPIC-sexual (mean difference, 8.5 points), FACIT-F (6.3 points), FACT-Functional wellbeing (8.6 points), FACT-physical wellbeing (5.5 points), and FACT-Social wellbeing (14.6 points). The yoga group showed increased numbers of circulating CD4+ and CD8+ T-cells, more production of interferon-gamma by natural killer cells, and increased Fc receptor III expression in natural killer cells. The yoga group also showed decreased numbers of regulatory T-cells, myeloid-derived suppressor cells, indicating antitumor activity, and reduction in inflammatory cytokine levels (granulocyte colony-stimulating factor 0.55 (0.05-1.05), p = 0.03, monocyte chemoattractant protein 0.22 (0.01-0.43), p = 0.04, and FMS-like tyrosine kinase-3 ligand 0.91 (-0.01, 1.82), p = 0.053. CONCLUSIONS: Perioperative yoga exercise improved QoL, promoted an immune response, and attenuated inflammation in men with prostate cancer. Yoga is feasible in this setting and has benefits that require further investigation. TRIAL REGISTRATION: clinicaltrials.org (NCT02620033).

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