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Physical activity decreases the risk of cancer reclassification in patients on active surveillance: a multicenter retrospective study



Physical activity (PA) is associated with favorable outcomes in prostate cancer (PCa) patients. We assessed its effect on the risk of PCa reclassification (PCaR) during active surveillance.


Anthropometric, demographic, and clinical data concerning men diagnosed with a low-risk PCa and initially managed with active surveillance at the two participating institutions were retrospectively collected. The Physical Activity Scale for the Elderly (PASE) was used for patients’ self-assessment of their daily exercise and their consequent stratification into three groups: sedentary (PASE ≤ 65), moderately active (65 < PASE < 125), active (PASE ≥ 125). Kaplan–Meier model was used to evaluate the predictive role of PA on PCaR, computed at 2, 5, 10 years after diagnosis; differences between lifestyle groups were assessed using the log-rank and uni-/multivariable Cox analyses applied to identify predictors of reclassification.


Eighty-five patients were included in the analysis, with a median age of 66 years (IQR: 59–70); 16% were active, 45% were former smokers, and 3 presented with metabolic syndrome (MetS). Prostate-specific antigen (PSA) density was 0.12 (IQR: 0.07–0.15); 34 men showed a PSA doubling time <10 years. The Median PASE score was 86 (IQR: 61.5–115.8): 24 patients were sedentary, 46 moderately active, and 15 active. At a median follow-up of 37 months (IQR: 14–53), 25% of patients experienced PCaR. These were less physically active (PASE score 69.3 vs 87.8; p = 0.056) and presented with significantly smaller prostates (46 ml vs 50.7 ml; p = 0.001) and a higher PSAD (0.14 vs 0.10; p = 0.019). At 2 years, the risk of reclassification was 25 ± 5%, while it was 38 ± 7% at both 5 and 10 years. The risk was significantly different in the three PA groups (Log Rank p = 0.033). PASE score was the only independent predictor of PCaR (HR: 0.987; 95%CI: 0.977–0.998; p = 0.016).


PA influences PCa evolution, as increasing levels are associated with a significantly reduced risk of tumor reclassification among patients undergoing active surveillance.

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Fig. 1: Kaplan-Meier analyses.


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Authors and Affiliations



AB, MF, GN, RS, GT, UA, AB, LM, RM, and FP collected data while FB managed them. AB carried out statistical analysis and drafted the manuscript. MG and GS critically reviewed the paper. All authors have read and approved the final article.

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Correspondence to Aldo Brassetti.

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The retrospective study was performed in accordance with the Declaration of Helsinki. Review board approval was acquired; informed consent for the retrospective study was obtained from all the participants.

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Informed consent for the submission and publication of the study was obtained from all individual participants included.

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Brassetti, A., Ferriero, M., Napodano, G. et al. Physical activity decreases the risk of cancer reclassification in patients on active surveillance: a multicenter retrospective study. Prostate Cancer Prostatic Dis 24, 1151–1157 (2021).

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