PROstaTe Cancer - Exercise-STudy (PRO-TEST) (PRO-TEST)

Effect of Different Exercise Regimens on Intratumoral Natural Killer (NK) Cell Variability in Men With Localized Prostate Cancer Undergoing Radical Prostatectomy - a Randomized Controlled Pilot Study

Background and purpose: The purpose of this study is to investigate the effect of exercise on intratumoral natural killer (NK)-cell variability in patients with localized prostate cancer undergoing radical prostatectomy.

The primary hypothesis is that exercise induces epinephrine-mediated intratumoral natural killer (NK)-cell infiltration in patients with localized prostate cancer, and that the infiltration is greater in patients performing High Intensity Interval Training compared to usual care controls.

Currently there is a lack of randomized controlled trials examining different types of exercise in patients with localized prostate cancer. Moreover there is a need for studies including biological measurements to allow a full assessment of the effect of exercise on diverse biomarkers and mechanistic pathways, which may influence cancer survival.

Subjects: Patients with histologically verified prostate adenocarcinoma scheduled for radical prostatectomy at Urologic Department, Rigshospitalet, Copenhagen, Denmark.

Methods: In this randomized controlled pilot study 30 patients with localized prostate cancer undergoing radical prostatectomy will be included and randomized 2:1 to either High Intensity Interval Training (HIIT) exercise intervention or observational control receiving usual care from inclusion and until planned surgery (radical prostatectomy).

All patients will undergo assessments at inclusion (baseline) and at follow-up after the exercise intervention period (maximum 8 weeks) 3-5 days prior to surgery.

Assessments include: anthropometrics; blood pressure; resting hearth rate; cardiorespiratory fitness by cardiopulmonary exercise test (VO2 peak.); body composition by DXA scan; quality of life by self-report questionnaires; fasting blood sample measuring cholesterol, triglycerides, insulin, c-peptide, HbA1c, glucose, hormones and inflammatory markers.

Biological tissue from tumor (primary prostate biopsies) will be retrieved from the respective local pathological departments and from the perioperative prostate specimen and sent to protocol analyses.

Study Overview

• Status: Completed
• Conditions: Prostate Cancer
• Intervention / Treatment: Behavioral: High Intensity Interval Training; Behavioral: Usual Care Observational Control

Detailed Description

The purpose of this study is to investigate the effect of exercise on the variability of intratumoral Natural Killer (NK)-cell infiltration in tumor biopsies taken before and after an exercise intervention in patients randomized 2:1 to one of two study arms: I) High Intensity Interval Training (HIIT) (N=20) or II) usual care, prior to radical prostatectomy.

In addition to this the investigators wish to investigate the effect of HIIT exercise on the infiltration of other immune cells into the tumor, tumor vessel morphology, modulation of tumor-metabolism, -biology and signaling.

Finally the aim is to explore the effect of pre-operative HIIT exercise on physiological (e.g. cardiovascular fitness, body composition, metabolic profile and metabolic inflammatory markers) and psycho-social (e.g. fatigue, emotional well-being, anxiety) endpoints relative to usual care.

• Study Type: Interventional
• Enrollment (Actual): 30
• Phase: Not Applicable

Contacts and Locations

Study Locations

• Denmark
  • Copenhagen, Denmark, DK-2100
    • Center for Physical Activity Research, Copenhagen University Hospital

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 18 years and older (Adult, Older Adult)
• Accepts Healthy Volunteers: No
• Genders Eligible for Study: Male

Description

Inclusion Criteria:

• Pathologically verified localized prostate cancer
• Eligible for curative radical prostatectomy

Exclusion Criteria:

• Any other known malignancy requiring active treatment
• Performance status > 1
• Ongoing treatment with beta blockers
• Physical disabilities precluding physical testing and/or exercise
• Inability to read and understand Danish

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Basic Science
• Allocation: Randomized
• Interventional Model: Factorial Assignment
• Masking: Single

Number of Arms

2

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Experimental: High Intensity Interval Training; The HIIT-group will receive usual care plus a supervised aerobic High Intensity Interval Training program consisting of 4 weekly sessions of approximately 35 minutes.	Behavioral: High Intensity Interval Training; Supervised aerobic High Intensity Interval Training program consisting of 4 weekly sessions of approximately 35 minutes. Patients will perform a test of maximum cardio-respiratory (VO2 peak test). Using the patient's individual wattmax, a personalized exercise program will be prescribed. After a light warm-up, patients will perform 25 min of aerobic high intensity interval training on a stationary bicycle, intervals will consist of cycles of HI intervals with 120% of wattmax for 1 min followed by recovery for 3 min at 30% of wattmax. Each session will be supervised by trained instructors to ensure proper technique, and progression in training load.
Active Comparator: Usual Care Observational Control; Patients randomized to usual care control will receive the standard patient care program as provided by the Department of Urology, Rigshospitalet.	Behavioral: Usual Care Observational Control; The reference group will receive the standard patient care program as provided by the Department of Urology, Rigshospitalet.This includes information regarding smoking cessation and alcohol reduction and a physiotherapist consultation regarding pelvic floor exercises. This group is allowed to exercise on their own initiative or participate in any standard care hospital- or municipality-based exercise program. This will be monitored by self-report.

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Variability in intratumoral Natural Killer (NK)-cell infiltration	Natural killer (NK)-cell infiltration will be quantified using histological analyses.	Primary prostate biopsies and up to 8 weeks

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Tumor vessel morphology	Tumor vessel morphology will be evaluated using histological analyses.	Primary prostate biopsies and up to 8 weeks
Tumor-metabolism, - biology and signaling	Tumor samples will undergo proteomic analyzes in order to uncover potential upregulated biomarkers.	Primary prostate biopsies and up to 8 weeks
Changes in immune cells	Quantification of immune cells will be measured in blood samples by flowcytometry analyses.	Baseline and up to 8 weeks
Changes in epinephrine concentration	Concentrations of epinephrine will be measured in blood samples by radioimmunoassay analyses.	Baseline and up to 8 weeks
Changes in nor-epinephrine concentration	Concentrations of nor-epinephrine will be measured in blood samples by radioimmunoassay analyses.	Baseline and up to 8 weeks
Changes in IL-1 concentration	Concentrations of IL-1 (Interleukin 1) will be measured in blood samples by Enzyme-Linked Immunosorbent Assay (ELISA) analyses.	Baseline and up to 8 weeks
Changes in IL- 2 concentration	Concentrations of IL-2 (Interleukin 2) will be measured in fasting blood samples by Enzyme-Linked Immunosorbent Assay (ELISA) analyses.	Baseline and up to 8 weeks
Changes in IL- 6 concentration	Concentrations of IL-6 (Interleukin 6) will be measured in fasting blood samples by Enzyme-Linked Immunosorbent Assay (ELISA) analyses.	Baseline and up to 8 weeks
Changes in IL- 8 concentration	Concentrations of IL-8 (Interleukin 8) will be measured in fasting blood samples by Enzyme-Linked Immunosorbent Assay (ELISA) analyses.	Baseline and up to 8 weeks
Changes in IL- 10 concentration	Concentrations of IL-10 (Interleukin 10) will be measured in fasting blood samples by Enzyme-Linked Immunosorbent Assay (ELISA) analyses.	Baseline and up to 8 weeks
Changes in IL- 15R alpha complex concentration	Concentrations of IL- 15Rα (IL- 15 receptor alpha) complex will be measured in blood samples by Enzyme-Linked Immunosorbent Assay (ELISA) analyses.	Baseline and up to 8 weeks
Changes in Tumor Necrosis Factor alpha (TNFa) concentration	Concentrations of TNFa will be measured in blood samples by Enzyme-Linked Immunosorbent Assay (ELISA) analyses.	Baseline and up to 8 weeks
Changes in Interferon Gamma (IFNγ) concentration	Concentrations of IFNγ will be measured in blood samples by Enzyme-Linked Immunosorbent Assay (ELISA) analyses.	Baseline and up to 8 weeks
Changes in Plasma Total-Cholesterol concentrations	Concentrations of total cholesterol will be measured in fasting blood samples by standard laboratory methods.	Baseline and up to 8 weeks
Changes in Plasma LDL-Cholesterol concentrations	Concentrations of LDL-cholesterol will be measured in fasting blood samples by standard laboratory methods	Baseline and up to 8 weeks
Changes in Plasma HDL-Cholesterol concentrations	Concentrations of HDL-cholesterol will be measured in fasting blood samples by standard laboratory methods	Baseline and up to 8 weeks
Changes in Plasma Triglyceride concentrations	Concentrations of triglycerides will be measured in fasting blood samples by standard laboratory methods	Baseline to and up to 8 weeks
Changes in HbA1C (fasting blood samples)	Concentrations of HbA1C will be measured in fasting blood samples by standard laboratory methods	Baseline and up to 8 weeks
Changes in insulin	Concentrations of Insulin will be measured in fasting blood samples by standard laboratory methods	Baseline and up to 8 weeks
Change in body composition	Body weight and anthropometrics (height, waist and hip circumference) will be assessed using standard procedures. Resting heart rate and blood pressure (Microlife, BPA100) will be determined in a supine position. Body composition (fat mass, bone mass and fat-free mass) and bone mineral density are analyzed by whole-body dual-energy X-ray absorptiometry (DXA) scan (Lunar, Lunar Corporation Madison, Wisconsin, USA). Transverse scans at 1 cm intervals are made from head to toe measuring the absorption of x-ray beams at two different energy levels as these are sent through the body. Since the different chemical compounds in the body absorb the intensity of the X-rays differently, the scan allows for a valid determination of bone mass, fat mass and fat-free/bone-free mass	Baseline and up to 8 weeks
Change in VO2peak	The participants will undergo a maximal graded exercise test on a bicycle ergometer for evaluation of cardiovascular function and determination of the peak oxygen uptake (VO2peak). The test starts with a 5 min warm up at 70 watt (the watts may have to be adjusted to the individual fitness level). Warm up is immediately followed by a 20 watt increase every 1 min until exhaustion. Ventilation and expired gases will be measured during the test via an indirect calorimetric system, and heart rate will be assessed simultaneously.	Baseline and up to 8 weeks
Change in wattmax	The participants will undergo a maximal graded exercise test on a bicycle ergometer for evaluation of cardiovascular function and determination of the maximum watt (wattmax). The test starts with a 5 min warm up at 70 watt (the watts may have to be adjusted to the individual fitness level). Warm up is immediately followed by a 20 watt increase every 1 min until exhaustion. The maximum watt will be calculated.	Baseline and up to 8 weeks
Changes in patient-reported Quality of Life - FACT	Patient reported quality of life is measured by Functional Assessment of Cancer Treatment (FACT)	Baseline and up to 8 weeks
Changes in Sleep Quality	Patient reported sleep quality is measured by the Pittsburgh Sleep Quality Index (PSQI) questionaire.	Baseline up to 8 weeks
Changes in Anxiety and Depression	Patient reported Anxiety and Depression is measured by the Hospital Anxiety and Depression Scale (HADS).	Baseline up to 8 weeks
Changes in Physical Activity level	Patient reported physical activity is measured by the International Physical Activity Questionaire (IPAQ) - short form.	Baseline up to 8 weeks
T-cell infiltration	T-cell infiltration will be quantified using histological analyses.	Primary prostate biopsies from baseline and up to 8 weeks

Collaborators and Investigators

• Sponsor: Rigshospitalet, Denmark

Study record dates

Study Major Dates

• Study Start: November 1, 2016
• Primary Completion (Actual): December 1, 2019
• Study Completion (Actual): December 1, 2019

Study Registration Dates

• First Submitted: October 28, 2016
• First Submitted That Met QC Criteria: November 2, 2016
• First Posted (Estimate): November 3, 2016

Study Record Updates

• Last Update Posted (Actual): December 18, 2019
• Last Update Submitted That Met QC Criteria: December 16, 2019
• Last Verified: December 1, 2019

More Information

Terms related to this study

• Keywords: Exercise; Prostate cancer; Physical activity; Immune cells; Localized; Natural killer cells
• Additional Relevant MeSH Terms: Neoplasms; Urogenital Neoplasms; Neoplasms by Site; Genital Neoplasms, Male; Prostatic Diseases; Prostatic Neoplasms
• Other Study ID Numbers: H-16034670

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: UNDECIDED