Regular physical activity reduces the risk of prostate cancer in older men, a single-centre study from Italy has shown.

A total of 286 men undergoing prostate biopsy, based on a PSA ≥ 4.0 or an abnormal digital rectal examination, were enrolled in the study. Median age was 68 (62-74) years and median PSA 6.1 (4.9-8.9).

Physical activity levels were assessed using the Physical Activity Scale for the Elderly (PASE) questionnaire. This is a validated tool with 12 questions on the frequency and duration of leisure activity (e.g. swimming, jogging etc), household activity and work-related activity. The total PASE score ranges from 0 to > 400.

Baseline measurements of factors contributing to the metabolic syndrome were assessed. The men had a median BMI of 26.4 kg/m2

and waist circumference of 102 cm. Fifty patients (17.4%) were considered obese (≥ 30 kg/m2) with 75 men (26%) meeting the criteria for a diagnosis of metabolic syndrome.

Overall, 117 men reported low physical activity (PASE < 100), 137 medium physical activity (PASE 100-249) and 30 high levels of physical activity (PASE ≥ 250).

Men identified with prostate cancer on biopsy were older, had higher PSA levels and reported significantly lower levels of physical activity. PASE score was also found to be inversely correlated with waist circumference and BMI.

Reduced physical activity was also associated with a significantly higher risk of high-grade disease, alongside factors such as waist circumference and prostate volume.

This is the first European study to assess the association between physical activity and prostate cancer risk based on a consecutive series of men undergoing prostate biopsy.

‘Further studies in large patient populations across multiple institutions and countries are needed to confirm the results of our present research,’ the authors state.

The data to suggest that increasing physical activity reduces prostate cancer risk (and the risk of high-grade disease) is not robust enough to prove that lack of physical activity has a causal role in the development of prostate cancer. However, the suggestion that exercise is protective is yet another reason that can be used to encourage men to increase their physical activity levels.

These findings provide an opportunity for GPs, when discussing prostate cancer risk with men, to explore wider issues around men’s health in general. If increased physical activity results, the benefits will extend way beyond the findings of this paper.

Dr Jonathan Rees

• De Nunzio C, Presicce F, Lombardo R et al. Physical activity as a risk factor for prostate cancer diagnosis: a prospective biopsy cohort analysis. BJU Int 2015. doi 10.1111/bju.13157