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Epidemiology

Postdiagnosis physical activity is associated with improved survival in prostate cancer patients treated with surgery but not with radiation therapy

British Journal of Cancer volume 133, pages 1029–1037 (2025)Cite this article

Subjects

A Correspondence to this article was published on 16 September 2025

Abstract

Background

The effects of exercise on cancer outcomes may differ depending on its positioning within different cancer treatment combinations. We examined whether the associations between physical activity (PA) and cancer outcomes varied by cancer treatment modality or timing of PA.

Methods

We conducted a secondary analysis of the Prostate Cancer Cohort Study consisting of 830 men in Alberta, Canada with newly diagnosed prostate cancer. Lifetime prediagnosis PA was assessed by an in-person interview shortly after diagnosis whereas postdiagnosis PA was assessed at 2–3 year intervals by an in-person interview (first follow-up) or self-report (second and third follow-ups). Cox proportional hazards regression models were used to test interactions between PA and treatment modalities for disease-free survival, overall survival, and prostate cancer-specific disease-free survival.

Results

Postdiagnosis vigorous PA significantly interacted with surgery (p < 0.001) and radiotherapy (p = 0.003). Specifically, patients who had surgery experienced a 61% lower likelihood of a disease-free survival event if they engaged in any versus no postdiagnosis vigorous PA (HR = 0.39, 95% CI = 0.27–0.57). Conversely, patients who received radiotherapy did not experience any benefit from postdiagnosis vigorous PA (HR = 1.14, 95% CI = 0.88–1.47).

Conclusions

The role of PA as a treatment for prostate cancer may depend on its combination and sequencing with other treatments.

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Fig. 1: Unadjusted associations between postdiagnosis vigorous physical activity and disease-free survival in prostate cancer patients by treatment modality.
Fig. 2: Unadjusted associations between postdiagnosis recreational physical activity and prostate cancer-specific disease-free survival by surgery.
Fig. 3: Unadjusted associations between postdiagnosis vigorous physical activity and prostate cancer-specific disease-free survival by treatment modality.

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Data availability

The data underlying this article will be shared on reasonable request to the corresponding author.

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Funding

This work was supported by the Canadian Institutes for Cancer Research (MOP-67217); the National Cancer Institute of Canada with funds from the Canadian Cancer Society (011004); and the Alberta Cancer Board-Research Initiative Program (4570). Christine M. Friedenreich was supported by career awards from Alberta Innovates-Health Solutions and the Alberta Cancer Foundation. Kerry S. Courneya was supported by the Canada Research Chair Program and a Foundation Grant from the Canadian Institutes of Health Research.

Author information

Authors and Affiliations

  1. Faculty of Kinesiology, Sport, and Recreation, College of Health Sciences, University of Alberta, Edmonton, AB, Canada

    Ki-Yong An, Fernanda Z. Arthuso & Kerry S. Courneya

  2. Department of Sport Industry Studies, Yonsei University, Seoul, Republic of Korea

    Justin Y. Jeon

  3. Exercise Medicine Center for Diabetes and Cancer Patients (ICONS), Seoul, Republic of Korea

    Justin Y. Jeon

  4. Cancer Prevention Center, Yonsei Cancer Center, Shinchon Severance Hospital, Yonsei University College of Medicine, Yonsei University, Seoul, Republic of Korea

    Justin Y. Jeon

  5. Department of Cancer Epidemiology and Prevention Research, Alberta Health Services, Calgary, AB, Canada

    Qinggang Wang & Christine M. Friedenreich

  6. Departments of Oncology and Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada

    Christine M. Friedenreich

Authors
  1. Ki-Yong An
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  2. Justin Y. Jeon
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  3. Fernanda Z. Arthuso
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  4. Qinggang Wang
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  5. Christine M. Friedenreich
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  6. Kerry S. Courneya
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Contributions

Conceptualization: KYA, JYJ, CMF, and KSC, Data curation: QW, Formal analysis: KYA, JYJ, QW, and KSC, Funding acquisition: CMF and KSC, Investigation: KYA, FZA, QW, CMF, and KSC, Methodology: KYA, JYJ, QW, CMF and KSC, Supervision: CMF and KSC, Writing-original draft: KYA, FZA, and KSC, Writing-review and editing: KYA, JYJ, FZA, QW, CMF, and KSC.

Corresponding author

Correspondence to Kerry S. Courneya.

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Competing interests

The authors declare no competing interests.

Ethics approval and consent to participate

Ethics approval was obtained from the former Alberta Cancer Board (ACB) and the University of Calgary for the case-control study, and from the Alberta Cancer Research Ethics Board and the Conjoint Health Research Ethics Board at the University of Calgary for the cohort follow-up study. All participants provided written informed consent for the cohort study. This study was performed in accordance with the Declaration of Helsinki.

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An, KY., Jeon, J.Y., Arthuso, F.Z. et al. Postdiagnosis physical activity is associated with improved survival in prostate cancer patients treated with surgery but not with radiation therapy. Br J Cancer 133, 1029–1037 (2025). https://doi.org/10.1038/s41416-025-03123-0

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