Physical Exercise as Supportive Therapy During Prostate Cancer Treatment: a Narrative Review

Abstract

Background. Prostate cancer is a leading malignancy in men, with incidence expected to increase by 2040. Curative treatments prolong survival, but they are associated with substantial adverse effects, particularly during androgen deprivation therapy (ADT), comprising physical functions and quality of life.

Aim. To review the current evidence on the efficacy and safety of exercise as an adjunctive intervention across the prostate cancer care continuum with its potential translation into practical clinical recommendations.

Material and methods. A narrative review of randomized controlled trials, systematic reviews and meta-analyses, mechanistic studies, and clinical practice guidelines from 2010–2026 was performed. The evidence was organized according to treatment phase and qualitatively evaluated with respect to efficacy, safety, and clinically relevant outcomes.

Results. Across all phases of prostate cancer management, structured exercise is safe and improves physical function, strength, body composition, and quality of life, attenuating the metabolic and cardiovascular effects of ADT. Exercise modality may be more important than dose in determining clinical benefits, with programs combining resistance and aerobic exercise showing the strongest evidence. Whether exercise improves oncological outcomes remains to be established.

Conclusions. Structured exercise is a safe and effective supportive care across the prostate cancer continuum. Individualized exercise prescriptions should reflect the treatment phase, patient needs, and clinical objectives. Adequately powered randomized trials with oncological endpoints and implementation research are needed to optimize translation into routine clinical care.