Phillip Koo: 

So oftentimes when patients get diagnosed with prostate cancer, or they're undergoing treatment, we focus a lot on the actual treatments themselves, but a question that I guess get asked very often is, “What can I do besides that, to help improve my outcomes?” And there was some data presented on this idea of “prehabilitation.” So what is prehabilitation? And what does that mean for patients?

Zachary Klaassen:

Yeah, it's interesting. It's kind of a new word. It comes from rehabilitation. And so we think of rehabilitation as what do we do after something's been done, such as a surgery, or going through chemotherapy or going through hormone therapy. How do we get better after that's done? That's the rehabilitation.

So there's been a lot of great work, a lot of it led by Sarah Psutka, who's a urological oncologist and a dear friend of mine up at the University of Washington, and she spoke about this at the European meeting. And a lot of this comes out of the bladder cancer literature, because when we take out bladders and we put patients through treatment, it's really debilitating.

That whole aspect and certainly prostate cancer is no different in terms of some of the surgeries and the chemotherapies and the hormone therapies that people are on, and really what it comes down to prehab is getting yourself at your best, as you're getting ready for a big intervention. Whether that be surgery, chemo, hormonal therapy, radiation, etc.

And there's a lot of different ways we can sort of put this together. I think that the main things for the listeners is exercise is absolutely important. Whether that is going for a walk for ten minutes, moving it to twenty minutes whether–if you're already in shape, going for a twenty-minute run or thirty-minute run, sort of taking what your baseline is and starting to build on that. I think exercise, and Sarah definitely reiterated this in her presentation as well, there's no substitute for exercise for both the patients and everybody in general.

I think the other thing is, you know, some more actionable things, you know, smoking cessation is very, very important. And that's key for anybody undergoing anesthesia, anybody getting chemotherapy. All these things have more complications in people that are actively smoking.

You know, there's some really fancy stuff looking at digital tools to sort of track this, I think that's cool. But for the majority of patients, we don't need digital tools. We just got to have a plan. This may be resistance training, especially for people that are starting hormone therapy. We know there's bone mineral density issues, muscle loss with hormone therapy. 

So any resistance training, whether that's band workouts or light weights, weights, or swimming, aerobics, all these sorts of things to get yourself to where you're going to be at your peak performance, and that's different for everybody, before this intervention happens.

Phillip Koo:

That's great. So this idea of getting you into peak performance and ready to sort of deal with what might lie ahead. You know, can you talk a little bit about nutrition? Any sort of quick advice that you have with regards to nutrition, when it comes to sort of this idea of “prehabbing.”

Zachary Klaassen:

Yeah, absolutely. I think, you know, water intake is always key. I think, you know, the more water we drink, the better we feel. That's certainly part of the nutrition. But I think when we talk–when I talk to patients in the clinic about upcoming surgeries or upcoming interventions, and they say, “What can I do?” I always mention exercise, but to your point with diet, I think if we all focused on a heart-healthy diet, if we're lucky, that helps our prostate cancer treatment, maybe helps our prostate cancer prognosis.

But without a doubt it helps our heart health. And I think I never take a minute to not mention cardiovascular mortality is still number one in this country. It's still the number one cause of mortality among prostate cancer survivors. So anything we're doing that's good for our heart, lean meats, vegetables, fruits, water, etc., is going to be good for our overall health, and hopefully, even our prostate cancer health as well.

Phillip Koo:

You know. That's a great message. And patients and their caregivers. You could–you can control that diet, that exercise, nutrition. So you know, do your best, and I think you'll set yourself up for the greatest degree of success afterwards.