For my 400 level class to my undergraduate degree, we were separated into research groups and choose a topic. The topic we researched all semester was sexual dysfunction. This topic incorporated prostate cancer and menopause. The following slide show is the result and conclusions of several papers read by our group. We were able to conclude with an exercise prescription to slow the progression of prostate cancer. including: mode, duration, frequency, and intensity. Through collaborative analysis of other studies, we were also able to conclude sexual recommendations to slow the disease and lower risk. Enjoy.

1. **click on the titles of the studies to be directed to the link
Sexual Dysfunctions
Rielly Moore, Becca Nygaard, Vanessa Hawkes, Natalie
Hughes, Natalie Wehrhahn

2. Prostate Cancer (PCa)
● One in seven men will be diagnosed with Prostate Cancer
● CANCER RANKS SECOND only to heart disease as the leading cause of
death in North America
● Healthy prostate is the size of a walnut
● Black people are at increased risk
● 20-29 Low/High Risk, 30-49 Medium Risk, 50-69 High Risk
● Higher risk if father or brother is diagnosed (2,5 times)

3. Introduction to
Recommendations
❏ Introductions
❏ Physical Activity
-Exercise
-Frequency
-Duration
-Intensity
-Mode
-Sexual Activity
-Frequency
-Treatment
-Prevention
-Hormones
-Correlation with Women and Menopause
❏ Recommendations
❏ Conclusion

5. Exercise for PCa:
A Prospective Study of Physical Activity and Incident and Fatal Prostate
Cancer:
-This study concluded that men >65 years old with vigorous exercise had a
70% reduction in developing Advanced Prostate Cancer, and slowing the
progression of PCa with 30 MET hours/week (25 min/day).
Recreational physical activity and risk of prostate cancer: A prospective
population-based study in Norway
-This study concluded that recreational physical activity was not associated
with overall prostate cancer. It does reduce the risk of advanced prostate
cancer, and can protect against prostate cancer death. Men who reported 1
weekly bout of exercise had a 30% lower risk of being diagnosed with
metastatic prostate cancer compared to men who reported no activity.

6. Exercise and PCa
Overall, any kind of exercise, even once a week, will help
with the reduction in developing Advanced PCa, and
slowing the progression of PCa

7. This graph shows how many of the studies read showed significance
in slowing the progression of Prostate Cancer (PCa).

8. Frequency:
A Prospective Study of Physical Activity and Incident and
Fatal Prostate Cancer
**refer to previous slide
Men, ages 65 and older, who participated in 30 MET hours per week would have a 70%
reduction in advanced prostate cancer.
30 MET hours per week equivalent to 3 hours of physical activity.
Men 65 and older should exercise 3 days a week to decrease the risk of being diagnosed
with high-grade, advanced, or fatal PCa
*physically active men may be at lower risk, but it is moderate and not statistically significant
all the time and sometimes only evident in older groups 65 and older and with high levels of
physical activity (vigorous)

9. Frequency cont.
Recreational physical activity and risk of prostate cancer. A
prospective population-based study in Norway (the HUNT
study).
Men who reported working out at least once a week had a 30% lower risk of
metastatic PCa than those men who did not exercise at all [27].

10. Frequency cont.
Exercise Prevents Fatigue and Improves Quality of Life in
Prostate Cancer Patients Under Radiotherapy
randomized study to show fatigue prevention and quality of life improvements from cardiovascular exercise
during radiotherapy; fatigue is the initial manifestation of cancer
21 subjects - ages 68-70
10 control: radiotherapy and no exercise
11 intervention radiotherapy and aerobic exercise 3x a week 8 weeks
*showed statistical improvements in these areas:
❏ Cardiac fitness (P=0.006)
❏ Strength (P=0.000)
❏ Flexibility (P<0.01)
❏ Fatigue (P= 0.001)
❏ Physical well-being (P< .001)
❏ Social well-being (P=.002)
❏ Functional well-being (P=.04)
**statistical significance pvalue of .05 or less

11. Exercise group:
7 of the 12 showed statistical significance (METS, stand-and-sit
test, flexibility, PFS, physical well-being, social well-being, FACT-P)
4 of the 5 other variables had changes in the direction of improvement
(BDI, relationship with the physician, emotional well-being, functional well-being)
Control group: showed significantly worse post-radiotherapy scores
8 out of the 10 (without statistically significant changes)
changed in the direction of poorer performance (METS, stand-and-
sit test, flexibility, BDI, physical well-being, social well-being, relationship with the physician,
functional well-being)
Conclusion:
There is evidence that physical activity influences other
aspects of the cancer experience: decreased fatigue,
improved recovery rate, improved quality of life, and
increasing survival after cancer diagnosis.

12. Frequency Recommendations
3 days a week - decreasing risk and improving symptoms in PCa
patients.
Any type of physical activity no matter the frequency will improve lifestyle for individuals

13. Duration
Physical Activity after Diagnosis and Risk of Prostate Cancer Progression: Data from the Cancer of
the Prostate Strategic Urologic Research Endeavor
physical activity was rated from none - 11h/wk
Main focus was PCa progression defined as death from PCa, bone metastases, biochemical
treatment, or secondary treatment.
It was found the those men who walked 30 MET h/wk or more at a brisk pace had a 57% reduction in
cancer progression when compared with those who did less than 30 MET h/wk. [P=0.03]
Independent of duration
Those who did 30 MET h/wk or more of vigorous exercise had a 37% reduction in cancer progression
when compared to those who didn’t. [Ptrend=0.17]

14. Duration Recommendations
duration recommendations are as follows:
over 60 minutes (>72 MET hours) required for significant
changes

15. Intensity
A Prospective Study of Physical Activity and Incident and Fatal Prostate
Cancer
The main findings within this study was the significant results in the age group of 65 or older. It was
found the those 65 or older who worked out vigorously saw decreased risk for both non-advanced
and advanced prostate cancer. respective values of P=0.009 and P=0.003.
vigorous define as running, jogging, biking, swimming, tennis, racquetball/squash,
rowing/calisthenics, heavy outdoor work, and weight training
Non-vigorous defined as flights of stairs climbed and walking.

17. Mode
-Aerobic (prolonged and steady) training proved to be beneficial in treatment
of PCa when combining all the studies that mentioned mode of exercise
-Resistance training raises testosterone levels in the body, which was
theorized to lower the risk of PCa. It also reduces fatigue and improves
muscular fitness
-Both have shown significant results
-Many of the studies that we read used the following activities for exercises:
❏ Running
❏ Jogging
❏ Biking
❏ Swimming
❏ Tennis
❏ Racquetball/squash
❏ Rowing/calisthenics
❏ Heavy outdoor work
❏ Weight training

18. Mode
*All studies below showed significance in slowing progression for PCa

19. Treatment and Prevention
Treatment
● Exercise
o Fatigue
o Body Mass
o Bone Density
Prevention
● Exercise
o Hormone levels
● Sexual Activity
o Ejaculation Frequency
o Prostate Cells
o Carcinogens
o STD’s

20. Current treatment available
PCa:
Hormone (androgen deprivation) therapy
reduces the levels of male hormones before they reach cancer cell
testosterone and dihydrotestosterone (DHT)
does not cure and eventually stops working
Surgery - radical prostatectomy, Castration
Radiation therapy
Menopause:
Hormone therapy
Increase Testosterone and Androgens

21. Sexual Activity & Ejaculation
Recommendations
*Recommendations given based off
year lifetime average
**limitation: questionnaires (not completely accurate or
honest)
We can confidently recommend to aim for
over 21 ejaculations per month

22. Sexual Behavior, STDs and Risks for
Prostate Cancer
Risk increase with Gonorrhea and Syphilis 1.6 x higher first time, 3.3 x higher if 3 times
Not using a condom and interactions with prostitutes increases risk
Family History 2 fold increase in risk with father being diagnosed, 5 fold increase in risk if
brother is diagnosed.

23. Ejaculation frequency and subsequent
risk of prostate cancer
Average Lifetime Ejaculation and correlation with risk >21,
decreased risk of developing prostate cancer
From each increase of 3 times a month showed 15% decreased risk in overall
PCa
Organ Confined showed 19% decreased risk with each increase of 3
Advanced cancers 40-49yrs old 4-7

24. Hormones and Prostate
Cancer
❏ Oxford University released a collaborative study in which they analyzed
18 papers discussing Hormones and PCa.
❏ There was no associations found between the risk of PCa and serum
concentrations of:
❏ Testosterone
❏ Calculated free testosterone
❏ Dihydrotestosterone
❏ Dehydroepiandrosterone sulfate
❏ Androstenedione
❏ Androstanediol glucuronide
❏ Estradiol,
❏ Calculated free estradiol
❏ ONE paper out of the 18 DID show a modest inverse relationship
between the serum concentration of sex hormone–binding globulin
(SHBG) and PCa risk (Ptrend = .01)

25. The One SHBG Study:
❏ What they did: Initially a study on Aspirin, blood kits were sent to all
participants with instructions to have their blood drawn and sent back
under proper conditions.
❏ Blood results were as following: estradol, 6.8%; testosterone, 8.7%;
DHT, 5.3%; SHBG, 8.9%; prolactin, 4.4%; and AAG, 7.6%.
❏ By March of 1992, 520 cases of prostate cancer were confirmed among
participants. Only 222 had plasma samples sufficient for analysis.
❏ High levels of plasma testosterone compared with low levels (within the
normal endogenous range were associated with an approximately 2.5-
fold increase in the risk of developing prostate cancer after adjustment
for plasma SHBG and estradiol.
❏ Men with the highest levels of SHBG (Increased levels of SHBG odd
ratios by quartile =1.00, .93, .6, and .46) <P trend.01> had about 50%
lower risk than men with lowest SHBG levels.

26. Increasing Sex Hormone Binding Globulin
through Exercise
Researchers had participants exercise (specifics detailed in study) and were measured at baseline,
3, and 12 months.
Results:
Exercise increased levels of the hormones DHT(dihydrotestosterone) and SHBG, but it had no
effect on the other hormones for men.. Exercisers had significantly increased DHT and SHBG
levels at 3 and 12 months after randomization when compared with participants who did not
exercise.
SHBG increased 14.3% in exercisers versus 5.7% in controls at 3 months (P=0.04); at 12 months,
it remained 8.9% above baseline in exercisers versus 4.0% in controls (P=13).

27. Menopause
● Menopause is what occurs 12 months after a woman’s last menstrual
period which marks the end of their menstrual cycle.
○ 3 phases (pre, peri, post)
● Typically occurs in 45 to 55 age range
● Common symptoms
○ Menstrual irregularity
○ Hot flashes
○ Sleep problems
○ Mood changes
○ Vaginal and bladder problems
○ Changes in sexual function (desire)
○ Loss of bone

28. Physical Activity and Sexuality in
Perimenopausal Women
- This study concluded that there was a significant correlation between
sexual dysfunctions and the general level of physical activity. Best results
were seen at high levels of physical activity. This study measured the
amount of physical activity by looking at;
● Job related physical Activity
● Transportation related physical activity
● Housework related physical activity
● Leisure related physical activity
High Levels of physical activity was defined as:
– vigorous activity on at least three days resulting in at least 25 MET-hours/
week (MET-Metabolic Equivalent of Work),
or
– seven days per week with any combination of walking, moderate-intensity
or vigorous activities representing at least 50 MET-hours/
week;

29. Results
● Because of the lack of research on physical activity and Menopause we
can not confidently recommend a certain amount of physical activity.
The research that was found shows improvements with physical activity
at vigorous levels. But common treatment is Hormone therapy.

30. Correlation: This chart shows the age range and risk level of
prostate cancer which is shown in blue and then in red it shows the
age at which women are going through menopause. Typically women
are going through menopause at the same time that men are at
highest risk for prostate cancer.
Fun Fact: The average age difference between couples is between two to three years

31. Recommendations
● Menopause Treatment
o Moderate to Vigorous
o Hormone Therapy
● PCa Prevention: Sexual Activity
o Ejaculation: >21 times/month
Lifetime avg.
o Older first time sexual
intercourse
o Less number of sexual
partners
● Treatment
● For men older than 65
o Frequency: 3 days/week
o Duration: >29 MET hrs/week
o Intensity: Vigorous
o Mode: Aerobic and
Resistance exercises
● For men <65yrs old
o Frequency: 3 days/week
o Duration: 6 MET hrs/day (60
min/day)
o Intensity: Light to vigorous
o Mode Aerobic and
Resistance Exercise

32. Conclusions
-More ejaculations, when younger (30 and older) decrease risk of developing PCa.
- STD’s and increased number of sexual partners increases risk.
-Males > 65 years old with vigorous exercise have a 70% reduction in developing
Advanced PCa, and slowing the progression of PCa
- Exercise after diagnosis improves quality of life, decreases fatigue, and slows
progression of PCa.
-From all of our studies we can hypothesize that women going through menopause
occurs during a crucial time for men in prevention of prostate cancer, which can be
an increased risk for men

33. Resources
*every title to a study in the powerpoint is a hyperlink to the actual study
mentioned
**link to the excel document with all our references used in this project:
https://docs.google.com/spreadsheets/d/1SIrJ4EfhvD7L74Ltx_g3MvRBqHP3
4JVGDwYy7dYt52I/edit?usp=sharing