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One of the most common complaints my patients have is fatigue. There is little doubt that being de-androgenized leads to loss of muscle strength. But there are many other causes: aging, cancer, chemotherapy, anemia. Any/all of these have been studied in relationship to fatigue and fighting them can sometimes produce excellent results, most of which have been documented in various studies. Take anemia. Often I find that pca patients on hormonal therapy will drop their hemoglobin from the 14-16 normal range down to around 12. Transfusion at 12 seldom produces any difference in fatigue or exercise tolerance. However, it is important to recognize this phenomenon and not have your doctor go chasing vitamin deficiency (especially iron) unless there are other indications like a low red cell volume. You need T in order to maintain a healthy level of hemoglobin. No T, and PSA will go down, but so does the red cell count. Transfusion at hemoglobin below 10 is often helpful.
As for fatigue from inactivity or other causes, my thanks to Medscape for providing some interesting articles on which to blog. In this case, a recent article brought to our attention describes a small randomized trial of Qigong versus stretching in fighting fatigue and emotional problems in patients with prostate cancer. Qigong is described in wikipedia as being “a practice of aligning breath, movement, and awareness for exercise, healing, and meditation”. In the study, 40 fatigued prostate cancer survivors were randomized to stretching classes versus qigong classes, and the latter group had a lower dropout rate as well as greater improvement in a “fatigue and distress” questionnaire. Of course let’s remember that the class leaders probably had lots more suggestive language about “letting the good humors in and bad humors out” during all the breathing exercises than the stretching instructors. I would be pretty skeptical about such a study in general.
Nevertheless, I strongly recommend we all get off our butts and do more exercise. Patients who do so survive longer, have better stamina (else why would the NFL players have “2-a-days” during training season?), and can do more with their families. Although meta-analyses of exercise studies aren’t all that strong, they do indicate a real trend in better life for exercisers. “Current data suggest that incontinence, fitness, fatigue, body constitution, and also quality of life can be improved by clinical exercise in patients during and after prostate cancer.” Maybe you can even find an attractive Qigong instructor to encourage you!
prost8blog 
Few cancer patients are unaffected by fatigue. Thus it is easy to blame fatigue on cancer. That doesn’t mean fatigue should be ignored. A moderate work-up should still be done to rule out other causes beyond ‘having cancer’, causes such as blood loss, low thyroid function and vitamin B-12 deficiency. Often as not this hunt will come up empty.
Exercise does indeed prove to be a decent treatment for this fatigue, especially for those being treated with chemotherapy.
Another sometimes useful intervention is ginseng. A RCT written by Debra Barton et al from Mayo published last July provides more detail on how to use and dose ginseng. These researchers used American ginseng rather than the more traditional Korean species, probably because Wisconsin’s ginseng growers supplied them with raw material. They used 2000 mg/day of dried ground root that was app. 3% ginsenosides. [see: “Wisconsin Ginseng (Panax quinquefolius) to ImproveCancer-Related Fatigue: A Randomized, Double-Blind Trial, N07C2. Debra L. Barton, Heshan Liu, Shaker R. Dakhil et al,”]
Barton point out something that I was previously unaware of, that in comparing the various extracts available on the market, care should be taken to distinguish between methanol and water extracts as the former will exhibit some degree of estrogenic effect, a concern more relevant in breast cancer of course but that might theoretically enhance estrogen effect during testosterone suppression therapy.
Another great article. I read it early this morning, then went to my workout at 24 Hour Fitness and now re-read it. It is a constant battle to keep muscle mass when you have not androgen but it works. Qi sounds interesting. I tried Yoga and it was helpful but I aggravated hip inflammation so will look into this. I do believe in the mind-body connection. You are as good as you feel. “Judge a man by his questions rather than by his answers.”
— Voltaire,
French writer and historian
Is exercise the “philosopher’s stone” of the 21st century?
absolutely is, although the gold may be more attainable
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