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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!