Prostate cancer is a complex health problem with many variants and subtypes.
Most men develop this type of cancer at a very advanced age. Some of them are unlikely to die from prostate cancer and only undergo active surveillance. Others have aggressive types of prostate cancer and need urgent treatment.
In either case, prostate cancer symptoms are usually similar to those of benign prostatic hyperplasia (BPH). They include mainly urinary problems such as a slow urinary stream, waking up to urinate at night, and sometimes urinary retention.
But even medical treatment causes new symptoms and side effects. For example, radiotherapy and chemotherapy cause severe fatigue. Surgery and androgen deprivation therapy can cause temporary erectile dysfunction. And there’s also a significant emotional burden and stress associated with prostate cancer and its treatment.
Several therapies are available, apart from surgery, chemotherapy, and other medical treatments.
Physical activity is a useful complementary, and different exercises are beneficial to improve prostate health. But they are also useful to control symptoms associated with the side effects of medical treatment. Yoga is one of those physical activity modalities, as we’re reviewing in this article.
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How can yoga benefit prostate cancer?
For decades, and sometimes supported by personal experience, we know that yoga is useful to reduce stress.
It is also helpful to control physical fatigue and other symptoms associated with cancer treatment. However, recent studies showed that we could also use yoga in patients with prostate cancer. Taking a yoga class twice a week is apparently very useful, especially for patients who are undergoing treatment.
Recent research shows that it is associated with fewer sexual health problems, less fatigue, and improved urinary function. So, it works if you’re undergoing hormone therapy, surgery, radiotherapy, or any other treatment modality.
What the research says
The leading investigator in this study is Dr. Beha Vapiwala, from the University of Pennsylvania School of Medicine. Her research group recruited 50 men with different stages of prostate cancer. None of the patients had metastasis (bone metastasis or any other). Their age was between 53 and 85 years, and their age of diagnosis was varied.
They designed a randomized controlled trial with these participants. 22 of these patients were assigned to a yoga group and received yoga classes twice a week. The rest did not take yoga classes and continued with their treatment without any change. None of them practiced yoga before they were enrolled. Treatments were similar, and all of them underwent radiotherapy.
During the yoga classes, the participants were instructed with Eischens yoga. This is a type of restorative yoga. It is quite simple and only requires learning and holding specific yoga poses. It is a type of yoga exercise available for everyone regardless of their age and body type.
Eischens yoga includes different poses and allows for standing, sitting, or reclining positions according to each body type, flexibility level, and ability. It does not require any level of expertise or previous experience. Each yoga session lasted up to 75 minutes, and they were held twice a week for 9 weeks.
The researchers asked the participants of both groups to rate how they felt. They evaluated fatigue level, urinary symptoms, sexual health symptoms, and other parameters. The results were impressive, and the difference was notable and very reliable. Patients who did not practice yoga had worsening symptoms over time. Conversely, patients in the yoga group had a better outcome. They either stabilized or improved their symptoms, even under continuing treatment. The changes in the yoga intervention group were very positive and encouraging.
Treating prostate cancer
Treatment for prostate cancer is sometimes mild, but some patients need a very aggressive approach. Otherwise, cancer may become out of control or grow very rapidly. One of the most common treatments is prostate surgery, and erectile dysfunction is one of the most commonly feared side effects.
With the most recent nerve-sparing techniques for radical prostatectomy, it is very unlikely that you will have a permanent sexual problem. However, erectile dysfunction may show up as a temporary side effect in these patients. The blood flow, the inflammation, and the nerves’ stretch during surgery are the most common reasons.
According to the study’s leading researcher above, Dr. Vapiwala, yoga improves cancer treatment side effects for many reasons. It strengthens the muscles, improves the blood flow, and enhances the emotional state of patients. Altogether, these factors significantly improve symptoms after surgery and other therapeutic options (1).
But let us review the most common side effects of surgical treatment, radiation therapy, and hormone therapy. How is yoga useful to lessen the impact of their side effects on a man’s life?
Yoga is known as a powerful aid for physical and emotional stress. According to studies, a quick yoga session promotes stress reduction and blood pressure control at any time of the day.
One of the reasons is that yoga is a relaxation technique. It improves mood and promotes mindfulness, which is also an important technique. This is evident in breast cancer patients, prostate cancer, and many other diseases.
Through controlled breathing exercises, stretching, and mental imagery, yoga can help you control stress. These are widely known relief techniques commonly used as stress management recommendations. They can be useful for prostate cancer patients who undergo several challenges from day one.
A cancer diagnosis can be difficult to assimilate, and cancer care changes our life radically. The treatment often makes you feel tired and compromises your work. It creates new problems for you, for your family, and your interaction with your loved ones. But yoga can reduce the effects of anxiety and stress, help you sleep, and give you a renewed sense of wellbeing.
No wonder why the name “Yoga” means bringing together. It refers to joining the body and the mind and learning to get yourself together with your own will (2).
One of the most striking results of the study by Dr. Vapiwala was the reduction in fatigue levels. Prostate cancer patients who underwent radiotherapy know how it feels in-between sessions. Cancer-related fatigue is one of the worst symptoms. It usually becomes more severe as the dose increases.
Yoga is known to reduce fatigue in other types of cancer, too. It has this particular effect through the practice of mindfulness. This practice focuses the attention on the here and now, improving focus and concentration. By doing so, the energy is not dispersed in multiple thoughts and activities. Instead, it is conserved and used with a better economy.
Another possibility has to do with cortisol and stress management. As mentioned above, yoga is an excellent aid for physical and emotional stress. This releases the hormone cortisol, known as the stress hormone. Through this hormone, the heartbeat increases, the metabolism accelerates, and the body consumes more energy. By modulating our circulating levels of cortisol, yoga may contribute to reducing the calories and energy spent by the body.
Either way, the difference before and after taking yoga lessons is striking, according to studies. Patients receiving radiotherapy or chemotherapy for prostate cancer may experience significant benefits with this practice. And it only takes 75 minutes twice a day, according to scientific evidence (1).
There is a very close link between our physical health, our perceived wellbeing, and our sexual health. Thus, it is reasonable to think that yoga improves sexual health by enhancing our wellbeing and physical health.
For example, yoga helps to focus on deep breathing and pay more attention. It also reduces the sensation of anxiety and may improve depressive symptoms. It is an excellent aid for stress management, as mentioned above, and induces relaxation. By doing all of this, yoga modulates the activity of the parasympathetic nervous system. This branch of the nervous system is deeply associated with erectile function.
All of the effects above contribute to improving sexual response in yoga practitioners. They tend to objectify their bodies to a lesser degree, increasing awareness in their sexual experience. Thus, they tend to develop better sexual assertiveness and may even increase their sexual desires.
Since yoga is deeply associated with mindfulness, it also contributes to staying present at the moment. This reduces worry and stress during sexual intercourse, which also contributes to erectile dysfunction. Lower distraction, more focus, and nervous system modulations may be the reason why yoga improves sexual health (3).
The study mentioned above evaluated sexual function by using the International Index of Erectile Function Questionnaire. The participants under the yoga group experienced significant improvements not reported by the control group. Thus, yoga may be recommended for patients who undergo surgery as a part of their sexual health rehabilitation. This is often a slow process that takes a few months to complete after surgery.
In most cases, patients recover their erections after a nerve-sparing procedure. However, yoga can be another useful tool to accelerate the process and recover erections faster (1).
Lower Urinary Tract Symptoms, also known as LUTS, are common in patients with prostate cancer. They may not be predominant in the earliest stage of the disease. But as the prostate grows, it creates pressure upon the urethra and causes an obstruction.
Inflammation, so dominant in cancer, is another cause of LUTS in prostate patients. It irritates the bladder and the urinary tract, reducing its capacity to hold urine. Thus, patients mainly have LUTS (waking up at night to urinate and increased urinary frequency). They usually have obstructive LUTS, too (slow urinary stream, straining, and hesitancy in urination).
What the research says
According to studies, yoga reduces the severity and frequency of urinary symptoms in these men. It mainly affects storage LUTS, the first symptoms reported in prostate cancer patients. Then, yoga positively impacts controlling nocturia (the habit of waking up several times at night to urinate). It is also useful against urinary urgency and the typical increase of frequency we see in prostate cancer.
Previous studies suggest multiple reasons that explain the improvement in urinary function. Most of them mention that yoga programs strengthen the pelvic floor muscles. By holding poses and strengthening these muscles, men regain their ability to control urinary function.
Another suggestion is that yoga regulates the autonomous nervous system and activates the central nervous system. In other words, it increases awareness and reduces the involuntary control of the bladder. Thus, it helps prostate cancer men to control the urinary system through increased focus and concentration. However, there is no evidence provided for this particular mechanism (4).
According to the study reviewed above, prostate cancer patients under treatment improve their urinary symptoms faster when they go to their yoga classes in a clinical trial setting. The improvements in urinary function are better than the control group, under treatment but without a yoga practice (1).
Yoga poses for prostate cancer
The best yoga poses for prostate cancer are similar to those recommended for prostate enlargement. They should be focused on stretching the pelvic floor and relieving tension. They also strengthen the pelvic floor, and some of them are similar to Kegels.
You can start your practice with the following:
The Cobbler Pose (also known as Baddha Konasana)
Another name is a butterfly stretch because the movement is similar to a butterfly opening the wings. It is a seated position that helps to relieve tension in the pelvic floor. Sit on a mat or cushion with your legs extended. Bend your knees and place them to each side, with your soles touching one another. With your hands, hold together your feet and lower the knees to the floor. It doesn’t matter if you do not touch the floor. Just reach as close as possible to the floor. When your soles are secured, take your hands to your knees, and keep breathing deeply. Hold the pose for 1-2 minutes.
The Hero Pose (also known as Virasana)
This is another easy yoga pose that releases pelvic tension. The starting position is by sitting on the floor between your feet, with your toes pointing backward. You will be sitting on your knees, touching the ground, and using a cushion if you want to be more comfortable. Straighten up the spine and your neck and take a few deep breaths. This pose is also great to release tension in your legs and improve blood circulation.
The hand to toe pose (also known as Supta Padangusthasana)
This pose is a great way to strengthen your pelvic floor muscle. It is a preparatory pose to other advanced techniques. To start with, you should lie on your back, with your legs extended. Bend one of the knees and straighten your leg perpendicular to the floor. It’s as if you’re creating a letter L with your body. Then, touch your big toe with your hand and keep the pose as straight as possible. Breathe deeply and maintain the position for a few seconds. If you cannot do this on your first try, you can help yourself with a stretching strap. Talk to your yoga instructor to ask how to use a stretching strap for this particular pose.
The Bow Pose (also known as Dhanurasana)
After stretching and relaxing your pelvic floor, you can also strengthen them with Dhanurasana. You can start by lying on your stomach with your hands on each side. Lift your legs and raise your head and back so that only your stomach is touching the floor. Grab your ankles with your hands and breathe. Hold this pose for 30 seconds. This pose is somewhat more difficult, and if you can’t do it on your first try, it’s because you should master other poses before. A Yoga teacher can help you if this is your case.
The head to knee pose (also known as Janu Sirsasana)
It is also possible to release tension in the pelvic floor and strengthen the muscles at the same time. This pose can do that for you, and it is a great way to promote blood circulation. The starting position is merely sitting on the floor with your legs extended in front of you. Then, bend one of your knees and place the sole of your feet on the opposite thigh. Bend your body towards your extended leg without rounding your spine. Breathe and maintain the pose for a few seconds. Then, repeat on the opposite side.
Prostate cancer therapy is excellent at reducing the risk of high-grade cancer. However, it also causes a few symptoms and sometimes side effects. It is a source of severe stress and emotional challenges as everything changes in the patient’s life.
Even nerve-sparing surgery can cause a temporary loss of erection function. And we can’t expect urinary symptoms to go away immediately. However, yoga therapy appears to be an excellent complementary cancer treatment in these cases.
According to a recent study, practicing yoga while receiving treatment reduces the side effects and severity of prostate cancer symptoms. Cancer survivors can experience a reduction in lower urinary tract symptoms, tend to regain their sexual life faster, and experience less cancer related fatigue, anxiety, and stress.
It can be combined with mindfulness and meditation and relaxation techniques, and patients can practice the poses with their caregivers and a yoga therapist. Yoga and cancer treatment can be thus good allies to improve the quality of life (QOL) and life expectancy of these patients.