Physical Activity During Radiotherapy in Prostate Cancer: Feasibility, Outcomes, and Clinical Integration

Physical activity (PA) is a safe and feasible intervention for prostate cancer (PCa) patients undergoing radiotherapy (RT) and may improve cancer-related fatigue, physical function, and quality of life (QoL). However, evidence specifically addressing PA delivered during RT and the biological mechanisms supporting potential radiosensitisation or normal-tissue protection remains heterogeneous.

We conducted a narrative review of studies published in the last 10 years evaluating PA interventions in men receiving RT for PCa or in survivors previously treated with RT, focusing on feasibility/adherence, safety, treatment-related toxicity, physical function, body composition/metabolic outcomes, and patient-reported QoL.

Supervised PA, both cardiovascular and strength-based, is safe and feasible during RT, with high adherence and low risk. Across trials, PA is associated with reduced short-term fatigue, better maintenance of muscle mass and physical performance, and improved QoL, including in men receiving concomitant androgen deprivation therapy. Evidence suggesting positive effects on urinary and bowel symptoms and the therapeutic index is emerging, although mechanistic data in humans during RT are limited and largely indirect.

Current evidence supports integrating structured, individualised PA as an adjunct to RT for PCa, given its consistent functional and quality-of-life benefits and favourable safety profile. Future trials should standardise PA dose and outcomes and further clarify dose-response relationships and biological mechanisms during RT.