Prostate cancer diagnosis and treatment significantly impact the quality of life for many men, leading to anxiety, fear, and depression in up to one-third of cases. The rising interest in integrative medicine approaches, coupled with a need for better QoL management, has prompted research into therapies like yoga and meditation. Existing studies demonstrate yoga's positive effects on QoL and wellbeing in various cancer types. However, evidence for its efficacy in prostate cancer patients is limited. Yoga's mechanisms are not fully understood, but improvements in mindfulness, stress reduction, and inflammation modulation are suggested. This pilot study aimed to evaluate the impact of a perioperative yoga program on QoL, fatigue, sexual and urinary function, mindfulness, immune response, and inflammatory markers in men with prostate cancer scheduled for radical prostatectomy.

Numerous studies have shown the benefits of yoga in improving health-related QoL and mental wellbeing in cancer patients, particularly in breast cancer. Yoga has been linked to improved mindfulness, reduced anxiety and stress, and attenuation of oxidative stress and chronic inflammation. However, research on yoga's impact in prostate cancer is scarce, making this study crucial in exploring its potential benefits and underlying mechanisms within this patient population. Existing research on exercise interventions following radical prostatectomy often focuses on urinary continence, with limited exploration of cancer-specific QoL impacts. Studies have demonstrated that exercise improves fatigue and overall QoL in prostate cancer patients, supporting the rationale for investigating yoga's similar effects.

This was a block randomized, open-label, parallel-group clinical trial involving 29 men with newly diagnosed localized prostate cancer scheduled for radical prostatectomy. Participants were randomized into a yoga group (n=14) or a control group (n=15) receiving standard-of-care. The yoga intervention consisted of 60-minute sessions twice weekly for 6 weeks pre- and postoperatively. QoL was assessed using the Expanded Prostate Index Composite (EPIC), Functional Assessment of Cancer Therapy-Prostate (FACT-P), Functional Assessment of Chronic Illness Therapy-Fatigue (FACIT-F), and Functional Assessment of Cancer Therapy-General (FACT-G) at baseline, preoperatively, and 6 weeks postoperatively. Immune cell status and cytokine levels were analyzed from blood samples collected at these time points. Statistical analysis included t-tests, Wilcoxon rank-sum tests, and assessment of minimally important differences (MID) to determine clinically meaningful changes. A t-distributed stochastic neighbor embedding (tSNE) algorithm was used to analyze immune cell data.

Yoga intervention resulted in statistically significant improvements in several QoL domains. The largest benefits were observed in EPIC-sexual (mean difference, 8.5 points), FACIT-F (6.3 points), FACT-Functional wellbeing (8.6 points), FACT-physical wellbeing (5.5 points), and FACT-Social wellbeing (14.6 points). These improvements surpassed the minimally important difference (MID) for these measures, indicating clinically meaningful effects. The yoga group exhibited increased numbers of circulating CD4+ and CD8+ T-cells, enhanced interferon-gamma production by natural killer cells, and increased Fc receptor III expression in NK cells. Conversely, the yoga group showed reduced numbers of regulatory T-cells and myeloid-derived suppressor cells, suggesting enhanced antitumor activity. Significant reductions were observed in inflammatory cytokine levels, including granulocyte colony-stimulating factor (G-CSF), monocyte chemoattractant protein (MCP-1), and FMS-like tyrosine kinase-3 ligand (Flt-3 ligand).

This study provides preliminary evidence that perioperative yoga improves QoL and modulates the immune response in men with prostate cancer. The observed improvements in QoL align with findings from other studies examining yoga's effects in cancer patients. The immune changes, specifically increased cytotoxic T cells and NK cell activity alongside decreased immune suppression, support a potential antitumor effect of yoga. The reduction in inflammatory cytokines further contributes to the overall positive effects. The findings suggest that yoga could be a valuable adjunct therapy in managing prostate cancer, improving both physical and psychological wellbeing, and potentially bolstering the body's natural defense against the disease. However, the small sample size and short follow-up period limit the generalizability of these results.

This pilot study demonstrates that a perioperative yoga program improves quality of life and enhances certain aspects of the immune response in men with prostate cancer. The significant improvements in QoL, coupled with evidence of antitumor activity and reduced inflammation, warrant further investigation in larger, more robust trials. Future research should focus on long-term effects, the impact on disease progression and recurrence, and a more detailed exploration of the immunological mechanisms underlying yoga's benefits.

The study had a small sample size, limiting the statistical power and generalizability of the findings. Assessments were performed at only two time points, and patient adherence to the yoga program was not directly tracked. The lack of a priori hypotheses resulted in the absence of correction for multiple comparisons. These limitations highlight the need for larger-scale, more rigorously designed trials to confirm these preliminary findings.