Seminar article Physical activity and urologic cancers Kathleen Y. Wolin, Sc.D.*, Carolyn Stoll, M.P.H., M.S.W. Division of Public Health Sciences, Washington University School of Medicine, 660 S Euclid Avenue, Box 8100, St. Louis, MO 63110, USA Received 11 June 2011; received in revised form 6 August 2012; accepted 6 August 2012 Abstract Despite convincing evidence that physical activity protects against colon and breast cancers, the association of physical activity with urologic cancers is less well explored. Expert panels have previously found a probably protective benefit for prostate cancer, but insufficient evidence for other urologic cancers. We review the evidence for testicular, kidney/renal, bladder, and prostate cancers, including whether benefits may exist within subgroups. While the limited evidence base does not support an association of physical activity with either testicular or bladder cancers, a growing body of research suggests that physical activity results in a modest risk reduction for kidney cancer. A large number (30) of studies suggests a probable small decrease in prostate cancer risk among those who are physically active, which is likely driven by the effect on advanced/aggressive tumors. The role of physical activity in decreasing urologic cancer risk is thus likely limited to advanced prostate and possibly kidney cancers with no association in testicular or bladder cancers. © 2012 Elsevier Inc. All rights reserved. Keywords: Prostate cancer; Bladder cancer; Kidney cancer; Testicular cancer; Exercise; Physical activity 1. Introduction In 2002, the International Agency for Research on Can- cer (IARC) issued a report stating convincing evidence showed that physical activity protects against breast and colon cancer, while a suggestive moderate effect was seen in prostate cancer and an inconsistent effect was seen in kidney cancer [1]. Since then, other researchers have reached similar conclusions for breast and colon cancer and have similarly found suggestive, but less conclusive, evi- dence for a decreased risk of endometrial, prostate, and lung cancers [2– 4]. More recent updates have yielded similar conclusions regarding relations with prostate cancer, with some reviews [5] arguing there is a possible association and others [6] concluding a small risk reduction exists. Data are much more limited for other urologic cancers, yet little of the evidence suggests either a strong or convincing associ- ation exists, such that reviews tend to conclude data are insufficient to conclude an association does or does not exist [4,5]. 2. Materials and methods We reviewed the literature on the association of physical activity with testicular, bladder, kidney/renal pelvis, and prostate cancers. In addition to searches of PubMed and the citations of published studies, we draw on existing expert reviews and reports, including the 2007 World Cancer Re- search Fund/American Institute for Cancer Research (WCRF/AICR) expert report [4] and the 2002 IARC expert report [1]. We focus on issues related to study design, subgroup specific associations, physical activity specific issues in methods or results, and possible mechanisms to inform our understanding of the evidence base. 3. Findings 3.1. Testicular The 2007 WCRF/AICR expert report did not find suffi- cient data to assess evidence of a relation between physical activity and testicular cancer [4]. Other reviews have ex- plored the data, but have similarly found data inconsistent [7,8] or insufficient with a suggestive decrease in risk for childhood physical activity [5]. Both cohort and case-con- trol studies have investigated the relation between physical The authors declare no conflict of interest. * Corresponding author. Tel.: +1-314-454 7958; fax: +1-314-454- 7941. E-mail address: wolink@wustl.edu (K.Y. Wolin). Urologic Oncology: Seminars and Original Investigations 30 (2012) 729 –734 1078-1439/$ – see front matter © 2012 Elsevier Inc. All rights reserved. http://dx.doi.org/10.1016/j.urolonc.2012.07.009