The research team, led by Sydney Yearley of Tufts University School of Medicine and the Harvard T.H. Chan School of Public Health, together with co-first authors Colleen B. McGrath and Hannah E. Guard, conducted a scoping review of exercise intervention studies that quantitatively measured depression or anxiety in survivors of the three major male genitourinary cancers. The reviewers searched the Embase and PubMed databases from their inception through June 2, 2025, and two reviewers independently screened titles, abstracts, and full texts before systematically extracting data from the eligible studies. From 2,314 unique search results, only 25 studies met the inclusion criteria.

The distribution of that evidence tells its own story. Twenty-four of the 25 included studies focused on prostate cancer, a single study examined testicular cancer, and not one investigated penile cancer. Within the prostate cancer literature, 23 studies assessed depression, 17 assessed anxiety, and four used a composite endpoint capturing both conditions. This concentration reflects the sheer scale of prostate cancer as a survivorship issue, but it also means that clinicians treating testicular cancer patients, who are typically younger and face distinct psychosocial burdens, have almost no direct trial evidence to guide exercise-based mental health care.

The interventions themselves varied considerably. The studies employed aerobic training, stretching, and strength-based exercise, and roughly half were multi-modal programs that combined several exercise types within a single protocol. A notable pattern emerged in program duration: 19 of the 25 studies lasted twelve weeks or less. That brevity matters, because depression and anxiety are often chronic or recurrent conditions in cancer survivors, and short trials may be structurally incapable of detecting the sustained psychological shifts that longer interventions could produce. The review’s authors suggest that future work should evaluate multi-modal interventions, including those that combine physical exercise with psychological components, in these patient populations.

The biological rationale for expecting mental health benefits from exercise in cancer survivors is well established in the broader literature. Exercise has documented antidepressive effects in randomized trials across populations, and international consensus statements, including the 2019 exercise guidelines for cancer survivors produced by a multidisciplinary roundtable, already recommend physical activity for a range of treatment-related symptoms. Cancer survivors face elevated risks of depression and anxiety compared with the general population, and epidemiological studies have linked cancer diagnosis to increased risks of suicide and cardiovascular death, making accessible, low-risk interventions particularly valuable in this group.

Prostate cancer patients on androgen deprivation therapy represent a especially vulnerable subgroup, because the hormonal suppression central to their treatment can itself worsen mood, fatigue, and cognitive function. Several of the included trials specifically enrolled men undergoing this therapy, including a year-long randomized controlled trial by Galvão and colleagues that examined psychological distress in men undertaking androgen deprivation therapy and found modifying effects of exercise. Other prostate cancer studies tested qigong, tai chi, home-based walking, high-intensity interval training, resistance training, and prehabilitation programs before radical prostatectomy, reflecting an unusually diverse methodological toolkit for a single cancer type.

The findings from testicular cancer, though drawn from a single study, offer a cautionary counterpoint. In that trial, high-intensity interval training did not improve depression and anxiety compared with usual care among testicular cancer survivors. The result does not rule out benefits from other exercise modalities or longer programs, but it underscores how little can be generalized from the prostate cancer literature to younger men with a different disease trajectory, different treatment toxicities, and different life-stage concerns such as fertility and long-term survivorship.

For prostate cancer, the picture was more encouraging but still qualified. Several studies of multi-modal interventions found improvements in depression and anxiety, though not all of those improvements were statistically significant. The review’s authors characterized the overall association as modest, and the scarcity of statistically significant outcomes across the field suggests that many trials may have been underpowered for psychological endpoints, or that single-mode, short-duration exercise simply produces effects too small to clear conventional significance thresholds. Measurement is another challenge: depression and anxiety were assessed with different instruments across studies, and the minimal clinically important differences for those scales vary by population, complicating direct comparison.

The complete absence of penile cancer studies is perhaps the review’s most striking finding. Penile cancer is rare, but its psychological toll is severe, involving body image disruption, sexual dysfunction, and substantial unmet supportive care needs documented in systematic reviews of affected men. The disease’s rarity makes large trials difficult, but the authors argue that this gap highlights an area for future study, and targeted collaborative research could begin to fill an evidence void that currently leaves patients and clinicians without any trial-based guidance on exercise for mental health.

Taken together, the review positions exercise as a promising but not yet proven component of psychological care for male genitourinary cancer survivors. The evidence supports modest improvements, particularly with multi-modal programs in prostate cancer, while pointing clearly toward the research agenda the field now needs: longer interventions, adequately powered trials with validated psychological endpoints, studies that integrate exercise with psychological support, and, urgently, inclusion of testicular and penile cancer populations that have been almost entirely left out of the exercise oncology conversation.

Subject of Research: Effects of exercise interventions on depression and anxiety in male genitourinary cancer survivors

Article Title: Exercise interventions and presentations of depression and anxiety in male genitourinary cancer survivors: A scoping review

Article References: Yearley, S., McGrath, C. B., Guard, H. E., Morgans, A. K., Dieli-Conwright, C. M., & Mucci, L. A. (2026). Exercise interventions and presentations of depression and anxiety in male genitourinary cancer survivors: A scoping review. European Journal of Epidemiology. https://doi.org/10.1007/s10654-026-01434-x

Image Credits: AI Generated

DOI: 10.1007/s10654-026-01434-x

Keywords: exercise interventions, prostate cancer, testicular cancer, penile cancer, depression, anxiety, cancer survivors, genitourinary cancer, scoping review, mental health, androgen deprivation therapy, multi-modal exercise