Active Surveillance Exercise Clinical Trial

Inclusion Criteria

ARM A and ARM B:

* Histologically-documented localized (stage \< T3) prostate adenocarcinoma
* Patient has selected active surveillance as their management strategy for low- or low-intermediate risk prostate cancer as defined below
* \>= 10 core prostate biopsy completed prior to randomization with Gleason sum =\< 6 with no pattern 4, or Gleason 3+4 in \< 34% of all cores
* Diagnostic or most recent prostate specific antigen (PSA) =\< 15 ng/ml, or PSA density (PSAD) \< 0.15
* Low to moderate fitness level at baseline (to be assessed via interview with the exercise staff and through the CPET)
* Clearance based on medical chart review and normal electrocardiogram (ECG) (administered by a trained health professional) to undergo a symptom-limited cardiopulmonary exercise test and aerobic training intervention
* Able to achieve and complete an acceptable cardiopulmonary exercise test defined as follows: achieving peak or plateau in oxygen consumption concurrent with increased power output; a respiratory exchange ratio \>= 1.1 or volitional exhaustion-rating of perceived exertion \> 19
* English-speaking
* A priori, we will allow men with concurrent benign prostatic hyperplasia (prostate volume \> 50 g) to have a PSA between 10-15 ng/ml; and include men with low volume Gleason 3+4 disease, because such men have similar outcomes on active surveillance to those with Gleason =\< 3+3; also a priori, we will allow men with \< than a 10 core biopsy at the discretion of the urologist if s/he classifies the patient as "low-risk" and a good candidate for active surveillance based on other favorable features (e.g., tumor molecular tests, prostate imaging, etc.)

NON-CANCER CONTROL GROUP (EXPLORATORY ARM C):

* Healthy males age 20-35 or \>=60 yrs.
* No history of prostate cancer or other cancer.
* Medical clearance based on medical chart review and normal ECG (administered by a trained health professional) to undergo a symptom-limited cardiopulmonary exercise test and aerobic training intervention OR medical clearance based on medical chart review and sub-maximal exercise testing for the remote aerobic training intervention.
* English-speaking.
* Low to moderate fitness level at baseline (to be assessed via interview with the exercise staff and through the CPET; similar to Arms A and B); subjects will be frequency-matched to subjects in the prostate cancer exercise intervention group (Arm A) to have a similar distribution of body mass index and facilitate comparisons between these two groups.

NON-RANDOMIZED OBSERVATIONAL COMPONENT ELIGIBILITY:

* Histologically-documented localized (stage \< T3) prostate adenocarcinoma.
* Undergoing or initiating active surveillance.
* Medical clearance based on medical chart review and normal ECG (administered by a trained health professional) to undergo a symptom-limited cardiopulmonary exercise test and aerobic training intervention.
* English-speaking.

Exclusion Criteria

* Any prior or concurrent treatment for prostate cancer
* Use of finasteride or dutasteride within 3 weeks or 6 months, respectively, of study entry
* Uncontrolled illness, physical disability, or other contraindication to aerobic exercise training including, but not limited to:

  * Acute myocardial Infarction (within 5 days of any planned study procedure)
  * Unstable angina
  * Uncontrolled arrhythmia causing symptoms or hemodynamic compromise
  * Recurrent syncope
  * Active endocarditis
  * Acute myocarditis or pericarditis
  * Symptomatic severe aortic stenosis
  * Uncontrolled heart failure
  * Acute (within 3 months) pulmonary embolus or pulmonary infarction
  * Thrombosis of lower extremities
  * Suspected dissecting aneurysm
  * Uncontrolled asthma
  * Pulmonary edema
  * Room air desaturation at rest =\< 85%
  * Respiratory failure
  * Acute non-cardiopulmonary disorders that may affect exercise performance or be aggravated by exercise (ie infection, renal failure, thyrotoxicosis)
  * Mental impairment leading to inability to cooperate

NON-RANDOMIZED OBSERVATIONAL AND INTERVENTION COMPONENTS (ARM C):

The same exclusion criteria apply as above. Additionally,

• Should have no prior history of cancer, except for non-melanoma skin cancer