1
|
Kang DW, Dawson JK, Barnes O, Wilson RL, Norris MK, Gonzalo-Encabo P, Christopher CN, Ficarra S, Dieli-Conwright CM. Resistance Exercise and Skeletal Muscle-Related Outcomes in Patients with Cancer: A Systematic Review. Med Sci Sports Exerc 2024; 56:1747-1758. [PMID: 38650124 DOI: 10.1249/mss.0000000000003452] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/25/2024]
Abstract
BACKGROUND Skeletal muscle loss is prevalent throughout the cancer continuum and correlated with morbidity and mortality. Resistance exercise has been trialed to mitigate skeletal muscle loss. This systematic review summarizes and qualitatively synthesizes the effects of resistance exercise on muscle-related outcomes in adult cancer populations, including skeletal muscle mass, performance and muscle-related biomarkers. METHODS The systematic review protocol was developed in accordance with the Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols (PRISMA-P). We searched electronic databases including AMED, CENTRAL, CINAHL, CIRRIE, EMBASE, MEDLINE, PEDro, REHABDATA, Scopus, and SPORTDiscus from inception to December 2021. We included randomized controlled trials that investigated the effects of resistance exercise on muscle-related outcomes in adult cancer populations. Interventions that involved any resistance exercise were included. Muscle-related outcomes were categorized as skeletal muscle mass (e.g., lean mass, appendicular muscle mass), muscle performance (e.g., muscle strength, physical function), and muscle-related biomarkers (e.g., muscle cells, metabolic/inflammatory markers). Risk of bias (RoB) was assessed using the Cochrane ROB tool. RESULTS A total of 102 studies from 101 randomized controlled trials were included. The majority of studies focused on breast cancer (46%) and those who completed treatment (43%). Resistance exercise interventions were largely 3-4 months long (48%), combined with aerobic exercise (56%), at a vigorous intensity (25%), and in-person/supervised settings (57%). Among the studies assessing muscle mass, performance, and biomarkers ( n = 42, 83, and 22, respectively), resistance exercise interventions improved upper/lower body or appendicular muscle mass (67%-100%), muscle strength (61%-68%), and physical function (74%-100%). Most biomarkers did not show significant changes (75%-100%) or showed inconsistent results. CONCLUSIONS Generally, resistance exercise had positive effects on skeletal muscle mass and performance with no negative effects compared to controls. Our findings demonstrated that resistance exercise may be an effective strategy to attenuate deterioration or exert improvements in muscle mass and performance outcomes.
Collapse
Affiliation(s)
| | - Jacqueline K Dawson
- Department of Physical Therapy, California State University, Long Beach, Long Beach, CA
| | - Oscar Barnes
- Green Templeton College, University of Oxford, UNITED KINGDOM
| | | | - Mary K Norris
- Division of Population Sciences, Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA
| | | | | | - Salvatore Ficarra
- Department of Psychology, Educational Science and Human Movement, University of Palermo, Palermo, ITALY
| | | |
Collapse
|
2
|
Park J, Ryu GW, Lee H, Choi YD, Kim Y. Frailty of Prostate Cancer Patients Receiving Androgen Deprivation Therapy: A Scoping Review. World J Mens Health 2024; 42:347-362. [PMID: 38449449 PMCID: PMC10949022 DOI: 10.5534/wjmh.220280] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Revised: 06/30/2023] [Accepted: 08/03/2023] [Indexed: 03/08/2024] Open
Abstract
PURPOSE This study aimed to explore the existing literature on frailty experienced by patients with prostate cancer (PC) receiving androgen deprivation therapy (ADT). MATERIALS AND METHODS Database and manual searches were conducted to identify relevant studies published in English, with no limitation on the year of publication, according to the Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews guidelines. Four databases-PubMed, Cochrane Library, EMBASE, and CINAHL-were used for database searches and reference lists, related journals, and Google Scholar were used for manual searches. RESULTS A total of 12 studies were analyzed for this scoping review. Of these, only 2 were intervention studies, and 1 was a randomized controlled trial. Among the two intervention studies, the multidisciplinary intervention program, including psychological counseling, nutritional coaching, and supervised group physical exercise did not show significant improvement in frailty. In contrast, high-dose vitamin D supplementation significantly decreased frailty. The conceptual and operational definitions of frailty used in each study varied, and the most used one was mainly focused on physical functions. As a result of analyzing the other health-related variables associated with frailty in patients with PC receiving ADT, age, metastases, comorbidities, and incident falls were related to a high frailty level. As for the physiological index, high levels of C-reactive protein, and interleukin-6, and fibrinogen, low levels of total testosterone, lymphocyte count, and creatinine were associated with a high level of frailty. A few studies explored the relationship between psychological and cognitive variables and frailty. CONCLUSIONS Further research related to frailty in patients with PC receiving ADT should be conducted, and effective interventions to manage frailty should be developed. Additionally, research that considers not only the physical domain of frailty but also the psychological, cognitive, and social domains needs to be conducted.
Collapse
Affiliation(s)
- Jeongok Park
- College of Nursing and Mo-Im Kim Nursing Research Institute, Yonsei University, Seoul, Korea
| | - Gi Wook Ryu
- Department of Nursing, Hansei University, Gunpo, Korea
| | - Hyojin Lee
- College of Nursing and Brain Korea 21 FOUR Project, Yonsei University, Seoul, Korea
| | - Young Deuk Choi
- Department of Urology, Urological Science Institute, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Youngkyung Kim
- College of Nursing and Brain Korea 21 FOUR Project, Yonsei University, Seoul, Korea.
| |
Collapse
|
3
|
Abstract
Individuals with cancer face unique risk factors for osteoporosis and fractures. Clinicians must consider the additive effects of cancer-specific factors, including treatment-induced bone loss, and premorbid fracture risk, utilizing FRAX score and bone mineral densitometry when available. Pharmacologic therapy should be offered as per cancer-specific guidelines, when available, or local general osteoporosis guidelines informed by clinical judgment and patient preferences. Our objective was to review and summarize the epidemiologic burden of osteoporotic fracture risk and fracture risk assessment in adults with cancer, and recommended treatment thresholds for cancer treatment-induced bone loss, with specific focus on breast, prostate, thyroid, gynecological, multiple myeloma, and hematopoietic stem cell transplant. This narrative review was informed by PubMed searches to July 25, 2022, that combined terms for cancer, stem cell transplantation, fracture, bone mineral density (BMD), trabecular bone score, FRAX, Garvan nomogram or fracture risk calculator, QFracture, prediction, and risk factors. The literature informs that cancer can impact bone health in numerous ways, leading to both systemic and localized decreases in BMD. Many cancer treatments can have detrimental effects on bone health. In particular, hormone deprivation therapies for hormone-responsive cancers such as breast cancer and prostate cancer, and hematopoietic stem cell transplant for hematologic malignancies, adversely affect bone turnover, resulting in osteoporosis and fractures. Surgical treatments such as hysterectomy with bilateral salpingo-oophorectomy for gynecological cancers can also lead to deleterious effects on bone health. Radiation therapy is well documented to cause localized bone loss and fractures. Few studies have validated the use of fracture risk prediction tools in the cancer population. Guidelines on cancer-specific treatment thresholds are limited, and major knowledge gaps still exist in fracture risk and fracture risk assessment in patients with cancer. Despite the limitations of current knowledge on fracture risk assessment and treatment thresholds in patients with cancer, clinicians must consider the additive effects of bone damaging factors to which these patients are exposed and their premorbid fracture risk profile. Pharmacologic treatment should be offered as per cancer-specific guidelines when available, or per local general osteoporosis guidelines, in accordance with clinical judgment and patient preferences.
Collapse
Affiliation(s)
- Carrie Ye
- University of Alberta, Edmonton, Canada.
| | | |
Collapse
|
4
|
Roch PJ, Wolgast V, Gebhardt MM, Böker KO, Hoffmann DB, Saul D, Schilling AF, Sehmisch S, Komrakova M. Combination of selective androgen and estrogen receptor modulators in orchiectomized rats. J Endocrinol Invest 2022; 45:1555-1568. [PMID: 35429299 PMCID: PMC9270269 DOI: 10.1007/s40618-022-01794-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2022] [Accepted: 03/22/2022] [Indexed: 11/22/2022]
Abstract
PURPOSE Selective androgen and estrogen receptor modulators, ostarine (OST) and raloxifen (RAL), reportedly improve muscle tissue and offer therapeutic approaches to muscle maintenance in the elderly. The present study evaluated the effects of OST and RAL and their combination on musculoskeletal tissue in orchiectomized rats. METHODS Eight-month-old Sprague Dawley rats were analyzed. Experiment I: (1) Untreated non-orchiectomized rats (Non-ORX), (2) untreated orchiectomized rats (ORX), (3) ORX rats treated with OST during weeks 0-18 (OST-P), (4) ORX rats treated with OST during weeks 12-18 (OST-T). Experiment II: 1) Non-ORX, (2) ORX, 3) OST-P, (4) ORX rats treated with RAL, during weeks 0-18 (RAL-P), 5) ORX rats treated with OST + RAL, weeks 0-18 (OST + RAL-P). The average daily doses of OST and RAL were 0.4 and 7 mg/kg body weight (BW). Weight, fiber size, and capillarization of muscles, gene expression, serum markers and the lumbar vertebral body were analyzed. RESULTS OST-P exerted favorable effects on muscle weight, expression of myostatin and insulin growth factor-1, but increased prostate weight. OST-T partially improved muscle parameters, showing less effect on the prostate. RAL-P did not show anabolic effects on muscles but improved body constitution by reducing abdominal area, food intake, and BW. OST + RAL-P had an anabolic impact on muscle, reduced androgenic effect on the prostate, and normalized food intake. OST and RAL improved osteoporotic bone. CONCLUSIONS The OST + RAL treatment appeared to be a promising option in the treatment of androgen-deficient conditions and showed fewer side effects than the respective single treatments.
Collapse
Affiliation(s)
- P. J. Roch
- Department of Trauma Surgery, Orthopaedics and Plastic Surgery, University of Göttingen, Robert-Koch-Str. 40, 37075 Göttingen, Germany
| | - V. Wolgast
- Department of Trauma Surgery, Orthopaedics and Plastic Surgery, University of Göttingen, Robert-Koch-Str. 40, 37075 Göttingen, Germany
| | - M.-M. Gebhardt
- Department of Trauma Surgery, Orthopaedics and Plastic Surgery, University of Göttingen, Robert-Koch-Str. 40, 37075 Göttingen, Germany
| | - K. O. Böker
- Department of Trauma Surgery, Orthopaedics and Plastic Surgery, University of Göttingen, Robert-Koch-Str. 40, 37075 Göttingen, Germany
| | - D. B. Hoffmann
- Department of Trauma Surgery, Orthopaedics and Plastic Surgery, University of Göttingen, Robert-Koch-Str. 40, 37075 Göttingen, Germany
| | - D. Saul
- Department of Trauma Surgery, Orthopaedics and Plastic Surgery, University of Göttingen, Robert-Koch-Str. 40, 37075 Göttingen, Germany
- Kogod Center On Aging and Division of Endocrinology, Mayo Clinic, Rochester, MN 55905 USA
| | - A. F. Schilling
- Department of Trauma Surgery, Orthopaedics and Plastic Surgery, University of Göttingen, Robert-Koch-Str. 40, 37075 Göttingen, Germany
| | - S. Sehmisch
- Department of Trauma Surgery, Orthopaedics and Plastic Surgery, University of Göttingen, Robert-Koch-Str. 40, 37075 Göttingen, Germany
- Department of Trauma Surgery, Hannover Medical School, University of Hannover, Carl-Neuberg-Str. 1, 30625 Hannover, Germany
| | - M. Komrakova
- Department of Trauma Surgery, Orthopaedics and Plastic Surgery, University of Göttingen, Robert-Koch-Str. 40, 37075 Göttingen, Germany
| |
Collapse
|
5
|
Turco F, Tucci M, Buttigliero C. Adverse event assessment in prostate cancer patients receiving androgen deprivation therapy: are we doing enough? Minerva Urol Nephrol 2022; 73:870-872. [PMID: 35144376 DOI: 10.23736/s2724-6051.21.04817-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- Fabio Turco
- Division of Medical Oncology, Department of Oncology, San Luigi Gonzaga Hospital, University of Turin, Orbassano, Turin, Italy
| | - Marcello Tucci
- Department of Medical Oncology, Cardinal Massaia Hospital, Asti, Italy
| | - Consuelo Buttigliero
- Division of Medical Oncology, Department of Oncology, San Luigi Gonzaga Hospital, University of Turin, Orbassano, Turin, Italy -
| |
Collapse
|
6
|
Trivedi T, Guise TA. Systemic effects of abnormal bone resorption on muscle, metabolism, and cognition. Bone 2022; 154:116245. [PMID: 34718221 DOI: 10.1016/j.bone.2021.116245] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2021] [Revised: 10/21/2021] [Accepted: 10/25/2021] [Indexed: 12/11/2022]
Abstract
Skeletal tissue is dynamic, undergoing constant remodeling to maintain musculoskeletal integrity and balance in the human body. Recent evidence shows that apart from maintaining homeostasis in the local microenvironment, the skeleton systemically affects other tissues. Several cancer-associated and noncancer-associated bone disorders can disrupt the physiological homeostasis locally in the bone microenvironment and indirectly contribute to dysregulation of systemic body function. The systemic effects of bone on the regulation of distant organ function have not been widely explored. Recent evidence suggests that bone can interact with skeletal muscle, pancreas, and brain by releasing factors from mineralized bone matrix. Currently available bone-targeting therapies such as bisphosphonates and denosumab inhibit bone resorption, decrease morbidity associated with bone destruction, and improve survival. Bisphosphonates have been a standard treatment for bone metastases, osteoporosis, and cancer treatment-induced bone diseases. The extraskeletal effects of bisphosphonates on inhibition of tumor growth are known. However, our knowledge of the effects of bisphosphonates on muscle weakness, hyperglycemia, and cognitive defects is currently evolving. To be able to identify the molecular link between bone and distant organs during abnormal bone resorption and then treat these abnormalities and prevent their systemic effects could improve survival benefits. The current review highlights the link between bone resorption and its systemic effects on muscle, pancreas, and brain.
Collapse
Affiliation(s)
- Trupti Trivedi
- Department of Endocrine Neoplasia and Hormonal Disorders, The University of Texas MD Anderson Cancer Center, Houston, TX, United States of America
| | - Theresa A Guise
- Department of Endocrine Neoplasia and Hormonal Disorders, The University of Texas MD Anderson Cancer Center, Houston, TX, United States of America.
| |
Collapse
|
7
|
Tan YJ, Lim SY, Yong VW, Choo XY, Ng YD, Sugumaran K, Md Shah MN, Raja Aman RRA, Paramasivam SS, Mohd Ramli N, Grossmann M, Tan AH. Osteoporosis in Parkinson's Disease: Relevance of Distal Radius Dual-Energy X-Ray Absorptiometry (DXA) and Sarcopenia. J Clin Densitom 2021; 24:351-361. [PMID: 32888777 DOI: 10.1016/j.jocd.2020.07.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2020] [Revised: 07/27/2020] [Accepted: 07/27/2020] [Indexed: 12/28/2022]
Abstract
Osteoporotic fractures are common in Parkinson's disease (PD). Standard dual-energy X-ray absorptiometry (DXA) measuring bone mineral density (BMD) at the femoral neck and lumbar spine (central sites) has suboptimal sensitivity in predicting fracture risk in the general population. An association between sarcopenia and osteoporosis in PD has not been studied. We compared BMD and osteoporosis prevalence in PD patients vs controls; determined the osteoporosis detection rates using central alone vs central plus distal radius DXA; and analyzed factors (in particular, sarcopenia) associated with osteoporosis. One hundred and fifty-six subjects (102 patients with PD, 54 spousal/sibling controls) underwent femoral neck-lumbar spine-distal radius DXA. Seventy-three patients and 46 controls were assessed for sarcopenia using whole-body DXA and handgrip strength. Patients underwent clinical and serum biochemical evaluations. PD patients had significantly lower body mass index compared to controls. After adjustment for possible confounders, distal radius BMD and T-scores were significantly lower in PD patients compared to controls, but not at the femoral neck/lumbar spine. With distal radius DXA, an additional 11.0% of patients were diagnosed with osteoporosis (32.0% to 43.0%), vs 3.7% in controls (33.3% to 37.0%) additionally diagnosed; this increase was largely driven by the markedly higher detection rate in female PD patients. Female gender (adjusted odds ratio [ORadjusted] = 11.3, 95% confidence interval [CI]: 2.6-48.6) and sarcopenia (ORadjusted = 8.4, 95% CI: 1.1-64.9) were independent predictors for osteoporosis in PD. Distal radius DXA increased osteoporosis detection, especially in female PD patients, suggesting that diagnostic protocols for osteoporosis in PD could be optimized. A close association between osteoporosis and sarcopenia was documented for the first time in PD, which has important implications for clinical management and future research.
Collapse
Affiliation(s)
- Yan Jing Tan
- Division of Neurology, Department of Medicine; and the Mah Pooi Soo & Tan Chin Nam Centre for Parkinson's & Related Disorders, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Shen-Yang Lim
- Division of Neurology, Department of Medicine; and the Mah Pooi Soo & Tan Chin Nam Centre for Parkinson's & Related Disorders, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Voon Wei Yong
- Division of Neurology, Department of Medicine; and the Mah Pooi Soo & Tan Chin Nam Centre for Parkinson's & Related Disorders, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Xing Yan Choo
- Division of Neurology, Department of Medicine; and the Mah Pooi Soo & Tan Chin Nam Centre for Parkinson's & Related Disorders, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Yi-De Ng
- Department of Biomedical Imaging, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Kavita Sugumaran
- Department of Biomedical Imaging, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Mohammad Nazri Md Shah
- Department of Biomedical Imaging, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | | | - Sharmila Sunita Paramasivam
- Division of Endocrinology, Department of Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Norlisah Mohd Ramli
- Department of Biomedical Imaging, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Mathis Grossmann
- Department of Endocrinology, Austin Health, University of Melbourne, Melbourne, Australia
| | - Ai Huey Tan
- Division of Neurology, Department of Medicine; and the Mah Pooi Soo & Tan Chin Nam Centre for Parkinson's & Related Disorders, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia.
| |
Collapse
|
8
|
Combined Naïve Bayesian, Chemical Fingerprints and Molecular Docking Classifiers to Model and Predict Androgen Receptor Binding Data for Environmentally- and Health-Sensitive Substances. Int J Mol Sci 2021; 22:ijms22136695. [PMID: 34206613 PMCID: PMC8267747 DOI: 10.3390/ijms22136695] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2021] [Revised: 06/18/2021] [Accepted: 06/20/2021] [Indexed: 12/15/2022] Open
Abstract
Many chemicals that enter the environment, food chain, and the human body can disrupt androgen-dependent pathways and mimic hormones and therefore, may be responsible for multiple diseases from reproductive to tumor. Thus, modeling and predicting androgen receptor activity is an important area of research. The aim of the current study was to find a method or combination of methods to predict compounds that can bind to and/or disrupt the androgen receptor, and thereby guide decision making and further analysis. A stepwise procedure proceeded from analysis of protein structures from human, chimp, and rat, followed by docking and subsequent ligand, and statistics based techniques that improved classification gradually. The best methods used multivariate logistic regression of combinations of chimpanzee protein structural docking scores, extended connectivity fingerprints, and naïve Bayesians of known binders and non-binders. Combination or consensus methods included data from a variety of procedures to improve the final model accuracy.
Collapse
|
9
|
Sattar S, Haase KR, Bradley C, Papadopoulos E, Kuster S, Santa Mina D, Tippe M, Kaur A, Campbell D, Joshua AM, Rediger C, Souied O, Alibhai S. Barriers and facilitators related to undertaking physical activities among men with prostate cancer: a scoping review. Prostate Cancer Prostatic Dis 2021; 24:1007-1027. [PMID: 34108646 DOI: 10.1038/s41391-021-00399-0] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2021] [Revised: 04/30/2021] [Accepted: 05/19/2021] [Indexed: 01/17/2023]
Abstract
BACKGROUND Prostate cancer (PC) and its treatments lead to significant acute, chronic, or latent adverse effects that result in declines in patients' physical functions, quality of life and reduced sense of masculinities. Robust evidence shows that physical activity (PA) can improve many health outcomes in men with PC; however, less is known about the facilitators, preferences, and barriers to PA engagement in this population. The purpose of this scoping review is to document the nature and extent of literature related to these aspects of PA participation among men with PC. METHODS We conducted a scoping review of PA among men with PC. Databases searched included Medline, CINAHL, Embase, Rehabilitation & Sports Medicine Source, and SportDiscus from inception to June 30, 2020. Multiple reviewers were used in all screening and data abstractions. RESULTS The search yielded 2788 individual citations after duplicates were removed. Following title and abstract screening, 129 underwent full-text review, and 46 articles were included. Quantitative data related to our research question showed that structured group exercise was the most commonly reported facilitator/preference among men with PC, whereas treatment-related effects and lack of time are the most common barriers. In terms of qualitative data, the most prominent theme noted related to masculinities and gender-specific needs within the context of having PC. CONCLUSION Men with PC have unique facilitators and barriers concerning PA. More work is needed from the research and clinical practice perspectives to enable this population to engage and remain in regular PA.
Collapse
Affiliation(s)
- S Sattar
- College of Nursing, University of Saskatchewan, Regina, SK, Canada.
| | - K R Haase
- Faculty of Applied Science, School of Nursing, University of British Columbia, Vancouver, BC, Canada
| | - C Bradley
- Library, University of Regina, Regina, SK, Canada
| | - E Papadopoulos
- Faculty of Kinesiology and Physical Education, University of Toronto, Toronto, ON, Canada
| | - S Kuster
- Faculty of Kinesiology and Health Studies, University of Regina, Regina, SK, Canada
| | - D Santa Mina
- Faculty of Kinesiology and Physical Education, University of Toronto, Toronto, ON, Canada.,University Health Network, Toronto, ON, Canada
| | - M Tippe
- Patient consultant, Toronto, ON, Canada
| | - A Kaur
- College of Nursing, University of Saskatchewan, Saskatoon, SK, Canada
| | - D Campbell
- College of Nursing, University of Saskatchewan, Saskatoon, SK, Canada
| | - A M Joshua
- Department of Medical Oncology, Kinghorn Cancer Centre; Faculty of Medicine, UNSW Sydney, Sydney, NSW, Australia
| | - C Rediger
- Saskatchewan Health Authority, Regina, SK, Canada
| | - O Souied
- Department of Medicine, University of Saskatchewan, Saskatoon, SK, Canada
| | - S Alibhai
- University Health Network, Toronto, ON, Canada.,Department of Medicine, Institute of Health Policy, Management, and Evaluation, Institute of Medical Sciences, University of Toronto, Toronto, ON, Canada
| |
Collapse
|
10
|
Li X, Cheng W, Shang H, Wei H, Deng C. The Interplay between Androgen and Gut Microbiota: Is There a Microbiota-Gut-Testis Axis. Reprod Sci 2021; 29:1674-1684. [PMID: 34037957 DOI: 10.1007/s43032-021-00624-0] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Accepted: 05/13/2021] [Indexed: 12/12/2022]
Abstract
The gut microbiota, a large ecosystem interacting with the host, has been shown to affect the health and fitness of the host-microbial superorganism. Increasing evidence suggests that the gut microbiota communicates with distal organs of the host including the brain, liver, and muscle, as well as testis, through various complex mechanisms. So far, we know that the androgen can markedly remodel the gut microbiota and has initiated an interdisciplinary field termed "microgenderome." More recently, the gut microbiota has been found as a major regulator of androgen production and metabolism in turn and even could trespass the blood-testis barrier (BTB) to regulate spermatogenesis, which largely updates the current knowledge on male reproduction. In this review, we provided a brief overview of the context of the gender bias of diseases related to gut microbiota, the sex dimorphism of gut microbiota, and their relationships with androgen. We also summarized the known interaction between the testis and gut microbiota based on published animal studies and tentatively discussed the hypothesis of microbiota-gut-testis axis. Finally, we highlighted the opportunities and challenges underlying the ongoing research. This knowledge may extend our understanding of the role of gut microbiota in male health and microbiota-related diseases.
Collapse
Affiliation(s)
- Xiangping Li
- Department of Urology and Andrology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, 510080, China
| | - Wei Cheng
- State Key Laboratory of Agricultural Microbiology, College of Animal Sciences and Technology, Huazhong Agricultural University, Wuhan, 430070, China
| | - Haitao Shang
- Precision Medicine Institute, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, 510080, China
| | - Hong Wei
- Precision Medicine Institute, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, 510080, China
| | - Chunhua Deng
- Department of Urology and Andrology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, 510080, China.
| |
Collapse
|
11
|
García-Sosa AT. Androgen Receptor Binding Category Prediction with Deep Neural Networks and Structure-, Ligand-, and Statistically Based Features. Molecules 2021; 26:1285. [PMID: 33652992 PMCID: PMC7956632 DOI: 10.3390/molecules26051285] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2021] [Revised: 02/23/2021] [Accepted: 02/24/2021] [Indexed: 01/10/2023] Open
Abstract
Substances that can modify the androgen receptor pathway in humans and animals are entering the environment and food chain with the proven ability to disrupt hormonal systems and leading to toxicity and adverse effects on reproduction, brain development, and prostate cancer, among others. State-of-the-art databases with experimental data of human, chimp, and rat effects by chemicals have been used to build machine-learning classifiers and regressors and to evaluate these on independent sets. Different featurizations, algorithms, and protein structures lead to different results, with deep neural networks (DNNs) on user-defined physicochemically relevant features developed for this work outperforming graph convolutional, random forest, and large featurizations. The results show that these user-provided structure-, ligand-, and statistically based features and specific DNNs provided the best results as determined by AUC (0.87), MCC (0.47), and other metrics and by their interpretability and chemical meaning of the descriptors/features. In addition, the same features in the DNN method performed better than in a multivariate logistic model: validation MCC = 0.468 and training MCC = 0.868 for the present work compared to evaluation set MCC = 0.2036 and training set MCC = 0.5364 for the multivariate logistic regression on the full, unbalanced set. Techniques of this type may improve AR and toxicity description and prediction, improving assessment and design of compounds. Source code and data are available on github.
Collapse
|
12
|
Handley NR, Feng FY, Guise TA, D'Andrea D, Kelly WK, Gomella LG. Preserving Well-being in Patients With Advanced and Late Prostate Cancer. Urology 2020; 155:199-209. [PMID: 33373704 DOI: 10.1016/j.urology.2020.12.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2020] [Revised: 11/23/2020] [Accepted: 12/13/2020] [Indexed: 10/22/2022]
Abstract
Androgen deprivation therapy, alone or in combination with androgen signaling inhibitors, is a treatment option for patients with advanced prostate cancer (PC). When making treatment decisions, health care providers must consider the long-term effects of treatment on the patient's overall health and well-being. Herein, we review the effects of these treatments on the musculoskeletal and cardiovascular systems, cognition, and fall risk, and provide management approaches for each. We also include an algorithm to help health care providers implement best clinical practices and interdisciplinary care for preserving the overall well-being of PC patients.
Collapse
Affiliation(s)
- Nathan R Handley
- Department of Medical Oncology, Sidney Kimmel Cancer Center, Thomas Jefferson University, Philadelphia, PA.
| | - Felix Y Feng
- Departments of Radiation Oncology, Urology, and Medicine, Helen Diller Family Comprehensive Cancer Center, University of California San Francisco, San Francisco, CA
| | - Theresa A Guise
- Department of Medicine, Indiana University School of Medicine, Indianapolis, IN
| | | | - William Kevin Kelly
- Department of Medical Oncology, Sidney Kimmel Cancer Center, Thomas Jefferson University, Philadelphia, PA; Department of Urology, Sidney Kimmel Cancer Center, Thomas Jefferson University, Philadelphia, PA
| | - Leonard G Gomella
- Department of Urology, Sidney Kimmel Cancer Center, Thomas Jefferson University, Philadelphia, PA
| |
Collapse
|
13
|
Laccetti AL, Morris MJ, Kantoff PW. A Clinical Evaluation of Enzalutamide in Metastatic Castration-Sensitive Prostate Cancer: Guiding Principles for Treatment Selection and Perspectives on Research. Onco Targets Ther 2020; 13:13247-13263. [PMID: 33402834 PMCID: PMC7778386 DOI: 10.2147/ott.s242921] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2020] [Accepted: 12/10/2020] [Indexed: 01/09/2023] Open
Abstract
Enzalutamide was the first novel androgen receptor signaling inhibitor to demonstrate an overall survival benefit in non-metastatic and metastatic castration-sensitive prostate cancer (CSPC). It has emerged as one of the most commonly prescribed oral prostate cancer therapies (ARSI) by medical oncologists and urologists. Amongst a panoply of treatment options for metastatic CSPC, safe and effective utilization of enzalutamide dictates a detailed understanding of alternative therapy options and competing toxicity profiles. Ongoing research supports the potential for expanded enzalutamide use in earlier disease states, in combination with other systemic agents and as monotherapy (without androgen deprivation therapy). Optimal application of enzalutamide will ultimately require greater insight and attention to mitigating strategies for treatment-associated fatigue, cognitive impairment, and functional decline. This publication will comprehensively analyze the clinical evidence and guiding principles of enzalutamide use in CSPC. We will also provide a critical review of ongoing and future ARSI research focusing on pharmacologic approaches to overcome treatment resistance and strategies to improve treatment-associated functional impairment.
Collapse
Affiliation(s)
- Andrew L Laccetti
- Genitourinary Oncology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Michael J Morris
- Genitourinary Oncology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Philip W Kantoff
- Genitourinary Oncology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| |
Collapse
|
14
|
Dell'Aquila E, Armento G, Iuliani M, Simonetti S, D'Onofrio L, Zeppola T, Madaudo C, Russano M, Citarella F, Ribelli G, Pantano F, Vincenzi B, Tonini G, Santini D. Denosumab for cancer-related bone loss. Expert Opin Biol Ther 2020; 20:1261-1274. [PMID: 32835531 DOI: 10.1080/14712598.2020.1814731] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
INTRODUCTION Prolonged use of anti-cancer treatments in breast and prostate tumors alters physiological bone turnover leading to adverse skeletal related events, such as osteoporosis, loss of bone mass, and increased risk of fractures. These complications known as cancer treatment-induced bone loss (CTIBL) should be managed with bone targeting agents such as the bisphosphonates and denosumab. The latter is a monoclonal antibody against the receptor activator of nuclear factor-kB ligand (RANKL) that suppresses osteoclasts function and survival increasing bone mass. AREAS COVERED This review will focus on the mechanisms associated with bone loss induced by cancer treatments and the most recent evidence about the use of denosumab as preventive and therapeutic strategy to protect bone health. Moreover, we will discuss several key aspects regarding the clinical practical use of denosumab to optimize the management of CTLIB in breast and prostate cancer. EXPERT OPINION Denosumab treatment strongly prevents cancer therapies-related skeletal issues in breast and prostate cancer with a good safety profile. Adjuvant six-monthly denosumab delays the time to first fracture onset in early stage breast cancer patients with normal or altered bone mineral density (BMD). Similarly, denosumab treatment is able to prevent fractures and BMD loss in nonmetastatic prostate cancer patients.
Collapse
Affiliation(s)
| | - Grazia Armento
- Medical Oncology Department, Campus Bio-Medico University of Rome , Rome, Itlay
| | - Michele Iuliani
- Medical Oncology Department, Campus Bio-Medico University of Rome , Rome, Itlay
| | - Sonia Simonetti
- Medical Oncology Department, Campus Bio-Medico University of Rome , Rome, Itlay
| | - Loretta D'Onofrio
- Medical Oncology Department, Campus Bio-Medico University of Rome , Rome, Itlay
| | - Tea Zeppola
- Medical Oncology Department, Campus Bio-Medico University of Rome , Rome, Itlay
| | - Cristina Madaudo
- Medical Oncology Department, Campus Bio-Medico University of Rome , Rome, Itlay
| | - Marco Russano
- Medical Oncology Department, Campus Bio-Medico University of Rome , Rome, Itlay
| | - Fabrizio Citarella
- Medical Oncology Department, Campus Bio-Medico University of Rome , Rome, Itlay
| | - Giulia Ribelli
- Medical Oncology Department, Campus Bio-Medico University of Rome , Rome, Itlay
| | - Francesco Pantano
- Medical Oncology Department, Campus Bio-Medico University of Rome , Rome, Itlay
| | - Bruno Vincenzi
- Medical Oncology Department, Campus Bio-Medico University of Rome , Rome, Itlay
| | - Giuseppe Tonini
- Medical Oncology Department, Campus Bio-Medico University of Rome , Rome, Itlay
| | - Daniele Santini
- Medical Oncology Department, Campus Bio-Medico University of Rome , Rome, Itlay
| |
Collapse
|
15
|
Lucas AR, Bitting RL, Fanning J, Isom S, Rejeski WJ, Klepin HD, Kritchevsky SB. Trajectories in muscular strength and physical function among men with and without prostate cancer in the health aging and body composition study. PLoS One 2020; 15:e0228773. [PMID: 32053654 PMCID: PMC7017990 DOI: 10.1371/journal.pone.0228773] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2019] [Accepted: 01/22/2020] [Indexed: 12/31/2022] Open
Abstract
Objectives To examine and compare changes in strength and physical function from pre- to post-diagnosis among men with prostate cancer (PC, [cases]) and matched non-cancer controls identified from the Health, Aging and Body Composition (Health ABC) study. Materials and methods We conducted a longitudinal analysis of 2 strength and 3 physical function-based measures among both cases and controls, identified from a large cohort of community living older adults enrolled in the Health ABC study. We plotted trajectories for each measure and compared cases vs. controls from the point of diagnosis onwards using mixed-effects regression models. For cases only, we examined predictors of poor strength or physical function. Results We identified 117 PC cases and 453 matched non-cancer controls (50% African Americans). At baseline, there were no differences between cases and controls in demographic factors, comorbidities or self-reported physical function; however, cases had slightly better grip strength (44.6 kg vs. 41.0 kg, p<0.01), quadriceps strength (360.5 Nm vs. 338.7 Nm, p = 0.02) and Health ABC physical performance battery scores (2.4 vs. 2.3, p = 0.01). All men experienced similar declines in strength and physical function over an equivalent amount of time. The loss of quad strength was most notable, with losses of nearly two-thirds of baseline strength over approximately 7 years of follow up. Conclusions Among both cases and controls, strength and physical function decline with increasing age. The largest declines were seen in lower body strength. Regular assessments should guide lifestyle interventions that can offset age- and treatment-related declines among men with PC.
Collapse
Affiliation(s)
- Alexander R. Lucas
- Department of Health Behavior and Policy, Virginia Commonwealth University, Richmond, Virginia, United States of America
- Division of Cardiology, Department of Internal Medicine, VCU Pauley Heart Center, Richmond, Virginia, United States of America
- * E-mail:
| | - Rhonda L. Bitting
- Department of Internal Medicine, Hematology and Oncology, Wake Forest Baptist Health, Winston-Salem, North Carolina, United States of America
| | - Jason Fanning
- Department of Health & Exercise Science, Wake Forest University, Winston-Salem, North Carolina, United States of America
| | - Scott Isom
- Department of Biostatistical Sciences, Wake Forest School of Medicine, Winston-Salem, North Carolina, United States of America
| | - W. Jack Rejeski
- Department of Health & Exercise Science, Wake Forest University, Winston-Salem, North Carolina, United States of America
| | - Heidi D. Klepin
- Department of Internal Medicine, Hematology and Oncology, Wake Forest Baptist Health, Winston-Salem, North Carolina, United States of America
| | - Stephen B. Kritchevsky
- Department of Internal Medicine, Sticht Center for Healthy Aging and Alzheimer’s Prevention, Wake Forest Baptist Health, Winston-Salem, North Carolina, United States of America
| |
Collapse
|
16
|
Lam T, Birzniece V, McLean M, Gurney H, Hayden A, Cheema BS. The Adverse Effects of Androgen Deprivation Therapy in Prostate Cancer and the Benefits and Potential Anti-oncogenic Mechanisms of Progressive Resistance Training. SPORTS MEDICINE-OPEN 2020; 6:13. [PMID: 32056047 PMCID: PMC7018888 DOI: 10.1186/s40798-020-0242-8] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/26/2019] [Accepted: 02/05/2020] [Indexed: 12/25/2022]
Abstract
Prostate cancer has the second highest incidence of all cancers amongst men worldwide. Androgen deprivation therapy (ADT) remains a common form of treatment. However, in reducing serum testosterone to castrate levels and rendering men hypogonadal, ADT contributes to a myriad of adverse effects which can affect prostate cancer prognosis. Physical activity is currently recommended as synergistic medicine in prostate cancer patients to alleviate the adverse effects of treatment. Progressive resistance training (PRT) is an anabolic exercise modality which may be of benefit in prostate cancer patients given its potency in maintaining and positively adapting skeletal muscle. However, currently, there is a scarcity of RCTs which have evaluated the use of isolated PRT in counteracting the adverse effects of prostate cancer treatment. Moreover, although physical activity in general has been found to reduce relapse rates and improve survival in prostate cancer, the precise anti-oncogenic effects of specific exercise modalities, including PRT, have not been fully established. Thus, the overall objective of this article is to provide a rationale for the in-depth investigation of PRT and its biological effects in men with prostate cancer on ADT. This will be achieved by (1) summarising the metabolic effects of ADT in patients with prostate cancer and its effect on prostate cancer progression and prognosis, (2) reviewing the existing evidence regarding the metabolic benefits of PRT in this cohort, (3) exploring the possible oncological pathways by which PRT can affect prostate cancer prognosis and progression and (4) outlining avenues for future research.
Collapse
Affiliation(s)
- Teresa Lam
- School of Medicine, Western Sydney University, Penrith, NSW, Australia. .,Department of Diabetes and Endocrinology, Westmead Hospital, Westmead, NSW, Australia. .,Department of Diabetes and Endocrinology, Blacktown Hospital, Blacktown, NSW, Australia.
| | - Vita Birzniece
- School of Medicine, Western Sydney University, Penrith, NSW, Australia.,Department of Diabetes and Endocrinology, Blacktown Hospital, Blacktown, NSW, Australia.,School of Medicine, UNSW Sydney, Sydney, NSW, Australia.,Garvan Institute of Medical Research, Darlinghurst, NSW, Australia.,Translational Health Research Institute, Penrith, NSW, Australia
| | - Mark McLean
- School of Medicine, Western Sydney University, Penrith, NSW, Australia.,Department of Diabetes and Endocrinology, Blacktown Hospital, Blacktown, NSW, Australia
| | - Howard Gurney
- Crown Princess Mary Cancer Centre, Westmead, NSW, Australia
| | - Amy Hayden
- Crown Princess Mary Cancer Centre, Westmead, NSW, Australia.,Department of Radiation Oncology, Blacktown Hospital, Blacktown, NSW, Australia
| | - Birinder S Cheema
- School of Science and Health, Western Sydney University, Penrith, NSW, Australia
| |
Collapse
|
17
|
Kojima I, Naito Y, Yamamoto A, Terashima Y, Sho N, Nagayama J, Okada Y, Nagai T. Efficacy of zoledronic acid in older prostate cancer patients undergoing androgen deprivation therapy. Osteoporos Sarcopenia 2020; 5:128-131. [PMID: 31938732 PMCID: PMC6953531 DOI: 10.1016/j.afos.2019.11.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2019] [Revised: 08/28/2019] [Accepted: 11/10/2019] [Indexed: 11/26/2022] Open
Abstract
Objectives The purpose of this study is to evaluate the efficacy of annual zoledronic acid treatment in Japanese patients with nonmetastatic prostate cancer during androgen deprivation therapy (ADT). Methods This is a single institution 12-month study. Between 2016 and 2019, patients aged 70 years or older on ADT for nonmetastatic prostate cancer had bone mineral density (BMD) measured and 10-year probability of fracture calculated using fracture risk assessment tool (FRAX). Patients who showed osteopenia or had a 10-year hip fracture risk ≥ 3% or a 10-year probability of major osteoporotic fracture ≥ 20% were offered treatment with zoledronic acid 5 mg intravenously (ZA group). The patients who did not receive treatment were set as the control group. Lumbar and hip BMD were measured 6 and 12 months after treatment in the ZA group and 12 months after baseline in the control group. The yearly BMD change of both groups was compared. Results The mean ages of the ZA group (n = 26) and control group (n = 12) were 80.5 ± 9.1 and 76.1 ± 6.7 years, respectively. In the ZA group, lumbar and hip BMD changes at 12 months were +2.1% and +0.8%, respectively. In the control group, lumbar and hip BMD changes were -0.9% and -4.9%, respectively. There were statistically significant differences between the 2 groups in BMD percent changes (P < 0.05). Conclusions Without intervention, BMD tends to continue to decrease during ADT. Our findings suggest that administration of zoledronic acid enables maintenance of BMD in the older adults.
Collapse
Affiliation(s)
- Ippei Kojima
- Department of Urology, Toyohashi Municipal Hospital, 50 Aza Hachiken Nishi, Aotake-Cho, Toyohashi, Aichi, 441-8570, Japan
| | - Yushi Naito
- Department of Urology, Toyohashi Municipal Hospital, 50 Aza Hachiken Nishi, Aotake-Cho, Toyohashi, Aichi, 441-8570, Japan
| | - Akiyuki Yamamoto
- Department of Urology, Toyohashi Municipal Hospital, 50 Aza Hachiken Nishi, Aotake-Cho, Toyohashi, Aichi, 441-8570, Japan
| | - Yasuhiro Terashima
- Department of Urology, Toyohashi Municipal Hospital, 50 Aza Hachiken Nishi, Aotake-Cho, Toyohashi, Aichi, 441-8570, Japan
| | - Norie Sho
- Department of Urology, Toyohashi Municipal Hospital, 50 Aza Hachiken Nishi, Aotake-Cho, Toyohashi, Aichi, 441-8570, Japan
| | - Jun Nagayama
- Department of Urology, Toyohashi Municipal Hospital, 50 Aza Hachiken Nishi, Aotake-Cho, Toyohashi, Aichi, 441-8570, Japan
| | - Yurika Okada
- Department of Urology, Toyohashi Municipal Hospital, 50 Aza Hachiken Nishi, Aotake-Cho, Toyohashi, Aichi, 441-8570, Japan
| | - Tatsuya Nagai
- Department of Urology, Toyohashi Municipal Hospital, 50 Aza Hachiken Nishi, Aotake-Cho, Toyohashi, Aichi, 441-8570, Japan
| |
Collapse
|
18
|
Chaves SN, Lima FDD, Bottaro M, Mota MR, Oliveira RJD. FATIGUE AND MUSCLE FUNCTION IN PROSTATE CANCER SURVIVORS RECEIVING DIFFERENT TREATMENT REGIMENS. REV BRAS MED ESPORTE 2019. [DOI: 10.1590/1517-869220192506220279] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
ABSTRACT Introduction Prostate cancer is the most prevalent neoplastic disease in men. After diagnosis, different treatment regimens are proposed based on the stage of the cancer. These treatments affect physical and muscle function, quality of life, and prognosis differently. Objectives To assess fatigue, muscle strength, muscle thickness, and muscle quality in prostate cancer survivors undergoing androgen deprivation therapy (ADT). Methods Ten ADT patients, eight non-ADT patients and 18 healthy control subjects were enrolled in this study. Perceived fatigue was assessed through the 20-item Multidimensional Fatigue Inventory. Muscle thickness and quality (e.g., echo intensity) were assessed through B-mode ultrasound. Muscle strength and work capacity were assessed using an isokinetic dynamometer. The groups were compared with one-way ANOVA and Bonferroni adjustment. Results Muscle thickness, peak torque, and work capacity were lower in ADT than in the control group (CON) (p = 0.021; p = 0.005; p <0.001, respectively). ADT showed greater echo intensity than CON (p = 0.005) and N-ADT (p = 0.046). There were no differences between N-ADT and CON in terms of muscle thickness, peak torque, work capacity, and echo intensity (p >0.05). General fatigue was greater in both ADT (p = 0.030) and N-ADT (p = 0.047) compared to CON. Physical fatigue was greater in ADT than CON (p = 0.006). Conclusion ADT patients showed lower levels of muscle function and greater levels of perceived fatigue than healthy control subjects. It appears that muscle function remains lower in ADT patients, even several years after treatment initiation, although this does not apply to non-ADT patients. Level of evidence II; Diagnostic Studies - Investigating a Diagnostic Test.
Collapse
|
19
|
Cheung AS, Cunningham C, Ko DKD, Ly V, Gray H, Hoermann R, Strauss BJG, Bani Hassan E, Duque G, Ebeling P, Pandy MG, Zajac JD, Grossmann M. Selective Loss of Levator Ani and Leg Muscle Volumes in Men Undergoing Androgen Deprivation Therapy. J Clin Endocrinol Metab 2019; 104:2229-2238. [PMID: 30602021 DOI: 10.1210/jc.2018-01954] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2018] [Accepted: 12/26/2018] [Indexed: 11/19/2022]
Abstract
CONTEXT Androgen deprivation therapy (ADT) for prostate cancer (PCa) leads to a selective loss of leg muscle function during walking. Rodent models of ADT have demonstrated that the levator ani is exquisitely androgen sensitive. OBJECTIVE To determine whether the high androgen responsiveness of the levator ani muscle documented in rodents is evolutionarily conserved and ADT is associated with a selective loss in leg muscle volume. DESIGN Prospective longitudinal case-control study. SETTING Tertiary referral hospital. PARTICIPANTS Thirty-four men newly beginning ADT and 29 age-matched controls with PCa. MAIN OUTCOME MEASURES The muscle volumes in liters of the levator ani and primary muscles involved in walking (iliopsoas, quadriceps, gluteus maximus, gluteus medius, calf). RESULTS Compared with controls, during a 12-month period, men receiving ADT experienced a mean reduction in total testosterone from 14.1 to 0.4 nmol/L and demonstrated greater decreases in levator ani [mean adjusted difference (MAD), -0.005 L; 95% CI, -0.007 to -0.002; P = 0.002; -16% of initial median value], gluteus maximus (MAD, -0.032 L; 95% CI, -0.063 to -0.002; P = 0.017; -5% of initial median value), iliopsoas (MAD, -0.005 L; 95% CI, -0.001 to 0.000; P = 0.013; -5% of initial median value), and quadriceps (MAD, -0.050 L; 95% CI, -0.088 to -0.012; P = 0.031; -3% of initial median value). No substantial differences were observed in the gluteus medius and calf muscles. CONCLUSIONS The androgen responsiveness of the levator ani appears to be evolutionarily conserved in humans. ADT selectively decreases the volume of muscles that support body weight. Interventional strategies to reduce ADT-related sarcopenia and sexual dysfunction should assess whether targeting these muscle groups, including the pelvic floor, will improve clinical outcomes.
Collapse
Affiliation(s)
- Ada S Cheung
- Department of Medicine, Austin Health, University of Melbourne, Heidelberg, Victoria, Australia
- Department of Endocrinology, Austin Health, Heidelberg, Victoria, Australia
| | - Christopher Cunningham
- Department of Medicine, Austin Health, University of Melbourne, Heidelberg, Victoria, Australia
| | - Dong-Kyoon Daniel Ko
- Department of Medicine, Austin Health, University of Melbourne, Heidelberg, Victoria, Australia
| | - Vivian Ly
- Department of Medicine, Austin Health, University of Melbourne, Heidelberg, Victoria, Australia
| | - Hans Gray
- Department of Mechanical Engineering, University of Melbourne, Parkville, Victoria, Australia
| | - Rudolf Hoermann
- Department of Medicine, Austin Health, University of Melbourne, Heidelberg, Victoria, Australia
| | - Boyd J G Strauss
- Department of Medicine, Faculty of Medicine, Nursing and Health Sciences, Monash University, Clayton, Victoria, Australia
- Faculty of Biology, Medicine and Health, University of Manchester, Manchester, United Kingdom
| | - Ebrahim Bani Hassan
- Department of Medicine, Western Precinct and Australian Institute for Musculoskeletal Science, University of Melbourne, St. Albans, Victoria, Australia
| | - Gustavo Duque
- Department of Medicine, Western Precinct and Australian Institute for Musculoskeletal Science, University of Melbourne, St. Albans, Victoria, Australia
| | - Peter Ebeling
- Department of Medicine, Faculty of Medicine, Nursing and Health Sciences, Monash University, Clayton, Victoria, Australia
| | - Marcus G Pandy
- Department of Mechanical Engineering, University of Melbourne, Parkville, Victoria, Australia
| | - Jeffrey D Zajac
- Department of Medicine, Austin Health, University of Melbourne, Heidelberg, Victoria, Australia
- Department of Endocrinology, Austin Health, Heidelberg, Victoria, Australia
| | - Mathis Grossmann
- Department of Medicine, Austin Health, University of Melbourne, Heidelberg, Victoria, Australia
- Department of Endocrinology, Austin Health, Heidelberg, Victoria, Australia
| |
Collapse
|
20
|
Walz S, Maas M, Stenzl A, Todenhöfer T. Bone Health Issues in Patients with Prostate Cancer: An Evidence-Based Review. World J Mens Health 2019; 38:151-163. [PMID: 31081297 PMCID: PMC7076314 DOI: 10.5534/wjmh.190044] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2019] [Accepted: 03/23/2019] [Indexed: 01/13/2023] Open
Abstract
Bone health in prostate cancer patients represents a prerequisite for acceptable quality of life and optimal outcome of this disease. The major threat for bone health in prostate cancer displays cancer treatment induced bone loss as well as the development of bone metastases. In recent years, several new pharmaceuticals targeting bone metabolism such as denosumab or androgen pathway targeting drugs (abiraterone acetate and enzalutamide) have been approved for the treatment of progressive disease aiming to interrupt the vicious circle of bone metastasis and aberrant bone resorption. This development raised the awareness of the pivotal role of bone health in prostate cancer and introduced (symptomatic) skeletal related events as an important end point in recent clinical trials. Bone targeted drugs have become standard of care in patients with metastatic castration resistant prostate cancer, their role in metastatic hormone sensitive prostate cancer has been discussed controversely. In oligometastatic prostate cancer patients several promising approaches in metastasis directed therapy, including conventional surgery, stereotactic ablative radiation and image-guided single-fraction robotic stereotactic radiosurgery (CyberKnife®) were launched but are not in routine clinical use until now caused by sparse clinical evidence.
Collapse
Affiliation(s)
- Simon Walz
- Department of Urology, Eberhard Karls University, Tuebingen, Germany
| | - Moritz Maas
- Department of Urology, Eberhard Karls University, Tuebingen, Germany
| | - Arnulf Stenzl
- Department of Urology, Eberhard Karls University, Tuebingen, Germany
| | - Tilman Todenhöfer
- Department of Urology, Eberhard Karls University, Tuebingen, Germany.
| |
Collapse
|
21
|
Lam T, McLean M, Hayden A, Poljak A, Cheema B, Gurney H, Stone G, Bahl N, Reddy N, Shahidipour H, Birzniece V. A potent liver-mediated mechanism for loss of muscle mass during androgen deprivation therapy. Endocr Connect 2019; 8:605-615. [PMID: 30991356 PMCID: PMC6510709 DOI: 10.1530/ec-19-0179] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2019] [Accepted: 04/15/2019] [Indexed: 12/25/2022]
Abstract
CONTEXT Androgen deprivation therapy (ADT) in prostate cancer results in muscular atrophy, due to loss of the anabolic actions of testosterone. Recently, we discovered that testosterone acts on the hepatic urea cycle to reduce amino acid nitrogen elimination. We now hypothesize that ADT enhances protein oxidative losses by increasing hepatic urea production, resulting in muscle catabolism. We also investigated whether progressive resistance training (PRT) can offset ADT-induced changes in protein metabolism. OBJECTIVE To investigate the effect of ADT on whole-body protein metabolism and hepatic urea production with and without a home-based PRT program. DESIGN A randomized controlled trial. PATIENTS AND INTERVENTION Twenty-four prostate cancer patients were studied before and after 6 weeks of ADT. Patients were randomized into either usual care (UC) (n = 11) or PRT (n = 13) starting immediately after ADT. MAIN OUTCOME MEASURES The rate of hepatic urea production was measured by the urea turnover technique using 15N2-urea. Whole-body leucine turnover was measured, and leucine rate of appearance (LRa), an index of protein breakdown and leucine oxidation (Lox), a measure of irreversible protein loss, was calculated. RESULTS ADT resulted in a significant mean increase in hepatic urea production (from 427.6 ± 18.8 to 486.5 ± 21.3; P < 0.01) regardless of the exercise intervention. Net protein loss, as measured by Lox/Lra, increased by 12.6 ± 4.9% (P < 0.05). PRT preserved lean body mass without affecting hepatic urea production. CONCLUSION As early as 6 weeks after initiation of ADT, the suppression of testosterone increases protein loss through elevated hepatic urea production. Short-term PRT was unable to offset changes in protein metabolism during a state of profound testosterone deficiency.
Collapse
Affiliation(s)
- Teresa Lam
- School of Medicine, Western Sydney University, Penrith, New South Wales, Australia
- Department of Diabetes and Endocrinology, Blacktown Hospital, Blacktown, New South Wales, Australia
- Department of Diabetes and Endocrinology, Westmead Hospital, Westmead, New South Wales, Australia
- Correspondence should be addressed to T Lam:
| | - Mark McLean
- School of Medicine, Western Sydney University, Penrith, New South Wales, Australia
- Department of Diabetes and Endocrinology, Blacktown Hospital, Blacktown, New South Wales, Australia
| | - Amy Hayden
- Department of Radiation Oncology, Blacktown Hospital, Blacktown, New South Wales, Australia
- Crown Princess Mary Cancer Centre, Westmead Hospital, Westmead, New South Wales, Australia
| | - Anne Poljak
- Bioanalytical Mass Spectrometry Facility and School of Medical Sciences, UNSW Sydney, Sydney, New South Wales, Australia
| | - Birinder Cheema
- School of Science and Health, Western Sydney University, Penrith, New South Wales, Australia
| | - Howard Gurney
- Crown Princess Mary Cancer Centre, Westmead Hospital, Westmead, New South Wales, Australia
| | - Glenn Stone
- School of Computing, Engineering and Mathematics, Western Sydney University, Penrith, New South Wales, Australia
| | - Neha Bahl
- School of Medicine, Western Sydney University, Penrith, New South Wales, Australia
| | - Navneeta Reddy
- Department of Diabetes and Endocrinology, Blacktown Hospital, Blacktown, New South Wales, Australia
- Garvan Institute of Medical Research, Darlinghurst, New South Wales, Australia
| | - Haleh Shahidipour
- School of Medicine, Western Sydney University, Penrith, New South Wales, Australia
- Department of Diabetes and Endocrinology, Blacktown Hospital, Blacktown, New South Wales, Australia
- School of Medicine, UNSW Sydney, Sydney, New South Wales, Australia
- Translational Health Research Institute, Penrith, New South Wales, Australia
| | - Vita Birzniece
- School of Medicine, Western Sydney University, Penrith, New South Wales, Australia
- Department of Diabetes and Endocrinology, Blacktown Hospital, Blacktown, New South Wales, Australia
- Garvan Institute of Medical Research, Darlinghurst, New South Wales, Australia
- School of Medicine, UNSW Sydney, Sydney, New South Wales, Australia
- Translational Health Research Institute, Penrith, New South Wales, Australia
| |
Collapse
|
22
|
Effect of Androgen-Deprivation Therapy on Bone Mineral Density in Patients with Prostate Cancer: A Systematic Review and Meta-Analysis. J Clin Med 2019; 8:jcm8010113. [PMID: 30669289 PMCID: PMC6352073 DOI: 10.3390/jcm8010113] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2018] [Revised: 01/14/2019] [Accepted: 01/15/2019] [Indexed: 01/04/2023] Open
Abstract
We aimed to evaluate the change in bone mineral density (BMD) in patients with prostate cancer (PCa) receiving androgen deprivation therapy (ADT) compared to those with PCa or other urologic conditions not receiving ADT. Literature searches were conducted throughout October 2018. The eligibility of each study was assessed according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines using the Participant, Intervention, Comparator, Outcome, and Study design method. The outcomes analyzed were the mean difference (MD) of percent changes in BMD of lumbar spine, femur neck, and total hip. Five prospective cohort studies with a total of 533 patients were included in the present study. Statistically significant decreases of BMD change relative to the control group were observed in the ADT treatment group in the lumbar spine (MD −3.60, 95% CI −6.72 to −0.47, P = 0.02), femoral neck (MD −3.11, 95% CI −4.73 to −1.48, P = 0.0002), and total hip (MD −1.59, 95% CI −2.99 to −0.19, P = 0.03). There is a significant relationship between ADT and BMD reduction in patients with PCa. Regular BMD testing and the optimal treatment for BMD loss should, therefore, be considered in patients with PCa undergoing ADT.
Collapse
|
23
|
Fairman CM, Zourdos MC, Helms ER, Focht BC. A Scientific Rationale to Improve Resistance Training Prescription in Exercise Oncology. Sports Med 2018; 47:1457-1465. [PMID: 28074412 DOI: 10.1007/s40279-017-0673-7] [Citation(s) in RCA: 51] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
To date, the prevailing evidence in the field of exercise oncology supports the safety and efficacy of resistance training to attenuate many oncology treatment-related adverse effects, such as risk for cardiovascular disease, increased fatigue, and diminished physical functioning and quality of life. Moreover, findings in the extant literature supporting the benefits of exercise for survivors of and patients with cancer have resulted in the release of exercise guidelines from several international agencies. However, despite research progression and international recognition, current exercise oncology-based exercise prescriptions remain relatively basic and underdeveloped, particularly in regards to resistance training. Recent publications have called for a more precise manipulation of training variables such as volume, intensity, and frequency (i.e., periodization), given the large heterogeneity of a cancer population, to truly optimize clinically relevant patient-reported outcomes. Indeed, increased attention to integrating fundamental principles of exercise physiology into the exercise prescription process could optimize the safety and efficacy of resistance training during cancer care. The purpose of this article is to give an overview of the current state of resistance training prescription and discuss novel methods that can contribute to improving approaches to exercise prescription. We hope this article may facilitate further evaluation of best practice regarding resistance training prescription, monitoring, and modification to ultimately optimize the efficacy of integrating resistance training as a supportive care intervention for survivors or and patients with cancer.
Collapse
Affiliation(s)
- Ciaran M Fairman
- Kinesiology, Department of Human Sciences, The Ohio State University, 305 W Anne and John Glenn Ave, Columbus, OH, 43201, USA.
| | - Michael C Zourdos
- Department of Exercise Science and Health Promotion, Muscle Physiology Laboratory, Florida Atlantic University, Boca Raton, FL, USA
| | - Eric R Helms
- Sport Performance Research Institute New Zealand (SPRINZ), Auckland University of Technology, Auckland, New Zealand
| | - Brian C Focht
- Kinesiology, Department of Human Sciences, The Ohio State University, 305 W Anne and John Glenn Ave, Columbus, OH, 43201, USA
| |
Collapse
|
24
|
Campos C, Sotomayor P, Jerez D, González J, Schmidt CB, Schmidt K, Banzer W, Godoy AS. Exercise and prostate cancer: From basic science to clinical applications. Prostate 2018; 78:639-645. [PMID: 29569731 DOI: 10.1002/pros.23502] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2017] [Accepted: 02/09/2018] [Indexed: 11/08/2022]
Abstract
Prostate cancer (PCa) is a disease of increasing medical significance worldwide. In developed countries, PCa is the most common non-skin cancer in men, and one of the leading causes of cancer-related deaths. Exercise is one of the environmental factors that have been shown to influence cancer risk. Moreover, systemic reviews and meta-analysis have suggested that total physical activity is related to a decrease in the risk of developing PCa. In addition, epidemiological studies have shown that exercise, after diagnosis, has benefits regarding PCa development, and positive outcome in patients under treatment. The standard treatment for locally advanced or metastatic PCa is Androgen deprivation therapy (ADT). ADT produces diverse side effects, including loss of libido, changes in body composition (increase abdominal fat), and reduced muscle mass, and muscle tone. Analysis of numerous research publications showed that aerobic and/or resistance training improve patient's physical condition, such us, cardiorespiratory fitness, muscle strength, physical function, body composition, and fatigue. Therefore, exercise might counteract several ADT treatment-induced side effects. In addition of the aforementioned benefits, epidemiological, and in vitro studies have shown that exercise might decrease PCa development. Thus, physical activity might attenuate the risk of PCa and supervised exercise intervention might improve deleterious effects of cancer treatment, such as ADT side effects. This review article provides evidence indicating that exercise could complement, and potentiate, the current standard treatments for advanced PCa, probably by creating an unfavorable microenvironment that can negatively affect tumor development, and progression.
Collapse
Affiliation(s)
- Christian Campos
- Faculty of Rehabilitation Sciences, Universidad Andres Bello, Santiago de, Chile
| | - Paula Sotomayor
- Center for Integrative Medicine and Innovative Science, Universidad Andres Bello, Santiago de, Chile
| | - Daniel Jerez
- Faculty of Rehabilitation Sciences, Universidad Andres Bello, Santiago de, Chile
| | - Javier González
- Department of Sport Medicine, Institute of Sport Science, Goethe University Frankfurt, Frankfurt am Main, Germany
| | - Camila B Schmidt
- Department of Physiology, Pontificia Universidad Católica de Chile, Santiago de, Chile
| | - Katharina Schmidt
- Department of Sport Medicine, Institute of Sport Science, Goethe University Frankfurt, Frankfurt am Main, Germany
| | - Winfried Banzer
- Department of Sport Medicine, Institute of Sport Science, Goethe University Frankfurt, Frankfurt am Main, Germany
| | - Alejandro S Godoy
- Department of Physiology, Pontificia Universidad Católica de Chile, Santiago de, Chile
- Department of Urology, Roswell Park Cancer Institute, Buffalo, New York
| |
Collapse
|
25
|
Abstract
PURPOSE OF REVIEW Exercise is a provocative medicine, known for its preventive, complimentary and rehabilitative role in the management of cancer. Impressively, exercise is also emerging as a synergistic and targeted medicine to enhance symptom control, modulate tumour biology and delay disease progression, with the potential to increase overall survival. Given the complex clinical presentation of advanced prostate cancer patients and their omnipresent comorbidities, this review describes the current and potential role of exercise medicine in advanced prostate cancer. RECENT FINDINGS Exercise has been shown to be safe, feasible and effective for advanced prostate cancer patients, inclusive of patients with bone metastases; a previously excluded population due to patient and clinician fear of adverse events. Preclinical data provide insight into the ability of exercise to modulate cancer-specific outcomes, may synergistically increase the potency of chemotherapy and radiotherapy and may endogenously and/or mechanically suppress tumour formation, growth and invasion in visceral and skeletal tissue. Epidemiological studies have also shown an association between physical activity and increased survival. SUMMARY Exercise oncology is rapidly evolving, with impressive possibilities that may directly improve patient outcomes in advanced prostate cancer. Research must focus on translating preclinical trials into human clinical trials and investigate the direct effect of exercise on overall survival.
Collapse
|
26
|
English RS. A hypothetical pathogenesis model for androgenic alopecia: clarifying the dihydrotestosterone paradox and rate-limiting recovery factors. Med Hypotheses 2017; 111:73-81. [PMID: 29407002 DOI: 10.1016/j.mehy.2017.12.027] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2017] [Revised: 11/25/2017] [Accepted: 12/28/2017] [Indexed: 12/30/2022]
Abstract
Androgenic alopecia, also known as pattern hair loss, is a chronic progressive condition that affects 80% of men and 50% of women throughout a lifetime. But despite its prevalence and extensive study, a coherent pathology model describing androgenic alopecia's precursors, biological step-processes, and physiological responses does not yet exist. While consensus is that androgenic alopecia is genetic and androgen-mediated by dihydrotestosterone, questions remain regarding dihydrotestosterone's exact role in androgenic alopecia onset. What causes dihydrotestosterone to increase in androgenic alopecia-prone tissues? By which mechanisms does dihydrotestosterone miniaturize androgenic alopecia-prone hair follicles? Why is dihydrotestosterone also associated with hair growth in secondary body and facial hair? Why does castration (which decreases androgen production by 95%) stop pattern hair loss, but not fully reverse it? Is there a relationship between dihydrotestosterone and tissue remodeling observed alongside androgenic alopecia onset? We review evidence supporting and challenging dihydrotestosterone's causal relationship with androgenic alopecia, then propose an evidence-based pathogenesis model that attempts to answer the above questions, account for additionally-suspected androgenic alopecia mediators, identify rate-limiting recovery factors, and elucidate better treatment targets. The hypothesis argues that: (1) chronic scalp tension transmitted from the galea aponeurotica induces an inflammatory response in androgenic alopecia-prone tissues; (2) dihydrotestosterone increases in androgenic alopecia-prone tissues as part of this inflammatory response; and (3) dihydrotestosterone does not directly miniaturize hair follicles. Rather, dihydrotestosterone is a co-mediator of tissue dermal sheath thickening, perifollicular fibrosis, and calcification - three chronic, progressive conditions concomitant with androgenic alopecia progression. These conditions remodel androgenic alopecia-prone tissues - restricting follicle growth space, oxygen, and nutrient supply - leading to the slow, persistent hair follicle miniaturization characterized in androgenic alopecia. If true, this hypothetical model explains the mechanisms by which dihydrotestosterone miniaturizes androgenic alopecia-prone hair follicles, describes a rationale for androgenic alopecia progression and patterning, makes sense of dihydrotestosterone's paradoxical role in hair loss and hair growth, and identifies targets to further improve androgenic alopecia recovery rates: fibrosis, calcification, and chronic scalp tension.
Collapse
|
27
|
Cheung AS, de Rooy C, Levinger I, Rana K, Clarke MV, How JM, Garnham A, McLean C, Zajac JD, Davey RA, Grossmann M. Actin alpha cardiac muscle 1 gene expression is upregulated in the skeletal muscle of men undergoing androgen deprivation therapy for prostate cancer. J Steroid Biochem Mol Biol 2017; 174:56-64. [PMID: 28756295 DOI: 10.1016/j.jsbmb.2017.07.029] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2017] [Revised: 07/24/2017] [Accepted: 07/25/2017] [Indexed: 02/06/2023]
Abstract
Androgen deprivation therapy (ADT) decreases muscle mass and function but no human studies have investigated the underlying genetic or cellular effects. We tested the hypothesis that ADT will lead to changes in skeletal muscle gene expression, which may explain the adverse muscle phenotype seen clinically. We conducted a prospective cohort study of 9 men with localised prostate cancer who underwent a vastus lateralis biopsy before and after 4 weeks of ADT. Next-generation RNA sequencing was performed and genes differentially expressed following ADT underwent gene ontology mining using Ingenuity Pathway Analysis. Differential expression of genes of interest was confirmed by quantitative PCR (Q-PCR) on gastrocnemius muscle of orchidectomised mice and sham controls (n=11/group). We found that in men, circulating total testosterone decreased from 16.5±4.3nmol/L at baseline to 0.4±0.15nmol/L post-ADT (p<0.001). RNA sequencing identified 19 differentially expressed genes post-ADT (all p<0.05 after adjusting for multiple testing). Gene ontology mining identified 8 genes to be of particular interest due to known roles in androgen-mediated signalling; ABCG1, ACTC1, ANKRD1, DMPK, THY1, DCLK1, CST3 were upregulated and SLC38A3 was downregulated post-ADT. Q-PCR in mouse gastrocnemius muscle confirmed that only one gene, Actc1 was concordantly upregulated (p<0.01) in orchidectomised mice compared with controls. In conclusion, given that ACTC1 upregulation is associated with improved muscle function in certain myopathies, we hypothesise that upregulation of ACTC1 may represent a compensatory response to ADT-induced muscle loss. Further studies will be required to evaluate the role and function of ACTC1.
Collapse
Affiliation(s)
- Ada S Cheung
- Department of Medicine (Austin Health), The University of Melbourne, Heidelberg, Victoria, Australia; Department of Endocrinology, Austin Health, Heidelberg, Victoria, Australia.
| | - Casey de Rooy
- Department of Medicine (Austin Health), The University of Melbourne, Heidelberg, Victoria, Australia
| | - Itamar Levinger
- Institute of Sport, Exercise, and Active Living (ISEAL), Victoria University, Victoria, Australia; Australian Institute for Musculoskeletal Science (AIMSS), Western Health, St. Albans, VIC, Australia
| | - Kesha Rana
- Department of Medicine (Austin Health), The University of Melbourne, Heidelberg, Victoria, Australia
| | - Michele V Clarke
- Department of Medicine (Austin Health), The University of Melbourne, Heidelberg, Victoria, Australia
| | - Jackie M How
- Department of Medicine (Austin Health), The University of Melbourne, Heidelberg, Victoria, Australia
| | - Andrew Garnham
- Centre for Physical Activity and Nutrition, School of Exercise and Nutrition Sciences, Deakin University, Burwood, Victoria, Australia
| | | | - Jeffrey D Zajac
- Department of Medicine (Austin Health), The University of Melbourne, Heidelberg, Victoria, Australia; Department of Endocrinology, Austin Health, Heidelberg, Victoria, Australia
| | - Rachel A Davey
- Department of Medicine (Austin Health), The University of Melbourne, Heidelberg, Victoria, Australia
| | - Mathis Grossmann
- Department of Medicine (Austin Health), The University of Melbourne, Heidelberg, Victoria, Australia; Department of Endocrinology, Austin Health, Heidelberg, Victoria, Australia
| |
Collapse
|
28
|
Owen PJ, Daly RM, Livingston PM, Mundell NL, Dalla Via J, Millar JL, Fraser SF. Efficacy of a multi-component exercise programme and nutritional supplementation on musculoskeletal health in men treated with androgen deprivation therapy for prostate cancer (IMPACT): study protocol of a randomised controlled trial. Trials 2017; 18:451. [PMID: 28974267 PMCID: PMC5627417 DOI: 10.1186/s13063-017-2185-z] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2017] [Accepted: 09/08/2017] [Indexed: 12/26/2022] Open
Abstract
Background Prostate cancer is the most commonly diagnosed cancer in men in developed countries. Androgen deprivation therapy (ADT) is a systemic treatment shown to increase survival in selected patients with prostate cancer. The use of ADT continues to increase for all stages and grades of prostate cancer despite known treatment-induced adverse effects. The primary aim of this study is to examine the efficacy of a targeted, multi-component resistance and impact-loading exercise programme together with a daily protein-, calcium- and vitamin D-enriched supplement on bone health in men treated with ADT for prostate cancer. Secondary aims are to determine the effects of this intervention on measures of total body and regional body composition, cardiometabolic risk, inflammatory markers, health-related quality of life and cognitive function. Methods This study is a two-arm randomised controlled trial. Men currently treated with ADT for prostate cancer will be randomised to either a 52-week, community-based, exercise training and nutritional supplementation intervention (n = 51) or usual care control (n = 51). Participants will be assessed at baseline, 26 weeks and 52 weeks for all measures. The primary outcome measures are proximal femur and lumbar spine areal bone mineral density (BMD). Secondary outcomes comprise: changes in tibial and radial bone structure and strength, total body and regional body composition, muscle strength and function, as well as cardiometabolic health, catabolic/inflammatory and anabolic/anti-inflammatory cytokines, health-related quality of life and cognitive function. Discussion This study investigates whether a multi-component intervention incorporating a targeted bone and muscle-loading programme in combination with a protein-, calcium- and vitamin D-enriched supplement can ameliorate multiple adverse effects of ADT when compared to usual care. The results will contribute to the development of exercise training and nutrition guidelines for optimising overall health in men treated with ADT for prostate cancer. Trial registration Australia New Zealand Clinical Trial Registry (ANZCTR), ID: ACTRN12614000317695. Registered on 25 march 2014. Electronic supplementary material The online version of this article (doi:10.1186/s13063-017-2185-z) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- Patrick J Owen
- Deakin University, Institute for Physical Activity and Nutrition (IPAN), School of Exercise and Nutrition Sciences, Geelong, Australia.
| | - Robin M Daly
- Deakin University, Institute for Physical Activity and Nutrition (IPAN), School of Exercise and Nutrition Sciences, Geelong, Australia
| | | | - Niamh L Mundell
- Deakin University, Institute for Physical Activity and Nutrition (IPAN), School of Exercise and Nutrition Sciences, Geelong, Australia
| | - Jack Dalla Via
- Deakin University, Institute for Physical Activity and Nutrition (IPAN), School of Exercise and Nutrition Sciences, Geelong, Australia
| | - Jeremy L Millar
- Alfred Health Radiation Oncology, The Alfred, Melbourne, Australia
| | - Steve F Fraser
- Deakin University, Institute for Physical Activity and Nutrition (IPAN), School of Exercise and Nutrition Sciences, Geelong, Australia
| |
Collapse
|
29
|
Russell N, Cheung A, Grossmann M. Estradiol for the mitigation of adverse effects of androgen deprivation therapy. Endocr Relat Cancer 2017; 24:R297-R313. [PMID: 28667081 DOI: 10.1530/erc-17-0153] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2017] [Accepted: 06/22/2017] [Indexed: 02/01/2023]
Abstract
Prostate cancer (PCa) is the second most commonly diagnosed cancer in men. Conventional endocrine treatment for PCa leads to global sex steroid deprivation. The ensuing severe hypogonadism is associated with well-documented adverse effects. Recently, it has become apparent that many of the biological actions attributed to androgens in men are in fact not direct, but mediated by estradiol. Available evidence supports a primary role for estradiol in vasomotor stability, skeletal maturation and maintenance, and prevention of fat accumulation. Hence there has been interest in revisiting estradiol as a treatment for PCa. Potential roles for estradiol could be in lieu of conventional androgen deprivation therapy or as low-dose add-back treatment while continuing androgen deprivation therapy. These strategies may limit some of the side effects associated with conventional androgen deprivation therapy. However, although available data are reassuring, the potential for cardiovascular risk and pro-carcinogenic effects on PCa via estrogen receptor signalling must be considered.
Collapse
Affiliation(s)
- Nicholas Russell
- Department of EndocrinologyAustin Health, Heidelberg, Victoria, Australia
- Department of Medicine (Austin Health)The University of Melbourne, Heidelberg, Victoria, Australia
| | - Ada Cheung
- Department of EndocrinologyAustin Health, Heidelberg, Victoria, Australia
- Department of Medicine (Austin Health)The University of Melbourne, Heidelberg, Victoria, Australia
| | - Mathis Grossmann
- Department of EndocrinologyAustin Health, Heidelberg, Victoria, Australia
- Department of Medicine (Austin Health)The University of Melbourne, Heidelberg, Victoria, Australia
| |
Collapse
|
30
|
Current and future strategies for the nutritional management of cardiometabolic complications of androgen deprivation therapy for prostate cancer. Nutr Res Rev 2017; 30:220-232. [DOI: 10.1017/s0954422417000087] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
AbstractAndrogen deprivation therapy (ADT) is used widely as part of a combined modality for the treatment of prostate cancer. However, ADT has also been associated with the development of cardiometabolic complications that can increase mortality from cardiovascular events. There is emerging evidence to suggest that ADT-related cardiometabolic risk can be mitigated by diet and lifestyle modification. While the clinical focus for a nutritional approach for achieving this effect is unclear, it may depend upon the timely assessment and targeting of dietary changes to the specific risk phenotype of the patient. The present review aims to address the metabolic origins of ADT-related cardiometabolic risk, existing evidence for the effects of dietary intervention in modifying this risk, and the priorities for future dietary strategies.
Collapse
|
31
|
Díaz Convalía EJ, Cano-García MDC, Miján-Ortiz JL, Arrabal-Martín M, Arrabal-Polo MÁ, Cózar-Olmo JM. Androgen deprivation therapy in prostate cancer and risk of developing renal calculi: Results of a case-control study. Med Clin (Barc) 2017; 148:495-497. [PMID: 28256207 DOI: 10.1016/j.medcli.2017.01.021] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2016] [Revised: 01/09/2017] [Accepted: 01/12/2017] [Indexed: 12/01/2022]
Abstract
BACKGROUND AND OBJECTIVE Androgenic deprivation therapy in prostate cancer is associated with the onset of different adverse effects, including osteoporosis and metabolic syndrome. Both are related to the onset of nephrolithiasis. The objective of this article is to study the incidence of renal stones in patients undergoing androgen deprivation therapy with LHRH analogue. PATIENTS AND METHODS Case-control study including a total of 85 patients divided into 2 groups: group 1, with 41 patients on androgen deprivation therapy, and group 2, with 44 patients not receiving androgen deprivation therapy. RESULTS New-onset lithiasis was observed in 12 cases (29.3%) in group 1 compared to 2 cases (4.5%) in group 2 (P=.0001), 4.4 years after starting the androgen deprivation therapy. The estimated odds ratio was 8.69 (95% CI 1.81-41.76). CONCLUSION The incidence of renal stones could be increased in patients receiving treatment with analogue LHRH. However, long-term prospective studies with a metabolic control are required to be able to establish the causes explaining the development of this phenomenon in patients undergoing treatment with androgen deprivation therapy.
Collapse
Affiliation(s)
| | | | - José Luis Miján-Ortiz
- Unidad de Gestión Clínica de Urología, Complejo Hospitalario Universitario de Granada, Granada, España
| | - Miguel Arrabal-Martín
- Unidad de Gestión Clínica de Urología, Complejo Hospitalario Universitario de Granada, Granada, España
| | - Miguel Ángel Arrabal-Polo
- Unidad de Gestión Clínica de Urología, Complejo Hospitalario Universitario de Granada, Granada, España.
| | - José Manuel Cózar-Olmo
- Unidad de Gestión Clínica de Urología, Complejo Hospitalario Universitario de Granada, Granada, España
| |
Collapse
|
32
|
Cianferotti L, Bertoldo F, Carini M, Kanis JA, Lapini A, Longo N, Martorana G, Mirone V, Reginster JY, Rizzoli R, Brandi ML. The prevention of fragility fractures in patients with non-metastatic prostate cancer: a position statement by the international osteoporosis foundation. Oncotarget 2017; 8:75646-75663. [PMID: 29088899 PMCID: PMC5650454 DOI: 10.18632/oncotarget.17980] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2016] [Accepted: 04/20/2017] [Indexed: 12/13/2022] Open
Abstract
Androgen deprivation therapy is commonly employed for the treatment of non-metastatic prostate cancer as primary or adjuvant treatment. The skeleton is greatly compromised in men with prostate cancer during androgen deprivation therapy because of the lack of androgens and estrogens, which are trophic factors for bone. Men receiving androgen deprivation therapy sustain variable degrees of bone loss with an increased risk of fragility fractures. Several bone antiresorptive agents have been tested in randomized controlled trials in these patients. Oral bisphosphonates, such as alendronate and risedronate, and intravenous bisphosphonates, such as pamidronate and zoledronic acid, have been shown to increase bone density and decrease the risk of fractures in men receiving androgen deprivation therapy. Denosumab, a fully monoclonal antibody that inhibits osteoclastic-mediated bone resorption, is also effective in increasing bone mineral density and reducing fracture rates in these patients. The assessment of fracture risk, T-score and/or the evaluation of prevalent fragility fractures are mandatory for the selection of patients who will benefit from antiresorptive therapy. In the future, new agents modulating bone turnover and skeletal muscle metabolism will be available for testing in these subjects.
Collapse
Affiliation(s)
- Luisella Cianferotti
- Department of Surgery and Translational Medicine, University of Florence, University Hospital of Florence, Florence, Italy
| | | | - Marco Carini
- Department of Urology, University of Florence, University Hospital of Florence, Largo Brambilla Florence, Italy
| | - John A Kanis
- Centre for Metabolic Bone Diseases, University of Sheffield, Sheffield, United Kingdom
| | - Alberto Lapini
- Department of Urology, University of Florence, University Hospital of Florence, Largo Brambilla Florence, Italy
| | - Nicola Longo
- Department of Urology, University of Naples Federico II, Naples, Italy
| | - Giuseppe Martorana
- Department of Urology, S Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
| | - Vincenzo Mirone
- Department of Urology, University of Naples Federico II, Naples, Italy
| | - Jean-Yves Reginster
- Department of Public Health, Epidemiology and Health Economics, University of Liege, CHU Sart-Tilman, Liege, Belgium
| | - Rene Rizzoli
- Service of Bone Diseases, Geneva University Hospitals and Faculty of Medicine, Geneva, Switzerland
| | - Maria Luisa Brandi
- Department of Surgery and Translational Medicine, University of Florence, University Hospital of Florence, Florence, Italy
| |
Collapse
|
33
|
Comparison of bone mineral loss by combined androgen block agonist versus GnRH in patients with prostate cancer: A 12 month-prospective observational study. Sci Rep 2017; 7:39562. [PMID: 28262724 PMCID: PMC5338031 DOI: 10.1038/srep39562] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2016] [Accepted: 10/24/2016] [Indexed: 11/15/2022] Open
Abstract
The multi-centre, prospective, observational study was designed to examine the efficacy of continuous combined androgen block (CAB) vs. GnRH agonist monotherapy in terms of bone mineral density (BMD) change during 12 months post-androgen deprivation therapy (ADT) in Asian prostate cancer patients. Multiple regression analysis and estimated the 10-year probability of major fractures among the patients with Fracture Risk Assessment Tool were conducted to investigate the underlying factors affecting BMD. Paired t-test to evaluate the change of BMD from baseline to 12 month, and two sample t-test to examine the difference of BMD changes were used between two groups. BMD significantly decreased in both the CAB and GnRH groups, with no group wise differences. The proportion of osteopenia or osteoporosis was slightly increased after the 12-month post-ADT. Ten-year probability of hip fracture and major osteoporotic fracture was approximately 3% and 5%, respectively. In conclusion, a significant decrease of BMD by 12-month ADT was observed without any differences between the two groups, whereas ADT-related BMD loss did not induce detrimental effects on bone health in terms of increased bone fracture risk. This was the first prospective study on BMD changes as a predictor of fracture during ADT in an Asian population.
Collapse
|
34
|
Cheung AS, Gray H, Schache AG, Hoermann R, Lim Joon D, Zajac JD, Pandy MG, Grossmann M. Androgen deprivation causes selective deficits in the biomechanical leg muscle function of men during walking: a prospective case-control study. J Cachexia Sarcopenia Muscle 2017; 8:102-112. [PMID: 27897410 PMCID: PMC5326829 DOI: 10.1002/jcsm.12133] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2016] [Revised: 05/20/2016] [Accepted: 05/30/2016] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND Although muscle mass declines with testosterone deficiency in men, previous studies of muscle function have not demonstrated consistent deficits, likely due to relatively insensitive methodology. Our objective was to determine the effects of testosterone deprivation on the biomechanical function of individual lower-limb muscles. METHODS We conducted a 12-month prospective, observational case-control study of 34 men newly commencing androgen deprivation treatment (ADT) for prostate cancer and 29 age-matched prostate cancer controls. Participants were assessed at 0, 6, and 12 months while walking in a biomechanics laboratory. We combined video-based motion capture and ground reaction force data with computerized musculoskeletal modelling to assess the following primary outcomes: (i) peak joint torques at the hip, knee and ankle, and corresponding individual muscle forces; (ii) individual muscle contributions to acceleration of the body's centre of mass; and (iii) walking speed, stride length, and step width. A linear mixed model was used to compare mean differences between groups. RESULTS Compared with controls over 12 months, men receiving ADT had a mean reduction in total testosterone level from 14.1 to 0.4 nmol/L, and demonstrated more marked decreases in peak hip flexor torque by 14% [mean difference -0.11 N/kg (-0.19, -0.03), P = 0.01] and peak knee extensor torque by 16% [-0.11 N/kg (-0.20, -0.02), P = 0.02] of the initial mean value. Correspondingly, iliopsoas force decreased by 14% (P = 0.006), and quadriceps force decreased by 11%, although this narrowly missed statistical significance (P = 0.07). Soleus decreased contribution to forward acceleration of the body's centre of mass by 17% [mean difference -0.17 m/s2 (-0.29, -0.05), P < 0.01]. No significant changes between groups were observed in other joint torques or individual muscle contributions to acceleration of the body. Step width increased by 18% [mean adjusted difference 1.4 cm (0.6, 27.4), P = 0.042] in the ADT group compared with controls, with no change in stride length or walking speed. CONCLUSIONS Testosterone deprivation selectively decreases lower-limb muscle function, predominantly affecting muscles that support body weight, accelerate the body forwards during walking, and mediate balance. Future exercise and pro-myogenic interventional studies to mitigate ADT-associated sarcopenia should target these deficits.
Collapse
Affiliation(s)
- Ada S Cheung
- Department of Medicine, Austin Health, The University of Melbourne, Melbourne, Victoria, Australia.,Department of Endocrinology, Austin Health, Heidelberg, Victoria, Australia
| | - Hans Gray
- Department of Mechanical Engineering, The University of Melbourne, Melbourne, Victoria, Australia
| | - Anthony G Schache
- Department of Mechanical Engineering, The University of Melbourne, Melbourne, Victoria, Australia
| | - Rudolf Hoermann
- Department of Medicine, Austin Health, The University of Melbourne, Melbourne, Victoria, Australia
| | - Daryl Lim Joon
- Department of Radiation Oncology, Austin Health, Heidelberg, Victoria, Australia
| | - Jeffrey D Zajac
- Department of Medicine, Austin Health, The University of Melbourne, Melbourne, Victoria, Australia.,Department of Endocrinology, Austin Health, Heidelberg, Victoria, Australia
| | - Marcus G Pandy
- Department of Mechanical Engineering, The University of Melbourne, Melbourne, Victoria, Australia
| | - Mathis Grossmann
- Department of Medicine, Austin Health, The University of Melbourne, Melbourne, Victoria, Australia.,Department of Endocrinology, Austin Health, Heidelberg, Victoria, Australia
| |
Collapse
|
35
|
Festuccia C. Investigational serine/threonine kinase inhibitors against prostate cancer metastases. Expert Opin Investig Drugs 2016; 26:25-34. [PMID: 27892725 DOI: 10.1080/13543784.2016.1266337] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
INTRODUCTION Androgen deprivation therapy (ADT) is used as first therapeutic approach in prostate cancer (PCa) although castration resistant disease (CRPC) develops with high frequency. CRPC is the consequence of lack of apoptotic responses to ADT. Alternative targeting of the androgen axis with abiraterone and enzalutamide, as well as taxane-based chemotherapy were used in CRPC. Serine/threonine protein kinases (STKs) regulate different molecular pathways of normal and neoplastic cells and participate to development of CRPC as well as to the progression towards a bone metastatic disease (mCRPC). Areas covered: The present review provide data on STK expression and activity in the development of CRPC as well as summarize recent reports of different strategies to block STK activity for the control of PCa progression. Expert Opinion: Inhibitors for different STKs have been developed but clinical trials in PCa are comparatively rare and few exhibit satisfactory 'drug-like' properties. It is, however, necessary to intensify, when possible, the number of clinical trials with these drugs in order to insert new therapies or combinations with standard hormone- and chemo-therapies in the treatment guidelines of the mPCA.
Collapse
Affiliation(s)
- Claudio Festuccia
- a Department of Biotechnological and Applied Clinical Sciences , University of L'Aquila , L'Aquila , Italy
| |
Collapse
|
36
|
Bjerre E, Bruun DM, Tolver A, Brasso K, Krustrup P, Johansen C, Christensen R, Rørth M, Midtgaard J. Effectiveness of community-based football compared to usual care in men with prostate cancer: Protocol for a randomised, controlled, parallel group, multicenter superiority trial (The FC Prostate Community Trial). BMC Cancer 2016; 16:767. [PMID: 27716218 PMCID: PMC5048405 DOI: 10.1186/s12885-016-2805-0] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2016] [Accepted: 09/22/2016] [Indexed: 01/07/2023] Open
Abstract
Background Prostate cancer is the most common non-cutaneous malignancy in men. Today most patients may expect to live years following the diagnosis and may thus experience significant morbidity due to disease progression and treatment toxicity. In order to address some of these problems exercise has been suggested and previously studies have shown improvements of disease specific quality of life and a reduction in treatment-related toxicity. Cohort studies with long term follow up have suggested that physical activity is associated with improved survival in prostate cancer patients. Previously one randomised controlled trial has examined the efficacy of football in prostate cancer patients undergoing androgen deprivation therapy to usual care and reported positive effects on lean body mass and bone markers. Against this background, we wish to examine the effectiveness of community-based football for men diagnosed with prostate cancer. Methods Using a randomised controlled parallel group, multicenter, superiority trial design, two hundred prostate cancer patients will be recruited and randomised (1:1) to either community-based football one hour twice weekly or to a control group. The intervention period will be six months. The primary outcome is quality of life assessed after 12 weeks based on the change from baseline in the Functional Assessment of Cancer Therapy–Prostate questionnaire. Secondary outcomes are change from baseline to six months in quality of life, lean body mass, fat mass, whole body and regional bone markers, as well as physical activity and functional capacity at 12 weeks and six months. Safety outcome variables will be falls resulting in seeking medical assessment and fractures during the six-month period. Discussion Football is viewed as a case for non-professional, supervised community-based team sport for promoting long-term physical activity in men diagnosed with prostate cancer. This randomised trial will provide data on effectiveness and safety for men with prostate cancer when football training is delivered in local football clubs. Trial registration Clinicaltrials.gov identifier: NCT02430792
Collapse
Affiliation(s)
- Eik Bjerre
- University Hospitals Centre for Health Research (UCSF), Rigshospitalet, University of Copenhagen, Copenhagen, Denmark.
| | - Ditte Marie Bruun
- University Hospitals Centre for Health Research (UCSF), Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Anders Tolver
- Department of Mathematical Sciences, Faculty of Science, University of Copenhagen, Copenhagen, Denmark
| | - Klaus Brasso
- Copenhagen Prostate Cancer Center, Department of Urology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Peter Krustrup
- Department of Sports Science and Clinical Biomechanics, SDU Sport and Health Sciences Cluster (SHSC), University of Southern Denmark, Odense M, Denmark.,Sport and Health Sciences, College of Life and Environmental Sciences, University of Exeter, Exeter, UK
| | - Christoffer Johansen
- Department of Oncology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark.,Unit of Survivorship, Danish Cancer Society Research Center, Copenhagen, Denmark
| | - Robin Christensen
- Musculoskeletal Statistics Unit, The Parker Institute, Bispebjerg and Frederiksberg Hospital, Copenhagen, Denmark
| | - Mikael Rørth
- University Hospitals Centre for Health Research (UCSF), Rigshospitalet, University of Copenhagen, Copenhagen, Denmark.,Department of Oncology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Julie Midtgaard
- University Hospitals Centre for Health Research (UCSF), Rigshospitalet, University of Copenhagen, Copenhagen, Denmark.,Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| |
Collapse
|
37
|
Wadosky KM, Koochekpour S. Molecular mechanisms underlying resistance to androgen deprivation therapy in prostate cancer. Oncotarget 2016; 7:64447-64470. [PMID: 27487144 PMCID: PMC5325456 DOI: 10.18632/oncotarget.10901] [Citation(s) in RCA: 111] [Impact Index Per Article: 13.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2016] [Accepted: 07/19/2016] [Indexed: 12/13/2022] Open
Abstract
Prostate cancer (PCa) is the most widely diagnosed male cancer in the Western World and while low- and intermediate-risk PCa patients have a variety of treatment options, metastatic patients are limited to androgen deprivation therapy (ADT). This treatment paradigm has been in place for 75 years due to the unique role of androgens in promoting growth of prostatic epithelial cells via the transcription factor androgen receptor (AR) and downstream signaling pathways. Within 2 to 3 years of ADT, disease recurs-at which time, patients are considered to have castration-recurrent PCa (CR-PCa). A universal mechanism by which PCa becomes resistant to ADT has yet to be discovered. In this review article, we discuss underlying molecular mechanisms by which PCa evades ADT. Several major resistance pathways center on androgen signaling, including intratumoral and adrenal androgen production, AR-overexpression and amplification, expression of AR mutants, and constitutively-active AR splice variants. Other ADT resistance mechanisms, including activation of glucocorticoid receptor and impairment of DNA repair pathways are also discussed. New therapies have been approved for treatment of CR-PCa, but increase median survival by only 2-8 months. We discuss possible mechanisms of resistance to these new ADT agents. Finally, the practicality of the application of "precision oncology" to this continuing challenge of therapy resistance in metastatic or CR-PCa is examined. Empirical validation and clinical-based evidence are definitely needed to prove the superiority of "precision" treatment in providing a more targeted approach and curative therapies over the existing practices that are based on biological "cause-and-effect" relationship.
Collapse
MESH Headings
- Androgen Antagonists/adverse effects
- Androgen Antagonists/therapeutic use
- Animals
- Antineoplastic Agents, Hormonal/adverse effects
- Antineoplastic Agents, Hormonal/therapeutic use
- Drug Resistance, Neoplasm/genetics
- Humans
- Kallikreins/blood
- Male
- Mutation
- Neoplasm Staging
- Phosphorylation
- Prostate-Specific Antigen/blood
- Prostatic Neoplasms, Castration-Resistant/blood
- Prostatic Neoplasms, Castration-Resistant/drug therapy
- Prostatic Neoplasms, Castration-Resistant/genetics
- Prostatic Neoplasms, Castration-Resistant/pathology
- Receptors, Androgen/drug effects
- Receptors, Androgen/genetics
- Receptors, Androgen/metabolism
- Risk Factors
- Signal Transduction/drug effects
- Treatment Outcome
Collapse
Affiliation(s)
- Kristine M. Wadosky
- Department of Cancer Genetics, Center for Genetics and Pharmacology, Roswell Park Cancer Institute, Buffalo, NY, USA
| | - Shahriar Koochekpour
- Department of Cancer Genetics, Center for Genetics and Pharmacology, Roswell Park Cancer Institute, Buffalo, NY, USA
- Department of Urology, Roswell Park Cancer Institute, Buffalo, NY, USA
| |
Collapse
|
38
|
Cheung AS, Hoermann R, Dupuis P, Joon DL, Zajac JD, Grossmann M. Relationships between insulin resistance and frailty with body composition and testosterone in men undergoing androgen deprivation therapy for prostate cancer. Eur J Endocrinol 2016; 175:229-37. [PMID: 27340081 DOI: 10.1530/eje-16-0200] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2016] [Accepted: 06/23/2016] [Indexed: 01/06/2023]
Abstract
OBJECTIVE While androgen deprivation therapy (ADT) has been associated with insulin resistance and frailty, controlled prospective studies are lacking. We aimed to examine the relationships between insulin resistance and frailty with body composition and testosterone. DESIGN Case-control prospective study. METHODS Sixty three men with non-metastatic prostate cancer newly commencing ADT (n=34) and age-matched prostate cancer controls (n=29) were recruited. The main outcomes were insulin resistance (HOMA2-IR), Fried's frailty score, body composition by dual x-ray absorptiometry and short physical performance battery (SPPB) measured at 0, 6 and 12months. A generalised linear model determined the mean adjusted difference (95% CI) between groups. RESULTS Compared with controls over 12months, men receiving ADT had reductions in mean total testosterone level (14.1-0.4nmol/L, P<0.001), mean adjusted gain in fat mass of 3530g (2012, 5047), P<0.02 and loss of lean mass of 1491g (181, 2801), P<0.02. Visceral fat was unchanged. HOMA2-IR in the ADT group increased 0.59 (0.24, 0.94), P=0.02, which was most related to the increase in fat mass (P=0.003), less to lean mass (P=0.09) or total testosterone (P=0.088). Frailty increased with ADT (P<0.0001), which was related to decreased testosterone (P=0.028), and less to fat mass (P=0.056) or lean mass (P=0.79). SPPB was unchanged. CONCLUSIONS ADT is associated with increased insulin resistance and frailty within 12months of commencement, independently of confounding effects of cancer or radiotherapy. Insulin resistance appears to be mediated by subcutaneous or peripheral sites of fat deposition. Prevention of fat gain is an important strategy to prevent adverse ADT-associated cardiometabolic risks.
Collapse
Affiliation(s)
- Ada S Cheung
- Department of MedicineThe University of Melbourne, Austin Health, Heidelberg, Victoria, Australia Department of Endocrinology
| | - Rudolf Hoermann
- Department of MedicineThe University of Melbourne, Austin Health, Heidelberg, Victoria, Australia
| | - Philippe Dupuis
- Department of MedicineThe University of Melbourne, Austin Health, Heidelberg, Victoria, Australia
| | - Daryl Lim Joon
- Department of Radiation Oncology Austin HealthHeidelberg, Victoria, Australia
| | - Jeffrey D Zajac
- Department of MedicineThe University of Melbourne, Austin Health, Heidelberg, Victoria, Australia Department of Endocrinology
| | - Mathis Grossmann
- Department of MedicineThe University of Melbourne, Austin Health, Heidelberg, Victoria, Australia Department of Endocrinology
| |
Collapse
|
39
|
Moyad MA, Newton RU, Tunn UW, Gruca D. Integrating diet and exercise into care of prostate cancer patients on androgen deprivation therapy. Res Rep Urol 2016; 8:133-43. [PMID: 27574584 PMCID: PMC4993404 DOI: 10.2147/rru.s107852] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
Improved diagnosis and treatment regimens have resulted in greater longevity for men with prostate cancer. This has led to an increase in both androgen deprivation therapy (ADT) use and duration of exposure, and therefore to its associated adverse effects, such as sexual dysfunction, osteoporosis, reduced muscle mass, increased fat mass, and increased incidence of cardiovascular disease and type 2 diabetes. Given that the adverse effects of ADT are systemic, often debilitating, and difficult to treat, efforts continue in the development of new strategies for long-term management of prostate cancer. The PubMed database was searched to select trials, reviews, and meta-analyses in English using such search terms as "prostate cancer" and "androgen deprivation therapy", "cardiovascular risk", "lean body mass", "exercise", and "diet". The initial searches produced 379 articles with dates 2005 or more recent. Articles published after 2004 were favored. This review utilizes the latest data to provide a status update on the effects of exercise and diet on patients with prostate cancer, focusing on ADT-associated side effects, and it discusses the evidence for such interventions. Since the evidence of large-scale trials in patients with prostate cancer is missing, and an extrapolation of supporting data to all patient subgroups cannot be provided, individualized risk assessments remain necessary before the initiation of exercise and diet programs. Exercise, diet, and nutritional supplementation interventions have the potential to provide effective, accessible, and relatively inexpensive strategies for mitigating ADT-associated toxicities without introducing additional adverse effects.
Collapse
Affiliation(s)
- Mark A Moyad
- Department of Urology, University of Michigan Medical Center, Ann Arbor, MI, USA
| | - Robert U Newton
- Exercise Medicine Research Institute, Edith Cowan University, Joondalup, WA, Australia
| | - Ulf W Tunn
- Urological Clinic, Facharztzentrum Academic Hospital Sana Klinikum Offenbach, Offenbach/Main
| | - Damian Gruca
- Global Medical Affairs, AbbVie Deutschland, Ludwigshafen, Germany
| |
Collapse
|
40
|
Wadosky KM, Koochekpour S. Therapeutic Rationales, Progresses, Failures, and Future Directions for Advanced Prostate Cancer. Int J Biol Sci 2016; 12:409-26. [PMID: 27019626 PMCID: PMC4807161 DOI: 10.7150/ijbs.14090] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2015] [Accepted: 11/15/2015] [Indexed: 02/07/2023] Open
Abstract
Patients with localized prostate cancer (PCa) have several therapeutic options with good prognosis. However, survival of patients with high-risk, advanced PCa is significantly less than patients with early-stage, organ-confined disease. Testosterone and other androgens have been directly linked to PCa progression since 1941. In this review, we chronicle the discoveries that led to modern therapeutic strategies for PCa. Specifically highlighted is the biology of androgen receptor (AR), the nuclear receptor transcription factor largely responsible for androgen-stimulated and castrate-recurrent (CR) PCa. Current PCa treatment paradigms can be classified into three distinct but interrelated categories: targeting AR at pre-receptor, receptor, or post-receptor signaling. The continuing challenge of disease relapse as CR and/or metastatic tumors, destined to occur within three years of the initial treatment, is also discussed. We conclude that the success of PCa therapies in the future depends on targeting molecular mechanisms underlying tumor recurrence that still may affect AR at pre-receptor, receptor, and post-receptor levels.
Collapse
Affiliation(s)
| | - Shahriar Koochekpour
- ✉ Corresponding author: Dr. Shahriar Koochekpour, Departments of Cancer Genetics and Urology, Center for Genetics and Pharmacology, Roswell Park Cancer Institute, Elm and Carlton Streets, Buffalo, NY, 14263, USA, Telephone: 716-845-3345; Fax: 716-845-1698;
| |
Collapse
|
41
|
Grossmann M, Cheung AS. Impact of Androgen Deprivation Therapy on High-level Physical Performance. Eur Urol 2016; 69:1161-2. [PMID: 26827095 DOI: 10.1016/j.eururo.2016.01.025] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2015] [Accepted: 01/13/2016] [Indexed: 11/19/2022]
Affiliation(s)
- Mathis Grossmann
- Department of Medicine, The University of Melbourne Austin Health, Heidelberg, Australia.
| | - Ada S Cheung
- Department of Medicine, The University of Melbourne Austin Health, Heidelberg, Australia
| |
Collapse
|
42
|
de Rooy C, Grossmann M, Zajac JD, Cheung AS. Targeting muscle signaling pathways to minimize adverse effects of androgen deprivation. Endocr Relat Cancer 2016; 23:R15-26. [PMID: 26432470 DOI: 10.1530/erc-15-0232] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/02/2015] [Indexed: 01/05/2023]
Abstract
Androgen deprivation therapy (ADT) is a highly effective treatment used in ∼30% of men with prostate cancer. Adverse effects of ADT on muscle are significant with consistent losses in muscle mass. However, effects of ADT on muscle strength and physical function, of most relevance to the patient, are less well understood. This is in part due to the fact that muscle effects of ADT at the cellular, genetic and protein level, critical to the understanding of the pathophysiology of sarcopenia, have come into focus only recently. This review highlights the complexity of androgen-dependent signaling in muscle with an emphasis on recent findings in the regulation of muscle growth and muscle atrophy pathways. Furthermore, the effects of ADT and testosterone on skeletal muscle histology, gene expression and protein transcription are discussed. A better mechanistic understanding of the regulation of muscle mass and function by androgens should not only pave the way for developing targeted promyogenic interventions for men with prostate cancer receiving ADT but also may have wider implications for age-associated sarcopenia in the general population.
Collapse
Affiliation(s)
- Casey de Rooy
- Department of MedicineUniversity of Melbourne, Heidelberg, Victoria, AustraliaDepartment of EndocrinologyAustin Health, Studley Road Heidelberg, Victoria, 3084, Australia
| | - Mathis Grossmann
- Department of MedicineUniversity of Melbourne, Heidelberg, Victoria, AustraliaDepartment of EndocrinologyAustin Health, Studley Road Heidelberg, Victoria, 3084, Australia Department of MedicineUniversity of Melbourne, Heidelberg, Victoria, AustraliaDepartment of EndocrinologyAustin Health, Studley Road Heidelberg, Victoria, 3084, Australia
| | - Jeffrey D Zajac
- Department of MedicineUniversity of Melbourne, Heidelberg, Victoria, AustraliaDepartment of EndocrinologyAustin Health, Studley Road Heidelberg, Victoria, 3084, Australia Department of MedicineUniversity of Melbourne, Heidelberg, Victoria, AustraliaDepartment of EndocrinologyAustin Health, Studley Road Heidelberg, Victoria, 3084, Australia
| | - Ada S Cheung
- Department of MedicineUniversity of Melbourne, Heidelberg, Victoria, AustraliaDepartment of EndocrinologyAustin Health, Studley Road Heidelberg, Victoria, 3084, Australia Department of MedicineUniversity of Melbourne, Heidelberg, Victoria, AustraliaDepartment of EndocrinologyAustin Health, Studley Road Heidelberg, Victoria, 3084, Australia
| |
Collapse
|
43
|
Bienz M, Saad F. Androgen-deprivation therapy and bone loss in prostate cancer patients: a clinical review. BONEKEY REPORTS 2015; 4:716. [PMID: 26131363 DOI: 10.1038/bonekey.2015.85] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/26/2015] [Accepted: 05/08/2015] [Indexed: 12/31/2022]
Abstract
Androgen-deprivation therapy (ADT) has become a standard of care in the management of advanced prostate cancer or as an adjunct therapy. However, ADT is associated with a well-known deleterious effect on bone health, resulting in a decrease in bone-mass density (BMD) and increased risk for fracture. With the longer life expectancy of prostate cancer patients, improvement of the quality of life has become increasingly important. Therefore, adequate screening, prevention and treatment of BMD loss is paramount. Zoledronic acid and denosumab have shown promising results in recent studies, which has led to the Food and Drug Administration approval of these treatment options in various settings throughout the course of the disease, including the prevention of ADT-associated bone loss. This review focuses on the various parameters that impact BMD loss in men initiating ADT, on the specific effect of ADT on bone health and on various lifestyle modifications and treatment options such as bisphosphonates, osteoclast-targeted therapy and selective estrogen-receptor modulators that have shown promising results in recent studies.
Collapse
Affiliation(s)
- Marc Bienz
- Faculty of Medicine, University of Montreal , Montreal, Canada
| | - Fred Saad
- Department of Urology, University of Montreal Hospital Center , Montreal, Canada
| |
Collapse
|
44
|
Todenhöfer T, Stenzl A, Hofbauer LC, Rachner TD. Targeting bone metabolism in patients with advanced prostate cancer: current options and controversies. Int J Endocrinol 2015; 2015:838202. [PMID: 25802521 PMCID: PMC4329828 DOI: 10.1155/2015/838202] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2014] [Accepted: 01/03/2015] [Indexed: 12/21/2022] Open
Abstract
Maintaining bone health remains a clinical challenge in patients with prostate cancer (PC) who are at risk of developing metastatic bone disease and increased bone loss due to hormone ablation therapy. In patients with cancer-treatment induced bone loss (CTIBL), antiresorptive agents have been shown to improve bone mineral density (BMD) and to reduce the risk of fractures. For patients with bone metastases, both zoledronic acid and denosumab delay skeletal related events (SREs) in the castration resistant stage of disease. Novel agents targeting the Wnt inhibitors dickkopf-1 and sclerostin are currently under investigation for the treatment of osteoporosis and malignant bone disease. New antineoplastic drugs such as abiraterone, enzalutamide, and Radium-223 are capable of further delaying SREs in patients with advanced PC. The benefit of antiresorptive treatment for patients with castration sensitive PC appears to be limited. Recent trials on the use of zoledronic acid for the prevention of bone metastases failed to be successful, whereas denosumab delayed the occurrence of bone metastases by a median of 4.1 months. Currently, the use of antiresorptive drugs to prevent bone metastases still remains a field of controversies and further trials are needed to identify patient subgroups that may profit from early therapy.
Collapse
Affiliation(s)
- Tilman Todenhöfer
- Department of Urology, University Hospital, Hoppe-Seyler-Straße 3, 72076 Tübingen, Germany
- Vancouver Prostate Centre, University of British Columbia, 2660 Oak Street, Vancouver, BC, Canada V6H 3Z6
| | - Arnulf Stenzl
- Department of Urology, University Hospital, Hoppe-Seyler-Straße 3, 72076 Tübingen, Germany
| | - Lorenz C. Hofbauer
- Department of Medicine III, Technische Universität Dresden Medical Center, Fetscherstraße 74, 01307 Dresden, Germany
| | - Tilman D. Rachner
- Department of Medicine III, Technische Universität Dresden Medical Center, Fetscherstraße 74, 01307 Dresden, Germany
| |
Collapse
|