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Cursano MC, Valsecchi AA, Pantano F, Di Maio M, Procopio G, Berruti A, Bertoldo F, Tucci M, De Giorgi U, Santini D. Bone health and body composition in prostate cancer: Meet-URO and AIOM consensus about prevention and management strategies. ESMO Open 2024; 9:103484. [PMID: 38901175 PMCID: PMC11252762 DOI: 10.1016/j.esmoop.2024.103484] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2024] [Revised: 04/23/2024] [Accepted: 04/30/2024] [Indexed: 06/22/2024] Open
Abstract
BACKGROUND Prostate cancer (PCa) treatments are associated with a detrimental impact on bone health (BH) and body composition. However, the evidence on these issues is limited and contradictory. This consensus, based on the Delphi method, provides further guidance on BH management in PCa. MATERIALS AND METHODS In May 2023, a survey made up of 37 questions and 74 statements was developed by a group of oncologists and endocrinologists with expertise in PCa and BH. In June 2023, 67 selected Italian experts, belonging to the Italian scientific societies Italian Association of Medical Oncology and Italian Network for Research in Urologic-Oncology (Meet-URO), were invited by e-mail to complete it, rating their strength of agreement with each statement on a 5-point scale. An agreement ≥75% defined the statement as accepted. RESULTS In non-metastatic hormone-sensitive PCa, the panel agreed that androgen deprivation therapy (ADT) alone implies sufficient fracture risk to warrant antifracture therapy with bone-targeting agents (BTAs) for cancer treatment-induced bone loss (CTIBL) prevention (79%). Therefore, no consensus was reached (48%) for the treatment with BTAs of patients receiving short-term ADT (<6 months). All patients receiving active treatment for metastatic hormone-sensitive PCa (75%), non-metastatic castration-resistant PCa (89%) and metastatic castration-resistant PCa (mCRPC) without bone metastases (84%) should be treated with BTAs at the doses and schedule for CTIBL prevention. All mCRPC patients with bone metastasis should be treated with BTAs to reduce skeletal-related events (94%). In all settings, the panel analyzed the type and timing of treatments and examinations to carry out for BH monitoring. The panel agreed on the higher risk of sarcopenic obesity of these patients and its correlation with bone fragility. CONCLUSIONS This consensus highlights areas lacking major agreement, like non-metastatic hormone-sensitive prostate cancer patients undergoing short-term ADT. Evaluation of these issues in prospective clinical trials and identification of early biomarkers of bone loss are particularly urgent.
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Affiliation(s)
- M C Cursano
- Department of Medical Oncology, IRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) "Dino Amadori", Meldola
| | - A A Valsecchi
- Department of Oncology, University of Turin, A.O.U. Città della Salute e della Scienza di Torino, Ospedale Molinette, Turin
| | - F Pantano
- Department of Medical Oncology, Campus Bio-Medico University, Rome
| | - M Di Maio
- Department of Oncology, University of Turin, A.O.U. Città della Salute e della Scienza di Torino, Ospedale Molinette, Turin
| | - G Procopio
- Programma Prostata Fondazione Istituto Nazionale Tumori Milano, Milan
| | - A Berruti
- Oncology Unit, Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia and ASST SpedaliCivili di Brescia, Brescia
| | - F Bertoldo
- Emergency Medicine, Department of Medicine, University of Verona, Verona
| | - M Tucci
- Department of Medical Oncology, Cardinal Massaia Hospital, Asti
| | - U De Giorgi
- Department of Medical Oncology, IRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) "Dino Amadori", Meldola
| | - D Santini
- Oncologia Medica A, Policlinico Umberto 1, La Sapienza Università Di Roma, Rome, Italy.
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Houben LHP, Beelen M, van Loon LJC, Beijer S. Resistance Exercise Training, a Simple Intervention to Preserve Muscle Mass and Strength in Prostate Cancer Patients on Androgen Deprivation Therapy. Int J Sport Nutr Exerc Metab 2024; 34:122-134. [PMID: 38048764 DOI: 10.1123/ijsnem.2023-0075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Revised: 08/14/2023] [Accepted: 10/03/2023] [Indexed: 12/06/2023]
Abstract
Androgen deprivation therapy (ADT) forms the cornerstone in the treatment of advanced prostate cancer. However, by suppressing testosterone ADT results in a decrease of skeletal muscle mass. In this narrative review, we explore the magnitude and mechanisms of ADT-induced muscle mass loss and the consequences for muscle strength and physical performance. Subsequently, we elucidate the effectiveness of supervised resistance exercise training as a means to mitigate these adverse effects. Literature shows that resistance exercise training can effectively counteract ADT-induced loss of appendicular lean body mass and decline in muscle strength, while the effect on physical performances is inconclusive. As resistance exercise training is feasible and can be safely implemented during ADT (with special attention for patients with bone metastases), it should be incorporated in standard clinical care for prostate cancer patients (starting) with ADT.
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Affiliation(s)
- Lisanne H P Houben
- Department of Human Biology, NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University Medical Centre+, Maastricht, The Netherlands
- Netherlands Comprehensive Cancer Organization (IKNL), Utrecht, The Netherlands
| | - Milou Beelen
- Department of Human Biology, NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University Medical Centre+, Maastricht, The Netherlands
| | - Luc J C van Loon
- Department of Human Biology, NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University Medical Centre+, Maastricht, The Netherlands
| | - Sandra Beijer
- Netherlands Comprehensive Cancer Organization (IKNL), Utrecht, The Netherlands
- Department of Dietetics, Maastricht University Medical Centre+, Maastricht, The Netherlands
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3
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Stelmach-Mardas M, Warchoł W, Garczyk A, Warchoł E, Korczak J, Litwiniuk M, Brajer-Luftmann B, Mardas M. Influence of Androgen Deprivation Therapy on the Development of Sarcopenia in Patients with Prostate Cancer: A Systematic Review. Nutrients 2024; 16:656. [PMID: 38474784 PMCID: PMC10934555 DOI: 10.3390/nu16050656] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2024] [Revised: 02/22/2024] [Accepted: 02/23/2024] [Indexed: 03/14/2024] Open
Abstract
The changes in body composition during androgen deprivation therapy (ADT) in patients suffering from prostate cancer (PCa) are recognized by professionals more often as biomarker for effective treatment. The aim of this study was to investigate the impact of ADT on the sarcopenia development in PCa. The following databases were used: PubMed, Embase, Web of Science and Scopus databases. Out of 2183 studies, 7 were included in this review. The fixed-effect model was used in the meta-analysis. A significant increase in SATI (Subcutaneous Adipose Tissue Index) of 0.32 (95% CI: 0.13-0.51) p = 0.001, decrease in SMI (Skeletal Muscle Index) of -0.38 (95% CI: -0.57 to -0.19) p < 0.0001, and SMD (Skeletal Muscle Density) of -0.46 (95% CI: -0.69 to -0.24) p < 0.0001 were observed. No statistical association was visible between ADT and changes in BMI (Body Mass Index), 0.05 (95% CI: -0.18-0.28), p = 0.686, and VATI (Visceral Adipose Tissue Index): 0.17 (95% CI: -0.02 to 0.37), p = 0.074. In conclusion, the ADT significantly contributes to the body composition changes and sarcopenia development.
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Affiliation(s)
- Marta Stelmach-Mardas
- Department of Obesity Treatment, Metabolic Disorders and Clinical Dietetics, Poznan University of Medical Sciences, 60-569 Poznan, Poland; (A.G.); (E.W.)
| | - Wojciech Warchoł
- Department of Ophthalmology and Optometry, Poznan University of Medical Sciences, 60-806 Poznan, Poland;
| | - Aleksandra Garczyk
- Department of Obesity Treatment, Metabolic Disorders and Clinical Dietetics, Poznan University of Medical Sciences, 60-569 Poznan, Poland; (A.G.); (E.W.)
| | - Emilia Warchoł
- Department of Obesity Treatment, Metabolic Disorders and Clinical Dietetics, Poznan University of Medical Sciences, 60-569 Poznan, Poland; (A.G.); (E.W.)
| | - Jolanta Korczak
- Department of Chemotherapy, The Greater Poland Cancer Center, 61-866 Poznan, Poland;
| | - Maria Litwiniuk
- Department of Cancer Pathology and Prevention, Poznan University of Medical Sciences, 61-866 Poznan, Poland;
| | - Beata Brajer-Luftmann
- Department of Pulmonology, Allergology and Pulmonary Oncology, Poznan University of Medical Sciences, 60-569 Poznan, Poland;
| | - Marcin Mardas
- Department of Gynecological Oncology, Institute of Oncology, Poznan University of Medical Sciences, 60-569 Poznan, Poland;
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4
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Neerhut T, Shin BNH, Rhee H, Chung E. A review of the objective cognitive function measurements in males receiving hormonal therapy for prostate cancer. Investig Clin Urol 2023; 64:521-540. [PMID: 37932563 PMCID: PMC10630686 DOI: 10.4111/icu.20230103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2023] [Revised: 06/26/2023] [Accepted: 08/21/2023] [Indexed: 11/08/2023] Open
Abstract
PURPOSE Prostate cancer (PC) is more common in the older population and the use of hormonal therapy in PC can increase medical frailty and cognitive decline. This narrative review examines the impact of androgen deprivation therapies (ADTs) and next-generational hormonal therapies (NGHT) on cognitive function outcomes amongst patients with hormone-sensitive or castrate-resistant PC. MATERIALS AND METHODS Six electronic databases were searched from January 2000 to June 2022 for quantitative studies to evaluate the impacts of hormonal therapies (ADT, combined androgen blockade, and NGHT) on cognitive functions in men with PC. RESULTS Of the 36 studies identified, 20 studies reported no effect of hormonal therapies on any cognitive domain while 16 studies found possible declines in at least one domain. The domains assessed were highly variable and objective assessment measurements were not standardized or widely adopted. While the results have been inconsistent, a relationship between declining androgen levels and poorer performances in the visuospatial and visual memory domains has been highlighted. It was not possible to distinguish the degree of cognitive parameter changes between the populations of hormone-sensitive and castrate-resistant PC. CONCLUSIONS While the exact impact of ADT and NGHT on cognitive function in men with PC remains controversial, appropriate care should be undertaken especially in older and frail individuals, specifically in those with progressive or established visuospatial or visual memory deficits.
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Affiliation(s)
- Thomas Neerhut
- Department of Urology, Princess Alexandra Hospital Brisbane QLD Australia, The University of Queensland, Brisbane, QLD, Australia
| | - Brian Ng Hung Shin
- Department of Urology, Princess Alexandra Hospital Brisbane QLD Australia, The University of Queensland, Brisbane, QLD, Australia
| | - Handoo Rhee
- Department of Urology, Princess Alexandra Hospital Brisbane QLD Australia, The University of Queensland, Brisbane, QLD, Australia
| | - Eric Chung
- Department of Urology, Princess Alexandra Hospital Brisbane QLD Australia, The University of Queensland, Brisbane, QLD, Australia
- AndroUrology Centre, Brisbane, QLD, Australia.
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5
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Overkamp M, Houben LHP, Aussieker T, van Kranenburg JMX, Pinckaers PJM, Mikkelsen UR, Beelen M, Beijer S, van Loon LJC, Snijders T. Resistance Exercise Counteracts the Impact of Androgen Deprivation Therapy on Muscle Characteristics in Cancer Patients. J Clin Endocrinol Metab 2023; 108:e907-e915. [PMID: 37161470 PMCID: PMC10505531 DOI: 10.1210/clinem/dgad245] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2023] [Revised: 04/05/2023] [Accepted: 05/09/2023] [Indexed: 05/11/2023]
Abstract
CONTEXT Androgen deprivation therapy (ADT) forms the cornerstone in prostate cancer (PCa) treatment. However, ADT also lowers skeletal muscle mass. OBJECTIVE To identify the impact of ADT with and without resistance exercise training on muscle fiber characteristics in PCa patients. METHODS Twenty-one PCa patients (72 ± 6 years) starting ADT were included. Tissue samples from the vastus lateralis muscle were assessed at baseline and after 20 weeks of usual care (n = 11) or resistance exercise training (n = 10). Type I and II muscle fiber distribution, fiber size, and myonuclear and capillary contents were determined by immunohistochemistry. RESULTS Significant decreases in type I (from 7401 ± 1183 to 6489 ± 1293 μm2, P < .05) and type II (from 6225 ± 1503 to 5014 ± 714 μm2, P < .05) muscle fiber size were observed in the usual care group. In addition, type I and type II individual capillary-to-fiber ratio (C/Fi) declined (-12% ± 12% and -20% ± 21%, respectively, P < .05). In contrast, significant increases in type I (from 6700 ± 1464 to 7772 ± 1319 μm2, P < .05) and type II (from 5248 ± 892 to 6302 ± 1385 μm2, P < .05) muscle fiber size were observed in the training group, accompanied by an increase in type I and type II muscle fiber myonuclear contents (+24% ± 33% and +21% ± 23%, respectively, P < .05) and type I C/Fi (+18% ± 14%, P < .05). CONCLUSION The onset of ADT is followed by a decline in both type I and type II muscle fiber size and capillarization in PCa patients. Resistance exercise training offsets the negative impact of ADT and increases type I and II muscle fiber size and type I muscle fiber capillarization in these patients.
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Affiliation(s)
- Maarten Overkamp
- NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University Medical Centre+, Maastricht, 6200 MD, the Netherlands
- Department of Research & Development, Netherlands Comprehensive Cancer Organisation, Utrecht, 3511 DT, the Netherlands
- Top Institute Food and Nutrition (TiFN), Wageningen, 6709 PA, the Netherlands
| | - Lisanne H P Houben
- NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University Medical Centre+, Maastricht, 6200 MD, the Netherlands
- Department of Research & Development, Netherlands Comprehensive Cancer Organisation, Utrecht, 3511 DT, the Netherlands
- Top Institute Food and Nutrition (TiFN), Wageningen, 6709 PA, the Netherlands
| | - Thorben Aussieker
- NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University Medical Centre+, Maastricht, 6200 MD, the Netherlands
| | - Janneau M X van Kranenburg
- NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University Medical Centre+, Maastricht, 6200 MD, the Netherlands
| | - Philippe J M Pinckaers
- NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University Medical Centre+, Maastricht, 6200 MD, the Netherlands
| | - Ulla R Mikkelsen
- Department of Nutrition & Health, Research & Development, Arla Foods Ingredients Group P/S, Viby J, 8260, Denmark
| | - Milou Beelen
- NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University Medical Centre+, Maastricht, 6200 MD, the Netherlands
- Top Institute Food and Nutrition (TiFN), Wageningen, 6709 PA, the Netherlands
| | - Sandra Beijer
- Department of Research & Development, Netherlands Comprehensive Cancer Organisation, Utrecht, 3511 DT, the Netherlands
- Top Institute Food and Nutrition (TiFN), Wageningen, 6709 PA, the Netherlands
| | - Luc J C van Loon
- NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University Medical Centre+, Maastricht, 6200 MD, the Netherlands
- Top Institute Food and Nutrition (TiFN), Wageningen, 6709 PA, the Netherlands
| | - Tim Snijders
- NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University Medical Centre+, Maastricht, 6200 MD, the Netherlands
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6
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Baguley B, Smith-Gillis C, Porter J, Kiss N, Ugalde A. Nutrition services during prostate cancer androgen deprivation therapy. BMJ Support Palliat Care 2023:spcare-2023-004304. [PMID: 37402540 DOI: 10.1136/spcare-2023-004304] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Accepted: 06/21/2023] [Indexed: 07/06/2023]
Abstract
OBJECTIVE Dietary interventions are effective strategies to mitigate multiple side effects from androgen deprivation therapy (ADT) in prostate cancer, however the perception of, and access to, nutrition services is relatively unknown. METHODS A qualitative study using semistructured, audio recorded interviews was conducted in men with prostate cancer treated with ADT for ≥3 months. Interviews explored (1) side effects of ADT and drivers for dietary change, (2) accessibility, barriers, facilitators and use of nutrition services and (3) the preferences for nutrition service delivery. Data were coded using interpretative descriptive techniques of textual interview data, and systematically summarised to generate thematical patterns, using NVivo software. RESULTS Interviews were completed of 20 men with prostate cancer treated with ADT (25.5±20.1 months). Thematic analysis revealed four overarching themes-(1) the changes from ADT: men revealed that weight gain, loss of muscle and strength from ADT were daily struggles that negatively impact body image and components of masculinity reduced; (2) strategies to take control: several dietary changes were trialled and restrictive in foods and nutrients. Barriers to accessing nutrition specialists were the cost for the service and absence of a clear referral pathway; (3) importance of nutrition knowledge: demand for specialised nutrition services with knowledge in addressing side effects from ADT; (4) diverse patients need diverse nutrition support: that includes peer or partner support, and technology supported nutrition content. CONCLUSION Evidence-based nutrition services are an unmet need for men treated with ADT. Future work is required to develop services that can be readily available and accessible to improve prostate cancer survivorship care.
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Affiliation(s)
- Brenton Baguley
- Deakin University, Institute for Physical Activity and Nutrition, Geelong, Victoria, Australia
| | - Caity Smith-Gillis
- School of Exercise and Nutrition Sciences, Deakin University, Burwood, Victoria, Australia
| | - Judi Porter
- Deakin University, Institute for Physical Activity and Nutrition, Geelong, Victoria, Australia
| | - Nicole Kiss
- Deakin University, Institute for Physical Activity and Nutrition, Geelong, Victoria, Australia
| | - Anna Ugalde
- Institute for Health Transformation, Deakin University, Burwood, Victoria, Australia
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Hu L, Ji J, Ennis RD, Hogan JW. A flexible approach for causal inference with multiple treatments and clustered survival outcomes. Stat Med 2022; 41:4982-4999. [PMID: 35948011 PMCID: PMC9588538 DOI: 10.1002/sim.9548] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2022] [Revised: 07/20/2022] [Accepted: 07/22/2022] [Indexed: 01/07/2023]
Abstract
When drawing causal inferences about the effects of multiple treatments on clustered survival outcomes using observational data, we need to address implications of the multilevel data structure, multiple treatments, censoring, and unmeasured confounding for causal analyses. Few off-the-shelf causal inference tools are available to simultaneously tackle these issues. We develop a flexible random-intercept accelerated failure time model, in which we use Bayesian additive regression trees to capture arbitrarily complex relationships between censored survival times and pre-treatment covariates and use the random intercepts to capture cluster-specific main effects. We develop an efficient Markov chain Monte Carlo algorithm to draw posterior inferences about the population survival effects of multiple treatments and examine the variability in cluster-level effects. We further propose an interpretable sensitivity analysis approach to evaluate the sensitivity of drawn causal inferences about treatment effect to the potential magnitude of departure from the causal assumption of no unmeasured confounding. Expansive simulations empirically validate and demonstrate good practical operating characteristics of our proposed methods. Applying the proposed methods to a dataset on older high-risk localized prostate cancer patients drawn from the National Cancer Database, we evaluate the comparative effects of three treatment approaches on patient survival, and assess the ramifications of potential unmeasured confounding. The methods developed in this work are readily available in the R $$ \mathsf{R}\kern.15em $$ package riAFTBART $$ \mathsf{riAFTBART} $$ .
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Affiliation(s)
- Liangyuan Hu
- Department of Biostatistics and EpidemiologyRutgers UniversityPiscatawayNew JerseyUSA
| | - Jiayi Ji
- Department of Biostatistics and EpidemiologyRutgers UniversityPiscatawayNew JerseyUSA
| | - Ronald D. Ennis
- Department of Radiation OncologyCancer Institute of New Jersey of Rutgers UniversityNew BrunswickNew JerseyUSA
| | - Joseph W. Hogan
- Department of BiostatisticsBrown UniversityProvidenceRhode IslandUSA
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8
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Chaudhary S, Zhornitsky S, Roy A, Summers C, Ahles T, Li CR, Chao HH. The effects of androgen deprivation on working memory and quality of life in prostate cancer patients: The roles of hypothalamic connectivity. Cancer Med 2022; 11:3425-3436. [PMID: 35315585 PMCID: PMC9487881 DOI: 10.1002/cam4.4704] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Revised: 03/08/2022] [Accepted: 03/11/2022] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Androgen deprivation therapy (ADT) has been associated with adverse effects on the brain. ADT alters testosterone levels via its action on the hypothalamus-pituitary-gonadal axis and may influence hypothalamic functions. Given the wide regional connectivity of the hypothalamus and its role in regulating cognition and behavior, we assessed the effects of ADT on hypothalamic resting state functional connectivity (rsFC) and their cognitive and clinical correlates. METHODS In a prospective observational study, 22 men with nonmetastatic prostate cancer receiving ADT and 28 patients not receiving ADT (controls), matched in age, years of education, and Montreal Cognitive Assessment score, participated in N-back task and quality of life (QoL) assessments and brain imaging at baseline and at 6 months. Imaging data were processed with published routines and the results of a group by time flexible factorial analysis were evaluated at a corrected threshold. RESULTS ADT and control groups did not differ in N-back performance or QoL across time points. Relative to controls, patients receiving ADT showed significantly higher hypothalamus-right mid-cingulate cortex (MCC) and precentral gyrus (PCG) rsFC during follow-up versus baseline. Further, the changes in MCC and PCG rsFC were correlated positively with the change in QoL score and 0-back correct response rate, respectively, in patients with undergoing ADT. CONCLUSION Six-month ADT affects hypothalamic functional connectivity with brain regions critical to cognitive motor and affective functions. Elevated hypothalamic MCC and PCG connectivity likely serve to functionally compensate for the effects of ADT and sustain attention and overall QoL. The longer-term effects of ADT remain to be investigated.
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Affiliation(s)
- Shefali Chaudhary
- Department of PsychiatryYale University School of MedicineNew HavenConnecticutUSA
| | - Simon Zhornitsky
- Department of PsychiatryYale University School of MedicineNew HavenConnecticutUSA
| | - Alicia Roy
- VA Connecticut Healthcare SystemWest HavenConnecticutUSA
| | | | - Tim Ahles
- Department of Psychiatry and Behavioral SciencesMemorial Sloan Kettering Cancer CenterNew YorkNew YorkUSA
| | - Chiang‐Shan R. Li
- Departments of Psychiatry and Neuroscience, Interdepartmental Neuroscience ProgramYale University School of Medicine, Wu Tsai Institute, Yale UniversityNew HavenConnecticutUSA
| | - Herta H. Chao
- VA Connecticut Healthcare SystemWest HavenConnecticutUSA
- Department of Medicine & Yale Comprehensive Cancer CenterYale University School of MedicineNew HavenCTUSA
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9
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Feasibility of home-based exercise training in men with metastatic castration-resistant prostate cancer. Prostate Cancer Prostatic Dis 2022:10.1038/s41391-022-00523-8. [DOI: 10.1038/s41391-022-00523-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Revised: 02/16/2022] [Accepted: 02/22/2022] [Indexed: 12/16/2022]
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10
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Hanson ED, Stopforth CK, Alzer M, Carver J, Lucas AR, Whang YE, Milowsky MI, Bartlett DB, Harrison MR, Hayes A, Bitting RL, Deal AM, Hackney AC, Battaglini CL. Body composition, physical function and quality of life in healthy men and across different stages of prostate cancer. Prostate Cancer Prostatic Dis 2021; 24:725-732. [PMID: 33495569 PMCID: PMC8310529 DOI: 10.1038/s41391-020-00317-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2020] [Revised: 11/30/2020] [Accepted: 12/21/2020] [Indexed: 02/01/2023]
Abstract
BACKGROUND Androgen deprivation therapy (ADT) for prostate cancer (PC) has detrimental effects on physical function and quality of life (QoL), but the addition of androgen receptor signalling inhibitors (ARSI) on these outcomes is unclear. PURPOSE To compare body composition, physical function, and QoL across progressive stages of PC and non-cancer controls (CON). METHODS In men with hormone sensitive PC (HSPC, n = 43) or metastatic castration-resistant PC (mCRPC, n = 22) or CON (n = 37), relative and absolute lean and fat mass, physical function (6 m walk, chair stands, timed up and go [TUG], stair climb), and QoL were determined. RESULTS Relative body composition differed amongst all groups, along with ~39% greater absolute fat mass in mCRPC vs. CON. TUG and chair stands were ~71% and ~33% slower in mCRPC compared to both CON and HSPC, whereas stair climb was ~29% and 6 m walk was ~18% slower in mCRPC vs. CON. Relative body composition was correlated with physical function (r = 0.259-0.385). Clinically relevant differences for mCRPC were observed for overall QoL and several subscales vs. CON, although body composition and physical function did not influence QoL. CONCLUSIONS PC progression is associated with deteriorations in body composition and physical function. As ADT length was similar between groups, ARSI use for mCRPC likely contributed in part to these changes. Given the difficulties of improving lean mass during ADT, interventions that reduce adiposity may lessen the side effects of hormone therapy.
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Affiliation(s)
- Erik D. Hanson
- Department of Exercise and Sport Science, University of North Carolina at Chapel Hill, Chapel Hill, NC,Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC,Institute of Health and Sport, Victoria University, Melbourne, Vic, Australia
| | - Cameron K. Stopforth
- Department of Exercise and Sport Science, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Mohamdod Alzer
- Department of Exercise and Sport Science, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Jackson Carver
- Department of Exercise and Sport Science, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Alexander R. Lucas
- Wake Forest Baptist Comprehensive Cancer Center, Winston-Salem, NC,Virginia Commonwealth University, Richmond, VA
| | - Young E. Whang
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC,Division of Oncology, Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Matthew I. Milowsky
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC,Division of Oncology, Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - David B. Bartlett
- Division of Medical Oncology, Duke Cancer Institute, Duke University, Durham, NC, USA
| | - Michael R. Harrison
- Division of Medical Oncology, Duke Cancer Institute, Duke University, Durham, NC, USA
| | - Alan Hayes
- Institute of Health and Sport, Victoria University, Melbourne, Vic, Australia,Australian Institute for Musculoskeletal Science, Victoria University, Melbourne, Vic, Australia
| | | | - Allison M. Deal
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Anthony C. Hackney
- Department of Exercise and Sport Science, University of North Carolina at Chapel Hill, Chapel Hill, NC,Department of Nutrition, School of Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Claudio L. Battaglini
- Department of Exercise and Sport Science, University of North Carolina at Chapel Hill, Chapel Hill, NC,Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC
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11
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Andela CD, Matte R, Jazet IM, Zonneveld WC, Schoones JW, Meinders AE. Effect of androgen deprivation therapy on cognitive functioning in men with prostate cancer: A systematic review. Int J Urol 2021; 28:786-798. [PMID: 34128263 PMCID: PMC9545697 DOI: 10.1111/iju.14596] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2020] [Accepted: 04/14/2021] [Indexed: 01/25/2023]
Abstract
The objective of this study was to review publications assessing cognitive functioning in patients with prostate cancer treated with androgen deprivation therapy. We conducted a systematic review of the literature published in PubMed, Embase, Web of Science, Cochrane Library, and PsycINFO up to February 2020. A total of 31 studies were included. Half of the studies (n = 16) demonstrated that androgen deprivation therapy in patients with prostate carcinoma did not result in a negative effect on cognitive functioning, however, still a substantial proportion of the studies (n = 11) reported a negative effect on cognitive functioning. In four studies the results were inconclusive. In the three studies using additional functional magnetic resonance imaging, no significant effect on neuropsychological tests was found, but grey matter volume, brain activity, and brain connectivity were affected. Given the substantial number of studies showing a significant negative effect of androgen deprivation therapy on cognitive functioning, clinicians should be aware of this side effect. Furthermore, future research should focus on the further examination of brain characteristics using functional magnetic resonance imaging, since these techniques might be more sensitive in detecting brain abnormalities as a result of androgen deprivation therapy.
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Affiliation(s)
- Cornelie D Andela
- Division of Endocrinology, Department of Medicine, Leiden University Medical Center, Leiden, The Netherlands
| | - Rafil Matte
- Division of Endocrinology, Department of Medicine, Leiden University Medical Center, Leiden, The Netherlands
| | - Ingrid M Jazet
- Division of Endocrinology, Department of Medicine, Leiden University Medical Center, Leiden, The Netherlands
| | | | - Jan W Schoones
- Walaeus Library, Leiden University Medical Center, Leiden, The Netherlands
| | - A Edo Meinders
- Division of Endocrinology, Department of Medicine, Leiden University Medical Center, Leiden, The Netherlands
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12
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Buskbjerg CR, Amidi A, Buus S, Gravholt CH, Hadi Hosseini SM, Zachariae R. Androgen deprivation therapy and cognitive decline-associations with brain connectomes, endocrine status, and risk genotypes. Prostate Cancer Prostatic Dis 2021; 25:208-218. [PMID: 34088994 DOI: 10.1038/s41391-021-00398-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2021] [Revised: 04/30/2021] [Accepted: 05/19/2021] [Indexed: 02/03/2023]
Abstract
BACKGROUND Evidence suggests that prostate cancer (PC) patients undergoing androgen deprivation therapy (ADT) are at risk for cognitive decline (CD), but the underlying mechanisms are less clear. In the present study, changes in cognitive performance and structural brain connectomes in PC patients undergoing ADT were assessed, and associations of cognitive changes with endocrine status and risk genotypes were explored. METHODS Thirty-seven PC patients underwent cognitive assessment, structural MRI, and provided blood samples prior to ADT and after 6 months of treatment. Twenty-seven age- and education-matched healthy controls (HCs) underwent the same assessments. CD was determined using a standardized regression-based approach and defined as z-scores ≤ -1.64. Changes in brain connectomes were evaluated using graph theory. Associations of CD with testosterone levels and genotypes (APOE, COMT, BDNF) were explored. RESULTS Compared with HCs, PC patients demonstrated reduced testosterone levels (p < 0.01) and higher rates of decline for 13 out of 15 cognitive outcomes, with three outcomes related to two cognitive domains, i.e., verbal memory and visuospatial learning and memory, reaching statistical significance (p ≤ 0.01-0.04). Testosterone level changes did not predict CD. COMT Met homozygote PC patients evidenced larger reductions in visuospatial memory compared with Val carriers (p = 0.02). No between-group differences were observed in brain connectomes across time, and no effects were found of APOE and BDNF. CONCLUSIONS Our results indicate that PC patients undergoing ADT may evidence CD, and that COMT Met homozygotes may be at increased risk of CD. The results did not reveal changes in brain connectomes or testosterone levels as underlying mechanisms. More research evaluating the role of ADT-related disruption of the dynamics of the hypothalamic-pituitary-gonadal axis is needed.
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Affiliation(s)
- Cecilie R Buskbjerg
- Unit for Psychooncology and Health Psychology, Department of Psychology and Behavioral Sciences, Aarhus University, Aarhus, Denmark.
| | - Ali Amidi
- Unit for Psychooncology and Health Psychology, Department of Psychology and Behavioral Sciences, Aarhus University, Aarhus, Denmark
| | - Simon Buus
- Department of Oncology, Aarhus University Hospital, Aarhus, Denmark
| | - Claus H Gravholt
- Department of Endocrinology, Aarhus University Hospital, Aarhus, Denmark.,Department of Molecular Medicine, Aarhus University Hospital, Aarhus, Denmark
| | - S M Hadi Hosseini
- Department of Psychiatry and Behavioral Sciences, School of Medicine, Stanford University, Stanford, CA, USA
| | - Robert Zachariae
- Unit for Psychooncology and Health Psychology, Department of Psychology and Behavioral Sciences, Aarhus University, Aarhus, Denmark.,Department of Oncology, Aarhus University Hospital, Aarhus, Denmark
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13
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Davidyan A, Pathak S, Baar K, Bodine SC. Maintenance of muscle mass in adult male mice is independent of testosterone. PLoS One 2021; 16:e0240278. [PMID: 33764986 PMCID: PMC7993603 DOI: 10.1371/journal.pone.0240278] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2020] [Accepted: 02/12/2021] [Indexed: 01/21/2023] Open
Abstract
Testosterone is considered a potent anabolic agent in skeletal muscle with a well-established role in adolescent growth and development in males. However, the role of testosterone in the regulation of skeletal muscle mass and function throughout the lifespan has yet to be fully established. While some studies suggest that testosterone is important for the maintenance of skeletal muscle mass, an understanding of the role this hormone plays in young, adult, and old males with normal and low serum testosterone levels is lacking. We investigated the role testosterone plays in the maintenance of muscle mass by examining the effect of orchiectomy-induced testosterone depletion in C57Bl6 male mice at ages ranging from early postnatal through old age (1.5-, 5-, 12-, and 24-month old mice). Following 28 days of testosterone depletion, we assessed mass and fiber cross-sectional-area (CSA) of the tibialis anterior, gastrocnemius, and quadriceps muscles. In addition, we measured global rates of protein synthesis and degradation using the SuNSET method, western blots, and enzyme activity assays. Twenty-eight days of testosterone depletion resulted in reduced muscle mass in the two youngest cohorts, but had no effect in the two oldest cohorts. Mean CSA decreased only in the youngest cohort and only in the tibialis anterior muscle. Testosterone depletion resulted in a general increase in proteasome activity at all ages. No change in protein synthesis was detected at the terminal time point. These data suggest that within physiological serum concentrations, testosterone may not be critical for the maintenance of muscle mass in mature male mice; however, in young mice testosterone is crucial for normal growth.
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Affiliation(s)
- Arik Davidyan
- Department of Neurobiology, Physiology and Behavior, University of California Davis, Davis, CA, United States of America
- Aging and Metabolism Research Program, Oklahoma Medical Research Foundation, Oklahoma City, OK, United States of America
| | - Suraj Pathak
- Department of Neurobiology, Physiology and Behavior, University of California Davis, Davis, CA, United States of America
| | - Keith Baar
- Department of Neurobiology, Physiology and Behavior, University of California Davis, Davis, CA, United States of America
- Department of Physiology and Membrane Biology University of California Davis, Davis, CA, United States of America
| | - Sue C. Bodine
- Department of Internal Medicine, University of Iowa, Iowa City, IA, United States of America
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14
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Storck LJ, Ruehlin M, Gaeumann S, Gisi D, Schmocker M, Meffert PJ, Imoberdorf R, Pless M, Ballmer PE. Effect of a leucine-rich supplement in combination with nutrition and physical exercise in advanced cancer patients: A randomized controlled intervention trial. Clin Nutr 2020; 39:3637-3644. [DOI: 10.1016/j.clnu.2020.04.008] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2019] [Revised: 03/28/2020] [Accepted: 04/04/2020] [Indexed: 01/05/2023]
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15
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Holtfrerich SKC, Knipper S, Purwins J, Castens J, Beyer B, Schlomm T, Diekhof EK. The impact of long‐term androgen deprivation therapy on cognitive function and socioeconomic decision making in prostate cancer patients. Psychooncology 2020; 29:1338-1346. [DOI: 10.1002/pon.5442] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2020] [Revised: 05/27/2020] [Accepted: 06/06/2020] [Indexed: 01/14/2023]
Affiliation(s)
- Sarah Katharina Charlotte Holtfrerich
- Neuroendocrinology and Human Biology Unit, Department of Biology, Institute of Zoology, Faculty of Mathematics, Informatics and Natural Sciences Universität Hamburg Hamburg Germany
| | - Sophie Knipper
- Martini‐Clinic, Prostate Cancer Center University Medical Center Hamburg‐Eppendorf Hamburg Germany
| | - Janna Purwins
- Neuroendocrinology and Human Biology Unit, Department of Biology, Institute of Zoology, Faculty of Mathematics, Informatics and Natural Sciences Universität Hamburg Hamburg Germany
| | - Jasmin Castens
- Neuroendocrinology and Human Biology Unit, Department of Biology, Institute of Zoology, Faculty of Mathematics, Informatics and Natural Sciences Universität Hamburg Hamburg Germany
| | - Burkhard Beyer
- Martini‐Clinic, Prostate Cancer Center University Medical Center Hamburg‐Eppendorf Hamburg Germany
| | - Thorsten Schlomm
- Martini‐Clinic, Prostate Cancer Center University Medical Center Hamburg‐Eppendorf Hamburg Germany
- Department of Urology Charité ‐ Universitätsmedizin Berlin Berlin Germany
| | - Esther Kristina Diekhof
- Neuroendocrinology and Human Biology Unit, Department of Biology, Institute of Zoology, Faculty of Mathematics, Informatics and Natural Sciences Universität Hamburg Hamburg Germany
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Timing of exercise for muscle strength and physical function in men initiating ADT for prostate cancer. Prostate Cancer Prostatic Dis 2020; 23:457-464. [PMID: 32020032 PMCID: PMC7423590 DOI: 10.1038/s41391-019-0200-z] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2019] [Revised: 12/12/2019] [Accepted: 12/17/2019] [Indexed: 11/09/2022]
Abstract
BACKGROUND Androgen deprivation therapy (ADT) in men with prostate cancer (PCa) results in adverse effects, including reduced muscle strength and physical function, potentially compromising daily functioning. We examined whether it was more efficacious to commence exercise at the onset of ADT rather than later in treatment to counter declines in strength and physical function. METHODS One-hundred-and-four men with PCa (68.3 ± 7.0 years) initiating ADT were randomised to immediate exercise (IMX, n = 54) or delayed exercise (DEL, n = 50) for 12 months. IMX comprised 6 months of supervised resistance/aerobic/impact exercise initiated at the onset of ADT with a 6-month follow-up. DEL comprised 6 months of usual care followed by 6 months of resistance/aerobic/impact exercise. Upper and lower body muscle strength and physical function were assessed at baseline, 6 and 12 months. RESULTS There was a significant difference for all strength measures at 6 months favouring IMX (P < 0.001), with net differences in leg press, seated row and chest press strength of 19.9 kg (95% CI, 12.3-27.5 kg), 5.6 kg (3.8-7.4 kg) and 4.3 kg (2.7-5.8 kg), respectively. From 7 to 12 months, DEL increased in all strength measures (P < 0.001), with no differences between groups at 12 months. Similarly, physical function improved (P < 0.001) in IMX compared with DEL at 6 months for the 6-m fast walk (-0.2, 95% CI -0.3 to -0.1 s), 400-m walk (-9.7, -14.8 to -4.6 s), stair climb (-0.4, -0.6 to -0.2 s) and chair rise (-1.0, -1.4 to -0.7 s), with no differences between groups by 12 months, except for the 6-m fast walk (P < 0.001). CONCLUSION Exercise either at the onset or after 6 months of ADT preserves/enhances muscle strength and physical function. However, to avoid initial treatment-related adverse effects on strength and function, exercise therapy should be implemented with initiation of ADT.
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17
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Cherrier MM, Higano CS. Impact of androgen deprivation therapy on mood, cognition, and risk for AD. Urol Oncol 2020; 38:53-61. [DOI: 10.1016/j.urolonc.2019.01.021] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2018] [Revised: 01/11/2019] [Accepted: 01/18/2019] [Indexed: 01/14/2023]
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18
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Owen PJ, Daly RM, Dalla Via J, Mundell NL, Livingston PM, Rantalainen T, Fraser SF. The clinical relevance of adiposity when assessing muscle health in men treated with androgen deprivation for prostate cancer. J Cachexia Sarcopenia Muscle 2019; 10:1036-1044. [PMID: 31067013 PMCID: PMC6818455 DOI: 10.1002/jcsm.12446] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2018] [Accepted: 04/05/2019] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Androgen deprivation therapy (ADT) for prostate cancer (PCa) may prospectively decrease absolute lean mass (LM) and increase absolute fat mass (FM). Given that estimates of LM by dual-energy X-ray absorptiometry may be overestimated in obese people, this study examined the influence of adiposity on muscle health in men treated with ADT for PCa. METHODS This cross-sectional study examined the influence of adiposity on total and appendicular LM (ALM), muscle cross-sectional (CSA), and muscle strength in 70 men treated with ADT [mean (standard deviation) age, 71 (6) years] for PCa compared with age-matched PCa (n = 52) and healthy controls (n = 70). Total body LM, FM and ALM, and 66% tibia and radius muscle CSA were quantified by dual-energy X-ray absorptiometry and peripheral quantitative computed tomography, respectively. ALM was further divided by height (m2 ) or body mass index, with muscle CSA expressed as a per cent of total limb CSA. Upper and lower body and back (three-repetition maximum and dynamometry) muscle strength were expressed per kilogram of body weight. RESULTS On average, ADT-treated men had 4.4-6.4 kg greater FM compared with controls (P ≤ 0.014) and there were no differences in total body or ALM. Total body per cent LM and ALMBMI were 3.8-5.4% (P ≤ 0.001) and 7.8-9.4% (P ≤ 0.001) lower, respectively, in ADT-treated men compared with both controls. Percentage muscle CSA at both sites and muscle strength (except leg) were 3.0-6.0% (P ≤ 0.031) and 15-17% (P ≤ 0.010) lower, respectively, in ADT-treated men compared with both controls. CONCLUSIONS The findings from this study indicate muscle mass, size, and strength are compromised in men treated with ADT after accounting for their increased adiposity or body size.
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Affiliation(s)
- Patrick J. Owen
- Institute for Physical Activity and Nutrition, School of Exercise and Nutrition SciencesDeakin UniversityGeelongVictoriaAustralia
| | - Robin M. Daly
- Institute for Physical Activity and Nutrition, School of Exercise and Nutrition SciencesDeakin UniversityGeelongVictoriaAustralia
| | - Jack Dalla Via
- Institute for Physical Activity and Nutrition, School of Exercise and Nutrition SciencesDeakin UniversityGeelongVictoriaAustralia
| | - Niamh L. Mundell
- Institute for Physical Activity and Nutrition, School of Exercise and Nutrition SciencesDeakin UniversityGeelongVictoriaAustralia
| | | | - Timo Rantalainen
- Institute for Physical Activity and Nutrition, School of Exercise and Nutrition SciencesDeakin UniversityGeelongVictoriaAustralia
- Gerontology Research Center and Faculty of Sport and Health SciencesUniversity of JyväskyläJyväskyläFinland
| | - Steve F. Fraser
- Institute for Physical Activity and Nutrition, School of Exercise and Nutrition SciencesDeakin UniversityGeelongVictoriaAustralia
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19
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20
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Cherrier MM, Cross DJ, Higano CS, Minoshima S. Changes in cerebral metabolic activity in men undergoing androgen deprivation therapy for non-metastatic prostate cancer. Prostate Cancer Prostatic Dis 2018; 21:394-402. [PMID: 29700388 PMCID: PMC6125255 DOI: 10.1038/s41391-018-0037-x] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2017] [Revised: 12/13/2017] [Accepted: 12/18/2017] [Indexed: 01/26/2023]
Abstract
OBJECTIVE Androgen deprivation therapy (ADT) is a common treatment option for men with biochemical relapse from prostate cancer. ADT is associated with changes in mood, cognition, and quality of life, and most recently with increased risk for Alzheimer's disease (AD). This study examined changes in brain metabolism using positron emission tomography (PET) in men undergoing intermittent ADT. METHODS Nine men with prostate cancer and a rising PSA (biochemical recurrence) without evidence of metastases were treated with intermittent ADT consisting of 9 months of complete androgen blockade achieved with combined leuprolide acetate and flutamide. Patients underwent resting [Fuorine-18] fluorodeoxyglucose PET (18F-FDGPET) at baseline (before treatment) and again after 9 months of ADT. RESULTS Whole-brain mapping analysis after 9 months of androgen deprivation compared to pretreatment baseline revealed decreased regional cerebral glucose metabolism in the cerebellum, posterior cingulate, and medial thalamus bilaterally. Associations of brain metabolism with measurements of cognition and mood while on androgen deprivation revealed positive correlations between the posterior cingulate, left inferior parietal lobule (BA40), and left mid temporal gyrus (BA39) and spatial reasoning and a negative correlation between left inferior parietal lobule and verbal memory. Several mood indices were negatively correlated with hypothalamus and brainstem. CONCLUSION These findings suggest that complete androgen deprivation may result in changes in regional brain metabolism associated with variation in mood, verbal memory, and spatial performance. Brain regions that were impacted from ADT are similar and overlap with brain regions with metabolic decline found in early AD and diabetes, suggesting possible common mechanisms.
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Affiliation(s)
- M M Cherrier
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, WA, USA.
| | - D J Cross
- Department of Radiology and Imaging Sciences, University of Utah, School of Medicine, Salt Lake City, UT, USA
| | - C S Higano
- Department of Medicine, Division of Oncology and Urology, University of Washington School of Medicine, Seattle, WA, USA
| | - S Minoshima
- Department of Radiology and Imaging Sciences, University of Utah, School of Medicine, Salt Lake City, UT, USA
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Donovan KA, Gonzalez BD, Nelson AM, Fishman MN, Zachariah B, Jacobsen PB. Effect of androgen deprivation therapy on sexual function and bother in men with prostate cancer: A controlled comparison. Psychooncology 2017; 27:316-324. [PMID: 28557112 DOI: 10.1002/pon.4463] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2016] [Revised: 03/31/2017] [Accepted: 05/22/2017] [Indexed: 11/06/2022]
Abstract
OBJECTIVES The adverse sexual effects of androgen deprivation therapy (ADT) on men with prostate cancer have been well described. Less well known is the relative degree of sexual dysfunction and bother associated with ADT compared to other primary treatment modalities such as radical prostatectomy. We sought to describe the trajectory and relative magnitude of changes in sexual function and bother in men on ADT and to examine demographic and clinical predictors of ADT's adverse sexual effects. METHODS Prostate cancer patients treated with ADT (n = 60) completed assessments of sexual function and sexual bother 3 times during a 1-year period after the initiation of ADT. Prostate cancer patients treated with radical prostatectomy only and not receiving ADT (n = 85) and men with no history of cancer (n = 86) matched on age and education completed assessments at similar intervals. RESULTS Androgen deprivation therapy recipients reported worsening sexual function and increasing bother over time compared to controls. Effect sizes for the differences in sexual function were large to very large, and for bother were small to very large. Age younger than 83 years predicted relatively poorer sexual function, and age younger than 78 years predicted greater sexual bother at 12 months in men on ADT compared to men not on ADT. CONCLUSIONS Most men on ADT for prostate cancer will never return to baseline levels of sexual function. Interventions focused on sexual bother over function and designed to help couples build and maintain satisfying relationship intimacy are likely to more positively affect men's psychological well-being while on ADT than medical or sexual aids targeting sexual dysfunction.
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Affiliation(s)
- Kristine A Donovan
- Health Outcomes and Behavior Program, Moffitt Cancer Center, Tampa, FL, USA
| | - Brian D Gonzalez
- Health Outcomes and Behavior Program, Moffitt Cancer Center, Tampa, FL, USA
| | - Ashley M Nelson
- Department of Psychology, University of South Florida, Tampa, FL, USA
| | - Mayer N Fishman
- Department of Genitourinary Oncology, Moffitt Cancer Center, Tampa, FL, USA
| | - Babu Zachariah
- Department of Radiation Oncology, James A. Haley Veterans' Hospital, Tampa, FL, USA
| | - Paul B Jacobsen
- Health Outcomes and Behavior Program, Moffitt Cancer Center, Tampa, FL, USA
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Lizarondo L, Turnbull C, Kroon T, Grimmer K, Bell A, Kumar S, McEvoy M, Milanese S, Russell M, Sheppard L, Walters J, Wiles L. Allied health: integral to transforming health. AUST HEALTH REV 2017. [PMID: 26210992 DOI: 10.1071/ah15044] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
Objective South Australia is taking an innovative step in transforming the way its healthcare is organised and delivered to better manage current and future demands on the health system. In an environment of transforming health services, there are clear opportunities for allied health to assist in determining solutions to various healthcare challenges. A recent opinion piece proposed 10 clinician-driven strategies to assist in maximising value and sustainability of healthcare in Australia. The present study aimed to seek the perspectives of allied health clinicians, educators, researchers, policy makers and managers on these strategies and their relevance to allied health. Methods A survey of allied health practitioners was undertaken to capture their perspectives on the 10 clinician-driven strategies for maximising value and sustainability of healthcare in Australia. Survey findings were then layered with evidence from the literature. Results Highly relevant across allied health are the strategies of discontinuation of low value practices, targeting clinical interventions to those getting greatest benefit, active involvement of patients in shared decision making and self-management and advocating for integrated systems of care. Conclusions Allied health professionals have been involved in the South Australian healthcare system for a prolonged period, but their services are poorly recognised, often overlooked and not greatly supported in existing traditional practices. The results of the present study highlight ways in which healthcare services can implement strategies not only to improve the quality of patient outcomes, but also to offer innovative solutions for future, sustainable healthcare. The findings call for concerted efforts to increase the utilisation of allied health services to ensure the 'maximum value for spend' of the increasingly scarce health dollar. What is known about the topic? In medicine, clinician-driven strategies have been proposed to minimise inappropriate and costly care and maximise highly appropriate and less expensive care. These strategies were developed based on clinical experiences and with supporting evidence from scientific studies. What does this paper add? Major changes to the health system are required to slow down the growth in healthcare expenditure. This paper describes opportunities in which allied health practitioners can implement similar strategies not only to improve the quality of patient outcomes, but also to offer cost-effective solutions for a sustainable healthcare. What are the implications for practitioners? Allied health practitioners can provide solutions to healthcare challenges and assist in the transformation of healthcare in Australia. However, for this to happen, there should be concerted efforts to increase recognition of and support for the use of allied health services.
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Affiliation(s)
- Lucylynn Lizarondo
- International Centre for Allied Health Evidence (iCAHE), P4-18 City East Campus, University of South Australia, Adelaide, SA 5001, Australia. ; ; ; ; ; ;
| | - Catherine Turnbull
- Allied & Scientific Health Office (ASHO), SA Health, Level 5, 11 Hindmarsh Square, Adelaide, SA 5000, Australia.
| | - Tracey Kroon
- Allied & Scientific Health Office (ASHO), SA Health, Level 5, 11 Hindmarsh Square, Adelaide, SA 5000, Australia.
| | - Karen Grimmer
- International Centre for Allied Health Evidence (iCAHE), P4-18 City East Campus, University of South Australia, Adelaide, SA 5001, Australia. ; ; ; ; ; ;
| | - Alison Bell
- International Centre for Allied Health Evidence (iCAHE), P4-18 City East Campus, University of South Australia, Adelaide, SA 5001, Australia. ; ; ; ; ; ;
| | - Saravana Kumar
- International Centre for Allied Health Evidence (iCAHE), P4-18 City East Campus, University of South Australia, Adelaide, SA 5001, Australia. ; ; ; ; ; ;
| | - Maureen McEvoy
- International Centre for Allied Health Evidence (iCAHE), P4-18 City East Campus, University of South Australia, Adelaide, SA 5001, Australia. ; ; ; ; ; ;
| | - Steve Milanese
- International Centre for Allied Health Evidence (iCAHE), P4-18 City East Campus, University of South Australia, Adelaide, SA 5001, Australia. ; ; ; ; ; ;
| | - Mary Russell
- International Centre for Allied Health Evidence (iCAHE), P4-18 City East Campus, University of South Australia, Adelaide, SA 5001, Australia. ; ; ; ; ; ;
| | - Lorraine Sheppard
- International Centre for Allied Health Evidence (iCAHE), P4-18 City East Campus, University of South Australia, Adelaide, SA 5001, Australia. ; ; ; ; ; ;
| | - Julie Walters
- International Centre for Allied Health Evidence (iCAHE), P4-18 City East Campus, University of South Australia, Adelaide, SA 5001, Australia. ; ; ; ; ; ;
| | - Louise Wiles
- International Centre for Allied Health Evidence (iCAHE), P4-18 City East Campus, University of South Australia, Adelaide, SA 5001, Australia. ; ; ; ; ; ;
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Gaskin CJ, Fraser SF, Owen PJ, Craike M, Orellana L, Livingston PM. Fitness outcomes from a randomised controlled trial of exercise training for men with prostate cancer: the ENGAGE study. J Cancer Surviv 2016; 10:972-980. [PMID: 27098346 PMCID: PMC5093191 DOI: 10.1007/s11764-016-0543-6] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2015] [Accepted: 04/09/2016] [Indexed: 12/23/2022]
Abstract
PURPOSE The main purpose of this study was to investigate the effects of a 12-week, clinician-referred, community-based exercise training program with supervised and unsupervised sessions for men with prostate cancer. The secondary purpose was to determine whether androgen deprivation therapy (ADT) modified responses to exercise training. METHODS Secondary analysis was undertaken on data from a multicentre cluster randomised controlled trial in which 15 clinicians were randomly assigned to refer eligible patients to an exercise training intervention (n = 8) or to provide usual care (n = 7). Data from 119 patients (intervention n = 53, control n = 66) were available for this analysis. Outcome measures included fitness and physical function, anthropometrics, resting heart rate, and blood pressure. RESULTS Compared to the control condition, men in the intervention significantly improved their 6-min walk distance (M diff = 49.98 m, p adj = 0.001), leg strength (M diff = 21.82 kg, p adj = 0.001), chest strength (M diff = 6.91 kg, p adj = 0.001), 30-s sit-to-stand result (M diff = 3.38 reps, p adj = 0.001), and reach distance (M diff = 4.8 cm, p adj = 0.024). A significant difference (unadjusted for multiplicity) in favour of men in the intervention was also found for resting heart rate (M diff = -3.76 beats/min, p = 0.034). ADT did not modify responses to exercise training. CONCLUSIONS Men with prostate cancer who act upon clinician referrals to community-based exercise training programs can improve their strength, physical functioning, and, potentially, cardiovascular health, irrespective of whether or not they are treated with ADT. IMPLICATIONS FOR CANCER SURVIVORS Clinicians should inform men with prostate cancer about the benefits of exercise and refer them to appropriately qualified exercise practitioners and suitable community-based programs. TRIAL REGISTRATION Australia and New Zealand Clinical Trials Register (ANZCTR): ACTRN12610000609055.
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Affiliation(s)
- Cadeyrn J Gaskin
- Faculty of Health, Deakin University, Locked Bag 20001, Geelong, Victoria, 3220, Australia
| | - Steve F Fraser
- Institute for Physical Activity and Nutrition Research, School of Exercise and Nutrition Sciences, Faculty of Health, Deakin University, Geelong, Australia
| | - Patrick J Owen
- Institute for Physical Activity and Nutrition Research, School of Exercise and Nutrition Sciences, Faculty of Health, Deakin University, Geelong, Australia
| | - Melinda Craike
- Faculty of Health, Deakin University, Locked Bag 20001, Geelong, Victoria, 3220, Australia.,Institute of Sport, Exercise and Active Living, College of Sport and Exercise Science, Victoria University, Melbourne, Australia
| | - Liliana Orellana
- Biostatistics Unit, Faculty of Health, Deakin University, Geelong, Australia
| | - Patricia M Livingston
- Faculty of Health, Deakin University, Locked Bag 20001, Geelong, Victoria, 3220, Australia.
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Nilsen TS, Thorsen L, Kirkegaard C, Ugelstad I, Fosså SD, Raastad T. The effect of strength training on muscle cellular stress in prostate cancer patients on ADT. Endocr Connect 2016; 5:74-82. [PMID: 27169606 PMCID: PMC5002963 DOI: 10.1530/ec-15-0120] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2016] [Accepted: 02/29/2016] [Indexed: 01/25/2023]
Abstract
BACKGROUND Androgen deprivation therapy (ADT) for prostate cancer (PCa) is associated with several side effects, including loss of muscle mass. Muscle atrophy is associated with reduced mitochondrial function and increased muscle cellular stress that may be counteracted by strength training. Thus, the aim of this study was to investigate the effect of strength training on mitochondrial proteins and indicators of muscle cellular stress in PCa patients on ADT. METHODS Men diagnosed with locally advanced PCa receiving ADT were randomised to a strength training group (STG) (n=16) or a control group (CG) (n=15) for 16 weeks. Muscle biopsies were collected pre- and post-intervention from the vastus lateralis muscle, and analysed for mitochondrial proteins (citrate synthase, cytochrome c oxidase subunit IV (COXIV), HSP60) and indicators of muscle cellular stress (heat shock protein (HSP) 70, alpha B-crystallin, HSP27, free ubiquitin, and total ubiquitinated proteins) using Western blot and ELISA. RESULTS No significant intervention effects were observed in any of the mitochondrial proteins or indicators of muscle cellular stress. However, within-group analysis revealed that the level of HSP70 was reduced in the STG and a tendency towards a reduction in citrate synthase levels was observed in the CG. Levels of total ubiquitinated proteins were unchanged in both groups. CONCLUSION Although reduced HSP70 levels indicated reduced muscle cellular stress in the STG, the lack of an intervention effect precluded any clear conclusions.
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Affiliation(s)
- T S Nilsen
- Department of Physical PerformanceNorwegian School of Sports Sciences, Oslo, Norway
| | - L Thorsen
- Department of OncologyOslo University Hospital, Oslo, Norway
| | - C Kirkegaard
- Department of Physical PerformanceNorwegian School of Sports Sciences, Oslo, Norway
| | - I Ugelstad
- Department of Physical PerformanceNorwegian School of Sports Sciences, Oslo, Norway
| | - S D Fosså
- Department of OncologyOslo University Hospital, Oslo, Norway
| | - T Raastad
- Department of Physical PerformanceNorwegian School of Sports Sciences, Oslo, Norway
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Sajid S, Dale W, Mustian K, Kotwal A, Heckler C, Porto M, Fung C, Mohile SG. Novel physical activity interventions for older patients with prostate cancer on hormone therapy: A pilot randomized study. J Geriatr Oncol 2016; 7:71-80. [PMID: 26916611 PMCID: PMC4818675 DOI: 10.1016/j.jgo.2016.02.002] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2015] [Revised: 01/07/2016] [Accepted: 02/01/2016] [Indexed: 10/22/2022]
Abstract
BACKGROUND Androgen deprivation therapy (ADT) can decrease the physical performance (PP) of older men with prostate cancer (PC). METHODS We conducted a three-arm randomized pilot study (n=19) comparing a home-based walking and resistance intervention (EXCAP) and a technology-mediated walking and resistance intervention using Wii-Fit to a usual-care arm in men ≥70 years with PC receiving ADT. The intervention lasted for 6 weeks, with follow-up at 12 weeks. The primary pre-specified outcome was change in Short Physical Performance Battery (SPPB) score. Mixed effects regression models were used to assess change in outcomes over time. RESULTS Mean participant age was 70 years (range: 67-93). Eight patients were randomized to the Wii-Fit arm, 6 to the EXCAP arm, and 5 to the usual-care arm. SPPB scores remained nearly constant in the usual-care arm (β=-0.12; p=0.79), while individuals in the EXCAP arm had on average a 1.2 point increase at each follow-up (β=1.20; 95% CI: 0.36, 2.06). The Wii-fit arm had a non-significant increase in SPPB score over time relative to usual-care (β=0.32; 95% CI -0.43, 1.06; p=0.46). Individuals in the EXCAP arm had an increase in steps per day over time compared to the usual-care arm (p-value=0.006); the EXCAP arm had an increase of 2720 steps (95% CI: 1313, 4128) while the usual-care arm had an increase of 97 steps (95% CI: -1140, 1333). Participants in the Wii-Fit arm had an increase of 1020 steps (95% CI: -474, 1238, p=0.710). Other outcomes (i.e., handgrip strength, lean muscle mass, and chest press repetitions) were not statistically significant. CONCLUSIONS A home-based aerobic and resistance exercise program, EXCAP, shows promise for improving PP in older men with PC on ADT.
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Affiliation(s)
- Saleha Sajid
- Department of Medicine, Section of Geriatrics & Palliative Medicine, and Hematology/Oncology, University of Chicago, Chicago, IL, USA.
| | - William Dale
- Department of Medicine, Section of Geriatrics & Palliative Medicine, and Hematology/Oncology, University of Chicago, Chicago, IL, USA.
| | - Karen Mustian
- Department of Medicine, James Wilmot Cancer Institute, University of Rochester, Rochester, NY, USA.
| | - Ashwin Kotwal
- Department of Medicine, Section of Geriatrics & Palliative Medicine, and Hematology/Oncology, University of Chicago, Chicago, IL, USA.
| | - Charles Heckler
- Department of Medicine, James Wilmot Cancer Institute, University of Rochester, Rochester, NY, USA
| | - Michelle Porto
- Department of Medicine, James Wilmot Cancer Institute, University of Rochester, Rochester, NY, USA
| | - Chunkit Fung
- Department of Medicine, James Wilmot Cancer Institute, University of Rochester, Rochester, NY, USA.
| | - Supriya G Mohile
- Department of Medicine, James Wilmot Cancer Institute, University of Rochester, Rochester, NY, USA.
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Winters-Stone KM, Lyons KS, Dobek J, Dieckmann NF, Bennett JA, Nail L, Beer TM. Benefits of partnered strength training for prostate cancer survivors and spouses: results from a randomized controlled trial of the Exercising Together project. J Cancer Surviv 2015; 10:633-44. [DOI: 10.1007/s11764-015-0509-0] [Citation(s) in RCA: 74] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2015] [Accepted: 12/10/2015] [Indexed: 10/22/2022]
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Gonzalez BD, Jim HSL, Small BJ, Sutton SK, Fishman MN, Zachariah B, Heysek RV, Jacobsen PB. Changes in physical functioning and muscle strength in men receiving androgen deprivation therapy for prostate cancer: a controlled comparison. Support Care Cancer 2015; 24:2201-2207. [PMID: 26563183 DOI: 10.1007/s00520-015-3016-y] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2015] [Accepted: 11/08/2015] [Indexed: 11/25/2022]
Abstract
PURPOSE The purpose of the study is to examine changes in muscle strength and self-reported physical functioning in men receiving androgen deprivation therapy (ADT) for prostate cancer compared to matched controls. METHODS Prostate cancer patients scheduled to begin ADT (n = 62) were assessed within 20 days of starting ADT and 6 and 12 months later. Age and geographically matched prostate cancer controls treated with prostatectomy only (n = 86) were assessed at similar time intervals. Grip strength measured upper body strength, the Chair Rise Test measured lower body strength, and the SF-12 Physical Functioning scale measured self-reported physical functioning. RESULTS As expected, self-reported physical functioning and upper body muscle strength declined in ADT recipients but remained stable in prostate cancer controls. Contrary to expectations, lower body muscle strength remained stable in ADT recipients but improved in prostate cancer controls. Higher Gleason scores, more medical comorbidities, and less exercise at baseline predicted greater declines in physical functioning in ADT recipients. CONCLUSIONS ADT is associated with declines in self-reported physical functioning and upper body muscle strength as well as worse lower body muscle strength relative to prostate cancer controls. These findings should be included in patient education regarding the risks and benefits of ADT. Findings also underscore the importance of conducting research on ways to prevent or reverse declines in physical functioning in this patient population.
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Affiliation(s)
- Brian D Gonzalez
- Division of Cancer Prevention and Control, Rutgers Cancer Institute of New Jersey, New Brunswick, NJ, USA
| | - Heather S L Jim
- Health Outcomes and Behavior Program, Moffitt Cancer Center, 12902 Magnolia Drive MRC-ADMIN, Tampa, FL, 33612, USA
| | - Brent J Small
- School of Aging Studies, University of South Florida, Tampa, FL, USA
| | - Steven K Sutton
- Department of Biostatistics and Bioinformatics, Moffitt Cancer Center, Tampa, FL, USA
| | - Mayer N Fishman
- Department of Genitourinary Oncology, Moffitt Cancer Center, Tampa, FL, USA
| | - Babu Zachariah
- Department of Radiation Oncology, James A. Haley Veterans' Hospital, Tampa, FL, USA
| | - Randy V Heysek
- Department of Radiation Oncology, Moffitt Cancer Center, Tampa, FL, USA
| | - Paul B Jacobsen
- Health Outcomes and Behavior Program, Moffitt Cancer Center, 12902 Magnolia Drive MRC-ADMIN, Tampa, FL, 33612, USA.
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Measurement of gait speed in older adults to identify complications associated with frailty: A systematic review. J Geriatr Oncol 2015; 6:484-96. [PMID: 26362356 DOI: 10.1016/j.jgo.2015.08.006] [Citation(s) in RCA: 122] [Impact Index Per Article: 13.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2015] [Revised: 07/24/2015] [Accepted: 08/17/2015] [Indexed: 11/22/2022]
Abstract
Several frailty screening tests in older cancer patients were developed but their statistical performance is low. We aimed to assess whether measurement of usual gait speed (GS) alone could be used as a frailty screening test in older cancer patients. This systematic review was conducted on "pub med" between 1984 and 2014 and included reviews and original studies. Eligibility criteria were: GS over a short distance, alone or included in composite walking tests (Timed Get Up and Go test: TGUG, Short Physical Performance Battery: SPPB) in older people (aged 65 and over) living in a community setting and predictive value of GS on medical complications associated with frailty. 46 articles were finally selected. GS alone is consensual and recommended for screening sarcopenia in elderly. A slow GS is predictive of early death, disability, falls and hospitalization/institutionalization in older people living in a community setting. GS alone is comparable to composite walking tests that do not provide additional information on the medical complications associated with frailty. Despite few studies in geriatric oncology, GS seems to predict overall survival and disability. We suggest GS over 4m (at a threshold of 1m/s) as a new frailty screening test in older cancer patients (65 and over) to guide the implementation of a comprehensive geriatric assessment during the initial management phase or during follow-up. Prospective cohort studies are needed to validate this algorithm and compare it with other screening tool.
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Schmid S, Omlin A, Blum D, Strasser F, Gillessen S, Rothermundt C. Assessment of anticancer-treatment outcome in patients with metastatic castration-resistant prostate cancer-going beyond PSA and imaging, a systematic literature review. Ann Oncol 2015. [PMID: 26216388 DOI: 10.1093/annonc/mdv326] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND In the past years, there has been significant progress in anticancer drug development for patients with metastatic castration-resistant prostate cancer (CRPC). However, the current instruments to assess clinical treatment response have limitations and may not sufficiently reflect patient benefit. Our objective was to systematically identify tools to evaluate both patient benefit and clinical anticancer-treatment response as basis for an international consensus process and development of a specific pragmatic instrument for men with CRPC. METHODS PubMed, Embase and CINAHL were searched to identify currently available tools to assess anticancer-treatment benefit, other than standard imaging procedures and prostate-specific antigen measurements, namely quality of life (QoL), detailed pain assessment, physical function and objective measures of other complex cancer-related syndromes in patients with CRPC. Additionally, all CRPC phase III trials published in the last 5 years were reviewed as well as studies using physical function tools in a general cancer population. The PRIMSA statement was followed for the systematic review process. RESULTS The search generated 1096 hits, 185 full-text papers were screened and finally 73 publications were included. Additional 89 publications were included by hand-search. We identified a total of 98 tools used in CRPC trials and grouped these into three categories: 22 tools assessing QoL domains and subgroups, 47 tools for pain assessment and 29 tools for objective measures, mainly physical function and assessment of skeletal disease burden. CONCLUSION A wide variety of assessment tools and also efforts to standardize and harmonize patient-reported outcomes and pain assessment were identified. However, the specific needs of the increasing CRPC population living longer with their incurable cancer are insufficiently captured and objective physical outcome measures are under-represented. In the age of new anticancer drug targets and principles, new methods to monitor patient relevant outcomes of antineoplastic therapy are of utmost importance.
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Affiliation(s)
- S Schmid
- Division of Oncology and Haematology, Division of Oncology and Palliative Centre, Cantonal Hospital St Gallen, St Gallen,Switzerland
| | - A Omlin
- Division of Oncology and Haematology, Division of Oncology and Palliative Centre, Cantonal Hospital St Gallen, St Gallen,Switzerland
| | - D Blum
- Division of Oncological Palliative Medicine, Division of Oncology and Palliative Centre, Cantonal Hospital St Gallen, St Gallen,Switzerland
| | - F Strasser
- Division of Oncology and Haematology, Division of Oncology and Palliative Centre, Cantonal Hospital St Gallen, St Gallen,Switzerland Division of Oncological Palliative Medicine, Division of Oncology and Palliative Centre, Cantonal Hospital St Gallen, St Gallen,Switzerland
| | - S Gillessen
- Division of Oncology and Haematology, Division of Oncology and Palliative Centre, Cantonal Hospital St Gallen, St Gallen,Switzerland
| | - C Rothermundt
- Division of Oncology and Haematology, Division of Oncology and Palliative Centre, Cantonal Hospital St Gallen, St Gallen,Switzerland
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Alibhai SMH, Breunis H, Timilshina N, Naglie G, Tannock I, Krahn M, Warde P, Fleshner NE, Canning SD, Tomlinson G. Long-term impact of androgen-deprivation therapy on physical function and quality of life. Cancer 2015; 121:2350-7. [DOI: 10.1002/cncr.29355] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2014] [Revised: 02/09/2015] [Accepted: 02/16/2015] [Indexed: 11/09/2022]
Affiliation(s)
- Shabbir M. H. Alibhai
- Department of Medicine; University Health Network; Toronto Canada
- Department of Medicine; University of Toronto; Toronto Canada
- Institute of Health Policy, Management, and Evaluation; Toronto Canada
| | | | | | - Gary Naglie
- Department of Medicine; University of Toronto; Toronto Canada
- Institute of Health Policy, Management, and Evaluation; Toronto Canada
- Baycrest Centre for Geriatric Care; Toronto Canada
| | - Ian Tannock
- Department of Medicine; University Health Network; Toronto Canada
- Department of Medicine; University of Toronto; Toronto Canada
| | - Murray Krahn
- Department of Medicine; University Health Network; Toronto Canada
- Department of Medicine; University of Toronto; Toronto Canada
- Institute of Health Policy, Management, and Evaluation; Toronto Canada
| | - Padraig Warde
- Department of Radiation Oncology; University of Toronto; Toronto Canada
| | | | | | - George Tomlinson
- Department of Medicine; University Health Network; Toronto Canada
- Department of Medicine; University of Toronto; Toronto Canada
- Institute of Health Policy, Management, and Evaluation; Toronto Canada
- Department of Public Health Sciences; University of Toronto; Toronto Canada
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Course and Moderators of Hot Flash Interference during Androgen Deprivation Therapy for Prostate Cancer: A Matched Comparison. J Urol 2015; 194:690-5. [PMID: 25791402 DOI: 10.1016/j.juro.2015.03.026] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/11/2015] [Indexed: 12/31/2022]
Abstract
PURPOSE Many men receiving androgen deprivation therapy for prostate cancer experience hot flashes. This study aimed to describe the course of hot flash interference with time in androgen deprivation therapy recipients relative to matched prostate cancer and cancer-free controls from before the start of androgen deprivation therapy to 12 months later. We also examined demographic, clinical and genetic predictors of the impact of androgen deprivation therapy on hot flash interference. MATERIALS AND METHODS Three groups were examined, including 60 patients with prostate cancer recruited before or within 21 days of starting androgen deprivation therapy, 83 age and education matched patients with prostate cancer treated with prostatectomy only, and 86 age and education matched men with no history of cancer. Participants provided blood samples and completed the Hot Flash Related Daily Interference Scale at baseline as well as 6 and 12 months later. RESULTS Androgen deprivation therapy recipients reported increasing hot flash interference with time relative to controls (p <0.001). Group differences were evident at 6 and 12 months (all p <0.001) with androgen deprivation therapy recipients reporting greater hot flash interference than controls. Several genetic polymorphisms were found to predict greater increases in hot flash interference (all p <0.01), including polymorphisms on genes associated with vasoconstriction, immune function, neurotransmission and circadian rhythms. Androgen deprivation therapy recipients who were younger and had a lower body mass index at baseline also showed greater increases in hot flash interference with time (all p ≤0.01). CONCLUSIONS This study, which is to our knowledge the first to prospectively examine hot flash interference in androgen deprivation therapy recipients, reveals that those with certain genetic polymorphisms, younger age and lower body mass index had greater increases in hot flash interference with time relative to controls.
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Uth J, Hornstrup T, Schmidt JF, Christensen JF, Frandsen C, Christensen KB, Helge EW, Brasso K, Rørth M, Midtgaard J, Krustrup P. Football training improves lean body mass in men with prostate cancer undergoing androgen deprivation therapy. Scand J Med Sci Sports 2015; 24 Suppl 1:105-12. [PMID: 24944134 DOI: 10.1111/sms.12260] [Citation(s) in RCA: 59] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/28/2014] [Indexed: 11/27/2022]
Abstract
Androgen deprivation therapy (ADT) remains a cornerstone in the management of patients with prostate cancer (PCa) despite adverse effects on body composition and functional parameters. We compared the effects of football training with standard care in PCa patients managed with ADT (> 6 months). Fifty-seven men aged 67 (range: 43-74) were randomly assigned to a football group (FG, n = 29) or a usual care control group (CON, n = 28). The primary outcome was change in lean body mass (LBM) assessed by dual-energy X-ray absorptiometry scanning. Secondary outcomes included changes in knee-extensor muscle strength (one repetition maximum), fat percentage, and maximal oxygen uptake (VO2max ). Mean heart rate during training was 137.7 (standard deviation 13.7) bpm or 84.6 (3.9)% HRmax. In FG, LBM increased by 0.5 kg [95% confidence interval (CI) 0.1-0.9; P = 0.02] with no change in CON (mean group difference 0.7 kg; 95% CI 0.1-1.2; P = 0.02). Also, muscle strength increased in FG (8.9 kg; 95% CI 6.0-11.8; P < 0.001) with no change in CON (mean group difference 6.7 kg; 95% CI 2.8-10.7; P < 0.001). In FG, VO2max increased (1.0 mL/kg/min; 95% CI 0.2-1.9; P = 0.02) and fat percentage tended to decrease (0.7%; 95%CI 1.3-0.0; P = 0.06), but these changes were not significantly different from CON. In conclusion, football training over 12 weeks improved LBM and muscle strength compared with usual care in men with prostate cancer receiving ADT.
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Affiliation(s)
- J Uth
- The University Hospitals Centre for Health Research (UCSF), Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
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Cheung AS, Zajac JD, Grossmann M. Muscle and bone effects of androgen deprivation therapy: current and emerging therapies. Endocr Relat Cancer 2014; 21:R371-94. [PMID: 25056176 DOI: 10.1530/erc-14-0172] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Prostate cancer and treatment with androgen deprivation therapy (ADT) affect significant numbers of the male population. Endocrine effects of ADT are a critical consideration in balancing the benefits and risks of treatment on long-term survival and quality of life. This review highlights the latest advances in androgen manipulation in prostate cancer with an emphasis on the effects of ADT on muscle and bone, which universally affects the health and well-being of men undergoing ADT for prostate cancer. Muscle mass declines with ADT; however, the evidence that this correlates with a decrease in muscle strength or a decrease in physical performance is discordant. Cortical bone decay also occurs in association with an increase in fracture risk, hence optimization of musculoskeletal health in men undergoing ADT is crucial. The role of exercise, and current and emerging anabolic therapies for muscle as well as various new strategies to prevent loss of bone mass in men undergoing ADT are discussed. Future well-designed, prospective, controlled studies are required to elucidate the effects of ADT on physical performance, which are currently lacking, and larger randomized controlled trials are required to test the efficacy of medical therapies and exercise interventions to target proven deficits and to ensure safety in men with prostate cancer.
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Affiliation(s)
- Ada S Cheung
- Department of EndocrinologyAustin Health, Heidelberg, Victoria, AustraliaDepartment of Medicine (Austin Health)The University of Melbourne, 300 Waterdale Road, Heidelberg West, Victoria 3081, Australia Department of EndocrinologyAustin Health, Heidelberg, Victoria, AustraliaDepartment of Medicine (Austin Health)The University of Melbourne, 300 Waterdale Road, Heidelberg West, Victoria 3081, Australia
| | - Jeffrey D Zajac
- Department of EndocrinologyAustin Health, Heidelberg, Victoria, AustraliaDepartment of Medicine (Austin Health)The University of Melbourne, 300 Waterdale Road, Heidelberg West, Victoria 3081, Australia Department of EndocrinologyAustin Health, Heidelberg, Victoria, AustraliaDepartment of Medicine (Austin Health)The University of Melbourne, 300 Waterdale Road, Heidelberg West, Victoria 3081, Australia
| | - Mathis Grossmann
- Department of EndocrinologyAustin Health, Heidelberg, Victoria, AustraliaDepartment of Medicine (Austin Health)The University of Melbourne, 300 Waterdale Road, Heidelberg West, Victoria 3081, Australia Department of EndocrinologyAustin Health, Heidelberg, Victoria, AustraliaDepartment of Medicine (Austin Health)The University of Melbourne, 300 Waterdale Road, Heidelberg West, Victoria 3081, Australia
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Neschadim A, Summerlee AJS, Silvertown JD. Targeting the relaxin hormonal pathway in prostate cancer. Int J Cancer 2014; 137:2287-95. [PMID: 25043063 DOI: 10.1002/ijc.29079] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2014] [Accepted: 07/07/2014] [Indexed: 11/11/2022]
Abstract
Targeting the androgen signalling pathway has long been the hallmark of anti-hormonal therapy for prostate cancer. However, development of androgen-independent prostate cancer is an inevitable outcome to therapies targeting this pathway, in part, owing to the shift from cancer dependence on androgen signalling for growth in favor of augmentation of other cellular pathways that provide proliferation-, survival- and angiogenesis-promoting signals. This review focuses on the role of the hormone relaxin in the development and progression of prostate cancer, prior to and after the onset of androgen independence, as well as its role in cancers of other reproductive tissues. As the body of literature expands, examining relaxin expression in cancerous tissues and its role in a growing number of in vitro and in vivo cancer models, our understanding of the important involvement of this hormone in cancer biology is becoming clearer. Specifically, the pleiotropic functions of relaxin affecting cell growth, angiogenesis, blood flow, cell migration and extracellular matrix remodeling are examined in the context of cancer progression. The interactions and intercepts of the intracellular signalling pathways of relaxin with the androgen pathway are explored in the context of progression of castration-resistant and androgen-independent prostate cancers. We provide an overview of current anti-hormonal therapeutic treatment options for prostate cancer and delve into therapeutic approaches and development of agents aimed at specifically antagonizing relaxin signalling to curb tumor growth. We also discuss the rationale and challenges utilizing such agents as novel anti-hormonals in the clinic, and their potential to supplement current therapeutic modalities.
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Affiliation(s)
- Anton Neschadim
- Armour Therapeutics Inc., Toronto, 124 Orchard View Blvd, Toronto, ON, Canada
| | | | - Joshua D Silvertown
- Armour Therapeutics Inc., Toronto, 124 Orchard View Blvd, Toronto, ON, Canada
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Tsang DS, Alibhai SM. Bone health care for patients with prostate cancer receiving androgen deprivation therapy. Hosp Pract (1995) 2014; 42:89-102. [PMID: 24769788 DOI: 10.3810/hp.2014.04.1107] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
Patients with prostate cancer often receive androgen deprivation therapy (ADT) as part of their treatment regimen. However, treatment with ADT causes multiple side effects, including reduced bone mineral density (BMD), lower lean body mass, and a higher risk for fractures. Several organizations provide clinical practice guidelines for osteoporosis screening, prevention, and treatment in this population, but adherence to these guidelines remains low. Areas for improvement in provider adherence include baseline and follow-up BMD testing, as well as counseling regarding healthy bone behaviors such as calcium/vitamin D intake, lifestyle changes, and physical exercise. Comparison of osteoporosis care in breast cancer and non-oncology populations shows that suboptimal bone health care is not isolated to prostate cancer. A summary of the literature examining improvements in patient adherence and provider delivery of bone health care is included in this review, but high-quality studies are lacking. Patients may be the most receptive to written educational information delivered at or near the time of ADT initiation. Involvement of a primary care practitioner and oncologist in care delivery is associated with higher BMD test use. Institution-level programs that automatically initiate osteoporosis screening and management may be effective at reducing the incidence of hip fracture. Lastly, suggestions are provided for future approaches to knowledge translation and quality of care studies to improve bone health.
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Affiliation(s)
- Derek S Tsang
- Resident Physician, Department of Radiation Oncology, University of Toronto, Toronto, Canada
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McGinty HL, Phillips KM, Jim HSL, Cessna JM, Asvat Y, Cases MG, Small BJ, Jacobsen PB. Cognitive functioning in men receiving androgen deprivation therapy for prostate cancer: a systematic review and meta-analysis. Support Care Cancer 2014; 22:2271-80. [PMID: 24859915 DOI: 10.1007/s00520-014-2285-1] [Citation(s) in RCA: 142] [Impact Index Per Article: 14.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2014] [Accepted: 05/06/2014] [Indexed: 11/29/2022]
Abstract
PURPOSE Prior research examining the impact of androgen deprivation therapy (ADT) for prostate cancer on cognitive performance has found inconsistent relationships. The purpose of this study was to systematically review the existing literature and determine the effect of ADT on performance across seven cognitive domains using meta-analysis. METHODS A search of PubMed Medline, PsycINFO, Cochrane Library, and Web of Knowledge/Science databases yielded 157 unique abstracts reviewed by independent pairs of raters. Fourteen studies with a total of 417 patients treated with ADT were included in the meta-analysis. Objective neuropsychological tests were categorized into seven cognitive domains: attention/working memory, executive functioning, language, verbal memory, visual memory, visuomotor ability, and visuospatial ability. RESULTS Separate effect sizes were calculated for each cognitive domain using pairwise comparisons of patients who received ADT with (1) prostate cancer patient controls, (2) noncancer controls, or (3) ADT patients' own pre-ADT baselines. Patients treated with ADT performed worse than controls or their own baseline on visuomotor tasks (g = -0.67, p = .008; n = 193). The magnitude of the deficits was larger in studies with a shorter time to follow-up (p = .04). No significant effect sizes were observed for the other six cognitive domains (p = .08-.98). CONCLUSIONS Prostate cancer patients who received ADT performed significantly worse on visuomotor tasks compared to noncancer control groups. These findings are consistent with the known effects of testosterone on cognitive functioning in healthy men. Knowledge of the cognitive effects of ADT may help patients and providers better understand the impact of ADT on quality of life.
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The Efficacy of a Group-based Exercise and Sexuality Education Program for Prostate Cancer Survivors. REHABILITATION ONCOLOGY 2014. [DOI: 10.1097/01893697-201432040-00008] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Barawid E, Covarrubias N, Tribuzio B, Liao S. The Benefits of Rehabilitation for Palliative Care Patients. Am J Hosp Palliat Care 2013; 32:34-43. [DOI: 10.1177/1049909113514474] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Palliative care requires an interdisciplinary team approach to provide the best care for patients with life-threatening illnesses. Like palliative medicine, rehabilitation also uses an interdisciplinary approach to treating patients with chronic illnesses. This review article focuses on rehabilitation interventions that can be beneficial in patients with late stage illnesses. Rehabilitation may be useful in improving the quality of life by palliating function, mobility, activities of daily living, pain relief, endurance, and the psyche of a patient while helping to maintain as much independence as possible, leading to a decrease in burden on caregivers and family. Rehabilitative services are underutilized in the palliative care setting, and more research is needed to address how patients may benefit as they approach the end of their lives.
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Affiliation(s)
- Edward Barawid
- Department of Physical Medicine and Rehabilitation, University of California Irvine Medical Center, Orange, CA, USA
| | - Natalia Covarrubias
- Department of Physical Medicine and Rehabilitation, University of California Irvine Medical Center, Orange, CA, USA
| | - Bianca Tribuzio
- Department of Physical Medicine and Rehabilitation, University of California Irvine Medical Center, Orange, CA, USA
| | - Solomon Liao
- Department of Palliative Care, University of California Irvine Medical Center, Orange, CA, USA
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Murphy R, Wassersug R, Dechman G. The role of exercise in managing the adverse effects of androgen deprivation therapy in men with prostate cancer. PHYSICAL THERAPY REVIEWS 2013. [DOI: 10.1179/1743288x11y.0000000029] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
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Keogh JWL, Patel A, MacLeod RD, Masters J. Perceived barriers and facilitators to physical activity in men with prostate cancer: possible influence of androgen deprivation therapy. Eur J Cancer Care (Engl) 2013; 23:263-73. [PMID: 24134506 DOI: 10.1111/ecc.12141] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/06/2013] [Indexed: 11/29/2022]
Abstract
While physical activity is beneficial for men with prostate cancer, too few perform sufficient activity for such benefit. This study examined perceptions of men with prostate cancer of their barriers and facilitators to physical activity, and how androgen deprivation therapy (ADT) may influence these perceptions. Two focus groups were conducted, involving six ADT and eight non-ADT patients respectively. Data were transcribed verbatim and themes developed using a general inductive thematic approach. Facilitators to physical activity common to both groups of cancer survivors included clinician and spousal involvement, with pre-existing co-morbidities and increased age cited as barriers by both groups. The ADT subgroup cited personal involvement as a facilitator to physical activity, with fatigue, reduced motivation and a relative lack of specific advice from their clinician as additional barriers. The non-ADT subgroup had no additional facilitators to physical activity but cited time constraints as a barrier. These results highlight the important role that cancer clinicians and spouses play in promoting physical activity for men with prostate cancer and how ADT may influence their other facilitators and barriers. As physical activity is beneficial for prostate cancer survivors, especially those on ADT, cancer clinicians should regularly discuss physical activity with their patients.
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Affiliation(s)
- J W L Keogh
- Exercise and Sports Sciences, Faculty of Health Sciences and Medicine, Bond University, Robina, Qld, Australia; Human Potential Centre, AUT University, Auckland, New Zealand; Cluster for Health Improvement, Faculty of Science, Health, Education and Engineering, University of the Sunshine Coast, Sippy Downs, Qld, Australia
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Trost LW, Serefoglu E, Gokce A, Linder BJ, Sartor AO, Hellstrom WJG. Androgen deprivation therapy impact on quality of life and cardiovascular health, monitoring therapeutic replacement. J Sex Med 2013; 10 Suppl 1:84-101. [PMID: 23387914 DOI: 10.1111/jsm.12036] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
INTRODUCTION Androgen deprivation therapy (ADT) is commonly utilized in the management of both localized and advanced adenocarcinoma of the prostate. The use of ADT is associated with several adverse events, physical changes, and development of medical comorbidities/mortality. AIM The current article reviews known adverse events associated with ADT as well as treatment options, where available. Current recommendations and guidelines are cited for ongoing monitoring of patients receiving ADT. METHODS A PubMed search of topics relating to ADT and adverse outcomes was performed, with select articles highlighted and reviewed based on level of evidence and overall contribution. MAIN OUTCOME MEASURES Reported outcomes of studies detailing adverse effects of ADT were reviewed and discussed. Where available, randomized trials and meta-analyses were reported. RESULTS ADT may result in several adverse events including decreased libido, erectile dysfunction, vasomotor symptoms, cognitive, psychological and quality of life impairments, weight gain, sarcopenia, increased adiposity, gynecomastia, reduced penile/testicular size, hair changes, periodontal disease, osteoporosis, increased fracture risk, diabetes and insulin resistance, hyperlipidemia, and anemia. The definitive impact of ADT on lipid profiles, cardiovascular morbidity/mortality, and all-cause mortality is currently unknown with available data. Treatment options to reduce ADT-related adverse events include changing to an intermittent treatment schedule, biophysical therapy, counseling, and pharmacotherapy. CONCLUSIONS Patients treated with ADT are at increased risk of several adverse events and should be routinely monitored for the development of potentially significant morbidity/mortality. Where appropriate, physicians should reduce known risk factors and counsel patients as to known risks and benefits of therapy.
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Gagnon B, Murphy J, Jelowicki M, Morris DV. The effect of severe androgen deficiency on physical function in male patients with cancer. J Pain Symptom Manage 2013; 45:892-900. [PMID: 23102563 DOI: 10.1016/j.jpainsymman.2012.05.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2012] [Accepted: 05/21/2012] [Indexed: 10/27/2022]
Abstract
CONTEXT Low circulating testosterone concentrations are commonly observed in male patients with cancer and have been shown to be associated with weight loss and increased severity of many symptoms, including fatigue and weakness. OBJECTIVES The aim of the present study was to determine the extent to which testosterone deficiency is associated with poor physical function in male patients with nonhormonal cancers. METHODS We measured serum free testosterone concentration in 101 male patients with cancer evaluated at a nutrition-rehabilitation clinic and performed univariate and multivariate linear regression analyses to assess the effect of a free testosterone concentration in the lowest quartile on six-minute walk distance (6-MWD) (n=100) and maximal gait speed (n=49). RESULTS In the univariate analyses, patients in the lowest free testosterone quartile had a 6-MWD that was 96 m (95% CI 51, 141) less and a maximal gait speed that was 0.26 m/second (95% CI 0.06, 0.47) slower on average than patients in the upper three free testosterone quartiles. When controlling for other demographic, clinical, and biological factors, a free testosterone concentration in the lowest quartile was associated, on average, with a 51 m (95% CI 44, 97) lower 6-MWD but did not affect maximal gait speed. CONCLUSION The present study shows that in male patients with cancer, an extremely low serum free testosterone concentration is independently associated with 6-MWD but not maximal gait speed. Hence, a severe testosterone deficiency may impair their ability to perform sustained activity, but to a lesser degree, short bursts of activity.
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Affiliation(s)
- Bruno Gagnon
- Department of Medicine, Faculty of Medicine, McGill University, Montreal, Quebec, Canada.
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Hanson ED, Sheaff AK, Sood S, Ma L, Francis JD, Goldberg AP, Hurley BF. Strength training induces muscle hypertrophy and functional gains in black prostate cancer patients despite androgen deprivation therapy. J Gerontol A Biol Sci Med Sci 2013; 68:490-8. [PMID: 23089339 PMCID: PMC3593619 DOI: 10.1093/gerona/gls206] [Citation(s) in RCA: 55] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2012] [Accepted: 09/10/2012] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Androgen deprivation therapy (ADT) for prostate cancer (PCa) is associated with weakness, fatigue, sarcopenia, and reduced quality of life (QoL). Black men have a higher incidence and mortality from PCa than Caucasians. We hypothesized that despite ADT, strength training (ST) would increase muscle power and size, thereby improving body composition, physical function, fatigue levels, and QoL in older black men with PCa. METHODS Muscle mass, power, strength, endurance, physical function, fatigue perception, and QoL were measured in 17 black men with PCa on ADT before and after 12 weeks of ST. Within-group differences were determined using t tests and regression models. RESULTS ST significantly increased total body muscle mass (2.7%), thigh muscle volume (6.4%), power (17%), and strength (28%). There were significant increases in functional performance (20%), muscle endurance (110%), and QoL scores (7%) and decreases in fatigue perception (38%). Improved muscle function was associated with higher functional performance (R (2) = 0.54) and lower fatigue perception (R (2) = 0.37), and both were associated with improved QoL (R (2) = 0.45), whereas fatigue perception tended to be associated with muscle endurance (R (2) = 0.37). CONCLUSIONS ST elicits muscle hypertrophy even in the absence of testosterone and is effective in counteracting the adverse functional consequences of ADT in older black men with PCa. These improvements are associated with reduced fatigue perception, enhanced physical performance, and improved QoL. Thus, ST may be a safe and well-tolerated therapy to prevent the loss of muscle mass, strength, and power commonly observed during ADT.
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Affiliation(s)
- Erik D. Hanson
- Department of Kinesiology, School of Public Health, University of Maryland, College Park
- Institute of Sport, Exercise, and Active Living, Victoria University, Melbourne, Australia
| | - Andrew K. Sheaff
- Department of Kinesiology, School of Public Health, University of Maryland, College Park
| | - Suchi Sood
- Department of Kinesiology, School of Public Health, University of Maryland, College Park
| | - Lei Ma
- Department of Kinesiology, School of Public Health, University of Maryland, College Park
| | | | - Andrew P. Goldberg
- Division of Gerontology and Geriatric Medicine, Department of Medicine, University of Maryland School of Medicine and the Baltimore VA Medical Center Geriatric Research, Education and Clinical Center, Maryland
| | - Ben F. Hurley
- Department of Kinesiology, School of Public Health, University of Maryland, College Park
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Lee CE, Leslie WD, Lau YKJ. A pilot study of exercise in men with prostate cancer receiving androgen deprivation therapy. BMC Cancer 2012; 12:103. [PMID: 22436542 PMCID: PMC3352294 DOI: 10.1186/1471-2407-12-103] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2012] [Accepted: 03/21/2012] [Indexed: 11/13/2022] Open
Abstract
Background Androgen deprivation therapy (ADT) is the mainstay therapy for men with prostate cancer. However, there are musculoskeletal side effects from ADT that increase the risk for osteoporosis and fracture, and can compromise the quality of life of these individuals. The objectives of this study are to determine the efficacy of a home-based walking exercise program in promoting bone health, physical function and quality of life in men with prostate cancer receiving ADT. Methods/Design A 12-month prospective, single-blinded, randomized controlled trial will be conducted to compare the Exercise Group with the Control Group. Sixty men with prostate cancer who will be starting ADT will be recruited and randomly assigned to one of the two groups: the Exercise Group will receive instructions in setting up an individualized 12-month home-based walking exercise program, while the Control Group will receive standard medical advice from the attending physician. A number of outcome measures will be used to assess bone health, physical function, and health-related quality of life. At baseline and 12 months, bone health will be assessed using dual-energy X-ray absorptiometry. At baseline and every 3 months up to 12 months, physical function will be evaluated using the Functional Assessment of Chronic Illness Therapy - Fatigue Scale, Activities-specific Balance Confidence Scale, Short Physical Performance Battery, and Six-Minute Walk Test; and health-related quality of life will be assessed using the Functional Assessment of Cancer Therapy Prostate Module and the Medical Outcomes Study 12-item Short Form Health Survey Version 2. A mixed multiple analysis of variance will be used to analyze the data. Discussion Musculoskeletal health management remains a challenge in men with prostate cancer receiving ADT. This study addresses this issue by designing a simple and accessible home-based walking exercise program that will potentially have significant impact on reducing the risk of fracture, promoting physical function, and ultimately improving the health-related quality of life in men with prostate cancer receiving ADT. Trial registration ClinicalTrials.gov: NCT00834392.
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Affiliation(s)
- C Ellen Lee
- Department of Physical Therapy, University of Manitoba, R106 - 771 McDermot Ave., Winnipeg MB R3E 0T6, Canada.
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45
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Storer TW, Miciek R, Travison TG. Muscle function, physical performance and body composition changes in men with prostate cancer undergoing androgen deprivation therapy. Asian J Androl 2012; 14:204-21. [PMID: 22367184 DOI: 10.1038/aja.2011.104] [Citation(s) in RCA: 50] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Prostate cancer (PCa) is the most common visceral malignancy in men with androgen deprivation therapy (ADT) the preferred therapy to suppress testosterone production and hence tumor growth. Despite its effectiveness in lowering testosterone, ADT is associated with side effects including loss of muscle mass, diminished muscle strength, decrements in physical performance, earlier fatigue and declining quality of life. This review reports a survey of the literature with a focus on changes in muscle strength, physical function and body composition, due to short-term and long-term ADT. Studies in these areas are sparse, especially well-controlled, prospective randomized trials. Cross-sectional and longitudinal data (up to 2 years) for men with PCa treated with ADT as well as patients with PCa not receiving ADT and age-matched healthy men are presented when available. Based on limited longitudinal data, the adverse effects of ADT on muscle function, physical performance and body composition occur shortly after the onset of ADT and tend to persist and worsen over time. Exercise training is a safe and effective intervention for mitigating these changes and initial guidelines for exercise program design for men with PCa have been published by the American College of Sports Medicine. Disparities in study duration, types of studies and other patient-specific variables such as time since diagnosis, cancer stage and comorbidities may all affect an understanding of the influence of ADT on health, physical performance and mortality.
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Affiliation(s)
- Thomas W Storer
- Section of Endocrinology, Diabetes, and Nutrition, Boston University School of Medicine, Boston, MA 02118, USA.
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Keogh JWL, MacLeod RD. Body composition, physical fitness, functional performance, quality of life, and fatigue benefits of exercise for prostate cancer patients: a systematic review. J Pain Symptom Manage 2012; 43:96-110. [PMID: 21640547 DOI: 10.1016/j.jpainsymman.2011.03.006] [Citation(s) in RCA: 129] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2010] [Revised: 03/02/2011] [Accepted: 03/04/2011] [Indexed: 12/21/2022]
Abstract
CONTEXT Prostate cancer patients, especially those on androgen deprivation therapy (ADT), experience many symptoms that make it difficult to maintain their independence and quality of life. Because ADT acts by means of reducing testosterone production, exercise may offset many of the ADT side effects and those of the cancer itself. OBJECTIVES This systematic review of the literature evaluates whether exercise could reduce symptoms and improve quality of life for prostate cancer patients. METHODS Using relevant databases and key words, 12 training studies were found meeting the inclusion and exclusion criteria. RESULTS Grade A level evidence was observed for the benefits of exercise in improving muscular endurance, aerobic endurance, and overall quality of life, as well as reducing fatigue in prostate cancer patients. Grade B evidence also suggested that exercise may improve prostate cancer patients' muscle mass, muscular strength, functional performance (walking and sit to stand speed), as well as health-related, social and physical quality of life. These effects appeared greater for group-rather than home-based-exercise, especially if these programs included resistance training. CONCLUSION It is recommended that most prostate cancer patients be encouraged to exercise regularly by their clinicians and significant others. Where possible, this exercise should be group-based and include some resistance training. Future research in this area should directly compare group- and home-based, as well as resistance, aerobic, and combined resistance and aerobic training to better elucidate the most effective forms of exercise for this population and what factors affect initiation and adherence to such programs.
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Winters-Stone KM, Lyons KS, Nail LM, Beer TM. The Exercising Together project: design and recruitment for a randomized, controlled trial to determine the benefits of partnered strength training for couples coping with prostate cancer. Contemp Clin Trials 2011; 33:342-50. [PMID: 22101224 DOI: 10.1016/j.cct.2011.10.015] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2011] [Revised: 09/29/2011] [Accepted: 10/31/2011] [Indexed: 10/15/2022]
Abstract
Prostate cancer can threaten quality of life for the patient and his spouse and the quality of his marital relationship. The purpose of our study is to evaluate the effects of "Exercising Together" - a partnered strength training program for married couples coping with prostate cancer - on the physical and emotional health of prostate cancer survivors (PCS) and their spouses and on marital quality. We are conducting a 6-month randomized controlled trial with two groups: 1) Exercising Together - a progressive, supervised strength training program and 2) a usual care control condition. The primary aims of this exploratory study are to: 1) Determine the effect of partnered strength training on physical and emotional health (muscle strength, physical function, body composition and self-report physical and mental health) in PCS, 2) Determine the effect of partnered strength training on physical and emotional health in spouses and 3) Explore the effect of partnered strength training on marital quality (incongruence, communication, relationship quality, intimacy) of the PCS and spouse. Target accrual has been met in this study with 64 couples enrolled and randomized to exercise (n=32) or usual care (n=32) groups. This study is the first to examine the feasibility of this exercise format in both the chronically ill patient and spouse and explore benefits at the individual and couple level.
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Affiliation(s)
- Kerri M Winters-Stone
- School of Nursing, Oregon Health and Science University, Portland, OR 97239, United States.
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Kumar SP. Cancer Pain: A Critical Review of Mechanism-based Classification and Physical Therapy Management in Palliative Care. Indian J Palliat Care 2011; 17:116-26. [PMID: 21976851 PMCID: PMC3183600 DOI: 10.4103/0973-1075.84532] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Mechanism-based classification and physical therapy management of pain is essential to effectively manage painful symptoms in patients attending palliative care. The objective of this review is to provide a detailed review of mechanism-based classification and physical therapy management of patients with cancer pain. Cancer pain can be classified based upon pain symptoms, pain mechanisms and pain syndromes. Classification based upon mechanisms not only addresses the underlying pathophysiology but also provides us with an understanding behind patient's symptoms and treatment responses. Existing evidence suggests that the five mechanisms – central sensitization, peripheral sensitization, sympathetically maintained pain, nociceptive and cognitive-affective – operate in patients with cancer pain. Summary of studies showing evidence for physical therapy treatment methods for cancer pain follows with suggested therapeutic implications. Effective palliative physical therapy care using a mechanism-based classification model should be tailored to suit each patient's findings, using a biopsychosocial model of pain.
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Affiliation(s)
- Senthil P Kumar
- Department of Physiotherapy, Kasturba Medical College, Manipal University, Mangalore, India
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Metabolic complications and increased cardiovascular risks as a result of androgen deprivation therapy in men with prostate cancer. Prostate Cancer 2011; 2011:391576. [PMID: 22110984 PMCID: PMC3200266 DOI: 10.1155/2011/391576] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2011] [Revised: 04/04/2011] [Accepted: 05/06/2011] [Indexed: 02/02/2023] Open
Abstract
Prostate cancer is one of the most common malignancies in men. Charles Huggins and Clarence V. Hodges reported the androgen dependence of prostate cancer in 1941. That led to the utilization of androgen deprivation therapy as an important therapeutic modality to treat prostate cancer. Androgen deprivation therapy has additional systemic effects that include sexual dysfunction, psychological changes and more important are the metabolic changes. Metabolic changes in particular include insulin resistance, increase fat mass and low-density lipoprotein cholesterol, and induce type 2 diabetes. In this review we will focus on the cardiovascular risk associated with androgen deprivation therapy that includes the mechanisms involved.
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Kumar SP, Jim A. Physical therapy in palliative care: from symptom control to quality of life: a critical review. Indian J Palliat Care 2011; 16:138-46. [PMID: 21218003 PMCID: PMC3012236 DOI: 10.4103/0973-1075.73670] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Physiotherapy is concerned with identifying and maximizing movement potential, within the spheres of promotion, prevention, treatment and rehabilitation. Physical therapists practice in a broad range of inpatient, outpatient, and community-based settings such as hospice and palliative care centers where as part of a multidisciplinary team of care, they address the physical and functional dimensions of the patients’ suffering. Physiotherapy treatment methods like therapeutic exercise, electrical modalities, thermal modalities, actinotherapy, mechanical modalities, manual physical therapy and assistive devices are useful for a range of life-threatening and life-limiting conditions like cancer and cancer-associated conditions; HIV; neurodegenerative disorders like amyotrophic lateral sclerosis, multiple sclerosis; respiratory disorders like idiopathic pulmonary fibrosis; and altered mental states. The professional armamentarium is still expanding with inclusion of other miscellaneous techniques which were also proven to be effective in improving quality of life in these patients. Considering the scope of physiotherapy in India, and in palliative care, professionals in a multidisciplinary palliative care team need to understand and mutually involve toward policy changes to successfully implement physical therapeutic palliative care delivery.
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Affiliation(s)
- Senthil P Kumar
- Department of Physiotherapy, Kasturba Medical College, Manipal University, Mangalore, India
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