Dietary interventions to improve body composition in men treated with androgen deprivation therapy for prostate cancer: a solution for the growing problem?

Abstract Background Androgen deprivation therapy (ADT) has adverse effects on body composition, including muscle wasting and body fat accumulation, which may be attenuated by nutrition therapy. This systematic review summarises available evidence on the effects of dietary interventions on lean mass, fat mass and body mass index (BMI) in men treated with ADT for prostate cancer. Methods MEDLINE, Embase, Web of Science and ClinicalTrials.org were searched from inception through December 2020. We included all controlled trials evaluating effects of supplementation or dietary interventions on body composition in men with prostate cancer receiving continuous ADT. Methodological quality of the studies was assessed using the Cochrane Collaboration’s risk of bias tool. Meta-analysis was performed using a random effects model to calculate standardised mean differences between intervention and comparator groups. (PROSPERO; CRD42020185777). Results Eleven studies (n = 536 participants) were included. Seven studies investigated the effects of dietary advice interventions, e.g. individual or group counselling, and four studies included a nutritional supplement. Eight studies combined the dietary intervention with exercise. Nine studies reported sufficient data for inclusion in the meta-analysis. Dietary advice and supplementation interventions combined were not associated with significant changes in lean mass (0.05 kg; 95% CI: −0.17, 0.26; p = 0.674; n = 355), fat mass (−0.22 kg; 95% CI: −0.45, 0.01; p = 0.064; n = 336) or BMI (−0.16 kg*m−2; 95% CI: −0.37, 0.04; p = 0.121; n = 399). Dietary advice interventions alone were associated with a significant fat mass reduction (−0.29 kg; 95% CI: −0.54, −0.03; p = 0.028; n = 266). Conclusions Most studies were dietary advice interventions targeting caloric restriction, which showed the potential to reduce fat mass but did not increase lean mass in men treated with ADT. Future interventions should investigate whether a combination of dietary advice and protein supplementation with concomitant resistance exercise could counteract ADT-induced muscle wasting.

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Relationships between insulin resistance and frailty with body composition and testosterone in men undergoing androgen deprivation therapy for prostate cancer

Acta Endocrinologica ◽

10.1530/eje-16-0200 ◽

2016 ◽

Vol 175 (3) ◽

pp. 229-237 ◽

Cited By ~ 26

Author(s):

Ada S Cheung ◽

Rudolf Hoermann ◽

Philippe Dupuis ◽

Daryl Lim Joon ◽

Jeffrey D Zajac ◽

...

Keyword(s):

Prostate Cancer ◽

Insulin Resistance ◽

Body Composition ◽

Androgen Deprivation Therapy ◽

Fat Mass ◽

Lean Mass ◽

Androgen Deprivation ◽

Total Testosterone ◽

The Mean ◽

Control Prospective Study

Objective While androgen deprivation therapy (ADT) has been associated with insulin resistance and frailty, controlled prospective studies are lacking. We aimed to examine the relationships between insulin resistance and frailty with body composition and testosterone. Design Case–control prospective study. Methods Sixty three men with non-metastatic prostate cancer newly commencing ADT (n=34) and age-matched prostate cancer controls (n=29) were recruited. The main outcomes were insulin resistance (HOMA2-IR), Fried’s frailty score, body composition by dual x-ray absorptiometry and short physical performance battery (SPPB) measured at 0, 6 and 12months. A generalised linear model determined the mean adjusted difference (95% CI) between groups. Results Compared with controls over 12months, men receiving ADT had reductions in mean total testosterone level (14.1–0.4nmol/L, P<0.001), mean adjusted gain in fat mass of 3530g (2012, 5047), P<0.02 and loss of lean mass of 1491g (181, 2801), P<0.02. Visceral fat was unchanged. HOMA2-IR in the ADT group increased 0.59 (0.24, 0.94), P=0.02, which was most related to the increase in fat mass (P=0.003), less to lean mass (P=0.09) or total testosterone (P=0.088). Frailty increased with ADT (P<0.0001), which was related to decreased testosterone (P=0.028), and less to fat mass (P=0.056) or lean mass (P=0.79). SPPB was unchanged. Conclusions ADT is associated with increased insulin resistance and frailty within 12months of commencement, independently of confounding effects of cancer or radiotherapy. Insulin resistance appears to be mediated by subcutaneous or peripheral sites of fat deposition. Prevention of fat gain is an important strategy to prevent adverse ADT-associated cardiometabolic risks.

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Responsiveness to Resistance-Based Multimodal Exercise Among Men With Prostate Cancer Receiving Androgen Deprivation Therapy

Journal of the National Comprehensive Cancer Network ◽

10.6004/jnccn.2019.7311 ◽

2019 ◽

Vol 17 (10) ◽

pp. 1211-1220 ◽

Cited By ~ 1

Author(s):

Dennis R. Taaffe ◽

Robert U. Newton ◽

Nigel Spry ◽

David J. Joseph ◽

Daniel A. Galvão

Keyword(s):

Prostate Cancer ◽

Skeletal Muscle ◽

Body Composition ◽

Muscle Strength ◽

Physical Function ◽

Androgen Deprivation Therapy ◽

Lean Mass ◽

Androgen Deprivation ◽

Whole Body ◽

Appendicular Skeletal Muscle

Background: Androgen deprivation therapy (ADT) in the management of prostate cancer (PCa) results in an array of adverse effects, and exercise is one strategy to counter treatment-related musculoskeletal toxicities. This study assessed the prevalence of exercise responsiveness in men with PCa undergoing ADT in terms of body composition, muscle strength, and physical function. Methods: Prospective analyses were performed in 152 men (aged 43–90 years) with PCa receiving ADT who were engaged in resistance exercise combined with aerobic or impact training for 3 to 6 months. Whole-body lean mass and fat mass (FM), trunk FM, and appendicular skeletal muscle were assessed with dual x-ray absorptiometry; upper and lower body muscle strength were assessed with the one-repetition maximum; and physical function was assessed with a battery of tests (6-m usual, fast, and backward walk; 400-m walk; repeated chair rise; stair climb). Results: Significant improvements were seen (P<.01) in lean mass (0.4±1.4 kg [range, −2.8 to +4.1 kg]), appendicular skeletal muscle (0.2±0.8 kg [range, −1.9 to +1.9 kg]), and all measures of muscle strength (chest press, 2.9±5.8 kg [range, −12.5 to +37.5 kg]; leg press, 29.2±27.6 kg [range, −50.0 to +140.0 kg]) and physical function (from −0.1±0.5 s [range, +1.3 to −2.1 s] for the 6-m walk; to −8.6±15.2 s [range, +25.2 to −69.7 s] for the 400-m walk). An increase in FM was also noted (0.6±1.8 kg [range, −3.6 to +7.3 kg]; P<.01). A total of 21 men did not exhibit a favorable response in at least one body composition component, 10 did not experience improved muscle strength, and 2 did not have improved physical function. However, all patients responded in at least one of the areas, and 120 (79%) favorably responded in all 3 areas. Conclusions: Despite considerable heterogeneity, most men with PCa receiving ADT responded to resistance-based multimodal exercise, and therefore our findings indicate that this form of exercise can be confidently prescribed to produce beneficial effects during active treatment.

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The Effects Of Exercise On Body Composition Of Prostate Cancer Patients Receiving Androgen Deprivation Therapy: A Systematic Review And Meta-analysis

Medicine & Science in Sports & Exercise ◽

10.1249/01.mss.0000764740.63066.09 ◽

2021 ◽

Vol 53 (8S) ◽

pp. 470-470

Author(s):

Wenjuan Shao ◽

Yimin Zhang ◽

Hanyue Zhang ◽

Shuhao Wang

Keyword(s):

Prostate Cancer ◽

Systematic Review ◽

Body Composition ◽

Cancer Patients ◽

Androgen Deprivation Therapy ◽

Meta Analysis ◽

Androgen Deprivation

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The effect of androgen deprivation therapy on body composition in men with prostate cancer: Systematic review and meta-analysis

Journal of Cancer Survivorship ◽

10.1007/s11764-009-0114-1 ◽

2010 ◽

Vol 4 (2) ◽

pp. 128-139 ◽

Cited By ~ 82

Author(s):

Farhana Haseen ◽

Liam J. Murray ◽

Chris R. Cardwell ◽

Joe M. O’Sullivan ◽

Marie M. Cantwell

Keyword(s):

Prostate Cancer ◽

Systematic Review ◽

Body Composition ◽

Androgen Deprivation Therapy ◽

Meta Analysis ◽

Androgen Deprivation

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Faculty Opinions recommendation of Comparison of Abiraterone Acetate and Docetaxel with Androgen Deprivation Therapy in High-risk and Metastatic Hormone-naïve Prostate Cancer: A Systematic Review and Network Meta-analysis.

Faculty Opinions – Post-Publication Peer Review of the Biomedical Literature ◽

10.3410/f.732006685.793538242 ◽

2017 ◽

Author(s):

Michael Glode

Keyword(s):

Prostate Cancer ◽

Systematic Review ◽

High Risk ◽

Androgen Deprivation Therapy ◽

Meta Analysis ◽

Abiraterone Acetate ◽

Androgen Deprivation

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Effect of Salvage Radiotherapy and Endocrine Therapy on Patients with Biochemical Recurrence After Prostate Cancer Operation— a Meta‑Analysis

American Journal of Men s Health ◽

10.1177/15579883211024881 ◽

2021 ◽

Vol 15 (3) ◽

pp. 155798832110248

Author(s):

Yong Yuan ◽

Qiang Zhang ◽

Chaofan Xie ◽

Tao Wu

Keyword(s):

Prostate Cancer ◽

Systematic Review ◽

Endocrine Therapy ◽

Androgen Deprivation Therapy ◽

Biochemical Recurrence ◽

Meta Analysis ◽

Combined Treatment ◽

Androgen Deprivation ◽

Salvage Radiotherapy ◽

End Point

Context: Several studies reported the application of androgen deprivation therapy and radiotherapy in patients with biochemical recurrence after prostate cancer operation. Objective: To perform a systematic review and meta-analysis evaluating of endocrine therapy and radiotherapy in patients with biochemical recurrence after prostate cancer surgery. The primary end point was biochemical progression-free survival (bPFS). Secondary end point was overall survival (OS). Methods: A systematic review of PubMed/Medline, Embase, and Cochrane databases to identify relevant studies published in English up to March 2020. Twelve studies were selected for inclusion. Results: There were 11 studies included in the present study. Including two randomized controlled trials and nine cohort studies. The meta-analysis shows a significant bPFS benefit from androgen deprivation therapy and radiotherapy in patients with biochemical recurrence after prostate cancer operation. (hazard ratio [HR]: 0.57; 95% confidence interval CI, 0.52–0.63; p < .001). For patients with GS < 7 and low-risk patients, combined treatment can have a benefit for BPFs (HR: 0.53; 95% CI, 0.37–0.76; HR: 0.58; 95% CI, 0.36–0.93). Androgen deprivation therapy and radiotherapy in patients with biochemical recurrence was associated with a slightly OS improvement (HR: 0.73; 95% CI, 0.57–0.93; p = 0.01). Conclusions: Compared with salvage radiotherapy alone, This meta-analysis shows a significant bPFS benefit from endocrine therapy combined with salvage radiotherapy in patients with biochemical recurrence after prostate cancer operation. And benefit more for high-risk groups. However, there was no significant benefit in group GS ≥ 8. It shows a slightly OS benefit from endocrine therapy combined with salvage radiotherapy in patients with biochemical recurrence.

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Clinical Utility of miRNA-1, miRNA-29g and miRNA-133s Plasma Levels in Prostate Cancer Patients With High-Intensity Training After Androgen-Deprivation Therapy

Physiological Research ◽

10.33549/physiolres.934298 ◽

2019 ◽

pp. S139-S147

Author(s):

A. GAZOVA ◽

A. SAMAKOVA ◽

E. LACZO ◽

D. HAMAR ◽

M. POLAKOVICOVA ◽

...

Keyword(s):

Prostate Cancer ◽

Body Composition ◽

Exercise Training ◽

Androgen Deprivation Therapy ◽

Plasma Levels ◽

Exercise Intervention ◽

Free Testosterone ◽

Androgen Deprivation ◽

Control Group ◽

The Impact

The randomized trials showed that the addition of training resistance program to androgen-deprivation therapy (ADT) had many beneficial effects for prostate cancer (PC) patients (significant protective effect on the volume of muscle mass) and the studies have revealed a panel of miRNAs, which are deregulate in PC and may serve as promising biomarkers of PC risk. The primary aim of our present study was to investigate the effect of exercise training to changes in body composition (muscle strength) and the secondary endpoint was to investigate the impact of an exercise training program on plasma levels of selected myogenic microRNAs (miRNAs) (miRNA-1, miRNA-29b, and miRNA-133) in PC patients undergoing the ADT. Effect of ADT and exercise intervention showed significant increase (experimental group vs. control group) the changes in body composition, free testosterone levels, IL-6 and plasma levels of myogenic miRNAs and significant reduced insulin serum levels. In conclusion, resistance training with ADT in the treatment of PC significantly changed the physical and metabolic function and the plasma levels of specific myogenic miRNAs. Our data support with the other publicized results.

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