Is physical function affected by androgen deprivation therapy (ADT) in men with non-metastatic prostate cancer?

2006 ◽  
Vol 24 (18_suppl) ◽  
pp. 4615-4615
Author(s):  
S. Gogov ◽  
F. Hussain ◽  
G. Naglie ◽  
I. Tannock ◽  
N. E. Fleshner ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Lower Extremity ◽  
Physical Function ◽  
Grip Strength ◽  
Upper Extremity ◽  
Metastatic Prostate Cancer ◽  
Older Men ◽  
Lower Extremity Strength ◽  
Prospective Longitudinal ◽  
The Impact

4615 Background: Although prolonged use ofADT is hypothesized to adversely affect physical function, only a few small studies have examined this relationship and it remains unclear if self-reported weakness represents a decline in actual physical performance or is related to fatigue. Loss of physical function may be particularly important to older men who already have limited functional reserves. Methods: Men age 50 or older with non-metastatic prostate cancer who were starting continuous ADT were enrolled in this prospective longitudinal study. Physical function was tested using a Jamar dynamometer (grip strength), the Timed Up and Go (TUG) test, and the six-minute walk test (6MWT), representing upper extremity strength, lower extremity strength, and endurance, respectively. Assessments were done at baseline (prior to ADT), 3 months, 6 months, and 12 months. Results: 42 patients on ADT have been enrolled to date (mean age 74.8 y). There was a gradual but steady decline in grip strength from baseline (39.2 kg) to 3 months (38.1 kg), 6 months (37.9 kg), and 12 months (35.3 kg) (p < 0.05 for all comparisons). On average, patients took 7.3 seconds to complete the TUG and walked 1507 feet during the 6MWT at baseline. TUG and 6MWT scores did not worsen over time (p > 0.05). Conclusions: Preliminary data suggest that 3–12 months of ADT is associated with worsening upper extremity strength but lower extremity strength and endurance are relatively unaffected. A larger sample size is needed to determine if all aspects of physical function or only upper extremity strength deteriorate with ADT use. Additionally, most patients in our study reported excellent health and functional status at baseline and our results may not adequately reflect the impact of ADT in more frail older men. No significant financial relationships to disclose.

Declines in physical function from androgen deprivation therapy (ADT) in men with nonmetastatic prostate cancer: A matched cohort study

2009 ◽  
Vol 27 (15_suppl) ◽  
pp. 9526-9526
Author(s):  
H. Breunis ◽  
N. Timilshina ◽  
G. Tomlinson ◽  
G. Naglie ◽  
I. Tannock ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Cohort Study ◽  
Physical Function ◽  
Grip Strength ◽  
Upper Extremity ◽  
Control Group ◽  
Healthy Controls ◽  
Matched Cohort ◽  
Control Groups ◽  
Sf 36

9526 Background: Although prolonged use of ADT is hypothesized to adversely affect physical function, few studies have examined this relationship longitudinally using objective measures of physical function. Methods: Men age 50+ with non-metastatic prostate cancer (PC) starting continuous ADT were enrolled in this prospective longitudinal matched cohort study. Physical function was assessed with the six-minute walk test (6MWT), grip strength, and the Timed Up and Go (TUG) test, representing endurance, upper extremity strength, and lower extremity strength, respectively. Self-reported physical function was measured with the Medical Outcomes Study SF-36. Assessments were done at baseline, 3 months, 6 months, and 12 months. Two control groups, matched on age, education, and baseline function were also enrolled. One control group had PC but did not receive ADT, and the other group did not have PC. Linear mixed effects regression models were fitted adjusting for baseline covariates. Results: 85 patients on ADT, 86 PC controls, and 86 healthy controls were enrolled. All 3 groups were similar in age (mean age 69.1 y, range 50–87) and physical function (all ANOVA p>0.05). The 6MWT distance improved in both control groups (p=0.05 and 0.05 for PC and healthy controls, respectively) but remained stable in the ADT group (p=0.96)). Grip strength declined in the ADT group (p=0.04), remained stable in the PC control group (p=0.31), and improved in the healthy control group (p=0.008). TUG scores remained stable over time and across groups (p>0.10). SF-36 physical function declined in the ADT group (p<0.001) but increased in both control groups (p<0.001). Negative effects on outcomes were noted within 3–6 months of starting ADT and were larger with older age. Conclusions: Endurance, upper extremity strength, and self-reported physical function are affected within 3–6 months of starting ADT, particularly in older men. Declines persist at 12 months after adjustment for baseline function and covariates. Exercise intervention studies to counteract these losses are warranted. No significant financial relationships to disclose.

Impact of treatment and frailty on elder-relevant physical function outcomes in older adults with metastatic castration-resistant prostate cancer (mCRPC).

2021 ◽  
Vol 39 (6_suppl) ◽  
pp. 76-76
Author(s):  
Helen Yang ◽  
Henriette Breunis ◽  
Narhari Timilshina ◽  
Seungyeon Kim ◽  
Shabbir M.H. Alibhai
Keyword(s):  
Older Adults ◽  
Physical Function ◽  
Grip Strength ◽  
Frailty Index ◽  
Well Being ◽  
Older Men ◽  
Frailty Status ◽  
Treatment Type ◽  
The Impact ◽  
Over Time

76 Background: Maintenance of physical function is a key consideration in treatment decision-making for older adults with metastatic cancer, many of whom are frail. However, physical function outcomes with treatment, and effects of frailty, have not been adequately explored in the mCRPC setting. We evaluated the effects of frailty status and treatment with docetaxel (CHEMO), abiraterone (ABI), enzalutamide (ENZA), and radium 223 (RAD) on elder-relevant physical function outcomes in older men with mCRPC. Methods: Men aged 65+ were enrolled in this multicenter prospective observational cohort study. Daily function was evaluated with the OARS instrumental activities of daily living (IADL). Objective physical function was assessed by grip strength and the Short Physical Performance Battery (SPPB). Falls were documented during interviews. We also collected FACT-G physical well-being (PWB) and functional well-being (FWB) subscales. Assessments were performed at baseline, 3 months, and 6 months. We identified frailty status with a validated frailty index. Mixed effects regression models were used to examine the difference in primary outcomes over time by treatment group or frailty status adjusted for baseline characteristics. Factors associated with falls within 6 months of treatment initiation were determined with logistic regression. Results: A total of 70, 38, 67, and 23 men starting CHEMO, ABI, ENZA, and RAD were included. Mean age, education, race, number of medications, and BMI were similar at baseline between treatment groups. In treatment-stratified analyses without considering frailty, no significant changes over time were reported for any physical function outcome. Frailty was significantly associated with lower IADL function (p < 0.0001), worse grip strength (p < 0.0001), worse SPPB score (p < 0.0001), worse PWB (p < 0.0001), and worse FWB (p < 0.0001) at baseline. In frailty-stratified analyses, grip strength (p = 0.0345) worsened, but SPPB (p = 0.0147) improved significantly over time. Also, changes in SPPB (p = 0.0394) and PWB scores (p = 0.0269) over time differed by frailty status, where frail cohorts had greater improvement over time in both scores. Frailty and treatment type were not predictors of falls whereas prior falls history (OR: 3.52, 95% CI: 1.40-8.86) and age (OR: 1.07, 95% CI: 1.01-1.14) were significant predictors. Conclusions: Frail older men receiving treatment for mCRPC have worse IADL function, grip strength, SPPB scores, PWB, and FWB at baseline. Although grip strength worsened over time, they had greater improvement in SPPB scores and PWB over time than fit patients. Contrary to our hypothesis, most older adults do not experience significant worsening in elder-relevant physical function outcomes over time regardless of treatment. The impact of frailty requires further study.

A prospective study examining PROs and other geriatric outcomes in older adults with prostate cancer undergoing chemotherapy.

2013 ◽  
Vol 31 (15_suppl) ◽  
pp. 9555-9555 ◽  
Author(s):  
Tharsika Manokumar ◽  
Salman Aziz ◽  
Faraz Rizvi ◽  
Henriette Breunis ◽  
Anthony Michael Joshua ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Physical Function ◽  
Grip Strength ◽  
Frail Elderly ◽  
Older Men ◽  
Castration Resistant Prostate Cancer ◽  
Lower Extremity Function ◽  
First Line ◽  
Timed Up And Go ◽  
Line Chemotherapy

9555 Background: Treatment of metastatic castration-resistant prostate cancer (mCRPC) with chemotherapy improves disease control and survival in older men (age 65+) based on large clinical trials. Its effects, though, on more frail elderly men are not well understood and chemotherapy may negatively impact frailty, daily function, physical performance, and quality of life (QOL), particularly outside the clinical trial setting. Methods: Men aged 65+ with mCRPC starting first-line chemotherapy were enrolled in this prospective observational pilot study. Physical function was assessed with the timed up and go (TUG) test, timed chair stands, and grip strength. Frailty was evaluated using the Vulnerable Elders Survey (VES-13) questionnaire in addition to functional status (OARS-IADL), social activities limitations and social support (MOS measures). Patients completed the FACT-P and FACT-G to measure prostate-specific QOL and general QOL, respectively. Assessments were completed before each cycle of chemotherapy. Pre-post within-group comparisons were done using student’s T-tests and linear regression. Results: 25 patients (mean age 75) receiving Docetaxel + Prednisone were enrolled, 3 of whom died and 2 dropped out. Both general and prostate-specific QOL improved over a median of 6 cycles. Patients’ instrumental activities of daily living (IADL) scores remained stable. On average, grip strength was stable and lower extremity function improved on both the TUG and Timed Chair Stands. At baseline, 13 of 25 patients (52%) were frail (VES score 3+). Of the patients that completed chemotherapy, 40% were frail. Conclusions: Contrary to our hypotheses, QOL did not decline in this frail elderly cohort, IADL function remained stable, and physical function remained stable or improved during first-line chemotherapy. Frailty also did not increase at the end of treatment as hypothesized. Older men with mCRPC appear to tolerate first-line chemotherapy fairly well in terms of QOL and geriatric domains.

scholarly journals Translation of Fit & Strong! for Use by Hispanics With Arthritis: A Feasibility Trial of ¡En Forma y Fuerte!

2017 ◽  
Vol 25 (4) ◽  
pp. 628-638 ◽  
Author(s):  
Cheryl Der Ananian ◽  
Renae Smith-Ray ◽  
Brad Meacham ◽  
Amy Shah ◽  
Susan Hughes
Keyword(s):  
Experimental Design ◽  
Lower Extremity ◽  
Physical Function ◽  
Feasibility Trial ◽  
Evidence Based ◽  
Single Group ◽  
Lower Extremity Strength ◽  
Quasi Experimental ◽  
Literacy Level ◽  
The Impact

This study evaluated the feasibility and effectiveness of translating the evidence-based program, Fit & Strong!, into a Spanish program, ¡En Forma y Fuerte!. A single-group, quasi-experimental design (n = 34, mean age = 58.8 [8.1], 87.2% female, 87.2% reported speaking mostly Spanish) was used to assess implementation feasibility and the impact of ¡En Forma y Fuerte! on arthritis-related outcomes in Hispanics with arthritis. Significant improvements in lower-extremity strength, perceived physical function, and pain were observed from baseline to 8 weeks (p < .05); these improvements were maintained at 6 months. Significant improvements in aerobic endurance and stiffness were observed from baseline to 6 months (p < .05). No major program adaptations (other than language) were observed or reported. However, the instructors provided several suggestions for program improvements, including adjusting the literacy level and length of the program. Findings suggest ¡En Forma y Fuerte! is feasible and effective, potentially providing a much-needed program for older Hispanics with arthritis.

scholarly journals Multidimensional Sleep Health and Physical Functioning in Older Adults

2020 ◽  
Vol 4 (Supplement_1) ◽  
pp. 428-428
Author(s):  
Caitlan Tighe ◽  
Ryan Brindle ◽  
Sarah Stahl ◽  
Meredith Wallace ◽  
Adam Bramoweth ◽  
...  
Keyword(s):  
Older Adults ◽  
Lower Extremity ◽  
Grip Strength ◽  
Physical Functioning ◽  
Gait Speed ◽  
The United States ◽  
Depression Symptoms ◽  
Sleep Health ◽  
Lower Extremity Strength ◽  
Sleep Parameters

Abstract Prior studies link specific sleep parameters to physical functioning in older adults. Recent work suggests the utility of examining sleep health from a multidimensional perspective, enabling consideration of an individual’s experience across multiple different sleep parameters (e.g., quality, duration, timing). We examined the associations of multidimensional sleep health with objective, performance-based measures of physical functioning in older adults. We conducted a secondary analysis of 158 adults (Mage=71.8 years; 51.9% female) who participated in the Midlife in the United States (MIDUS) 2 and MIDUS Refresher studies. We used data from daily diaries, wrist actigraphy, and self-report measures to derive a composite multidimensional sleep health score ranging from 0-6, with higher scores indicating better sleep health. Physical function was assessed using gait speed during a 50-foot timed walk, lower extremity strength as measured by a chair stand test, and grip strength assessed with dynamometers. We used hierarchical regression to examine the associations between sleep health and gait speed, lower extremity strength, and grip strength. Age, sex, race, education, depression symptoms, medical comorbidity, and body mass index were covariates in each model. In adjusted analyses, better multidimensional sleep health was significantly associated with faster gait speed (B=.03, p=.01). Multidimensional sleep health was not significantly associated with lower limb strength (B=-.12, p=.89) or grip strength (B=.45, p=.40). Gait speed is a key indicator of functional capacity as well as morbidity and mortality in older adults. Multidimensional sleep health may be a therapeutic target for improving physical functioning and health in older adults.

scholarly journals Prognostic role of docetaxel-induced suppression of free testosterone serum levels in metastatic prostate cancer patients

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Paula Kappler ◽  
Michael A. Morgan ◽  
Philipp Ivanyi ◽  
Stefan J. Brunotte ◽  
Arnold Ganser ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Metastatic Prostate Cancer ◽  
Cox Regression ◽  
Specific Antigen ◽  
Progression Free Survival ◽  
Serum Levels ◽  
Biologically Active ◽  
Free Form ◽  
Total Testosterone ◽  
The Impact

AbstractTo date, only few data concerning the biologically active, free form of testosterone (FT) are available in metastatic prostate cancer (mPC) and the impact of FT on disease, therapy and outcome is largely unknown. We retrospectively studied the effect of docetaxel on FT and total testosterone (TT) serum levels in 67 mPC patients monitored between April 2008 and November 2020. FT and TT levels were measured before and weekly during therapy. The primary endpoint was overall survival (OS). Secondary endpoints were prostate-specific antigen response and radiographic response (PSAR, RR), progression-free survival (PFS), FT/TT levels and safety. Median FT and TT serum levels were completely suppressed to below the detection limit during docetaxel treatment (FT: from 0.32 to < 0.18 pg/mL and TT: from 0.12 to < 0.05 ng/mL, respectively). Multivariate Cox regression analyses identified requirement of non-narcotics, PSAR, complete FT suppression and FT nadir values < 0.18 pg/mL as independent parameters for PFS. Prior androgen-receptor targeted therapy (ART), soft tissue metastasis and complete FT suppression were independent prognostic factors for OS. FT was not predictive for treatment outcome in mPC patients with a history of ART.

Metastatic Prostate Cancer Presenting as Lower Extremity Soft Tissue Mass: A Rare Case Presentation

Urology ◽  
2017 ◽  
Vol 99 ◽  
pp. e27-e28
Author(s):  
Paulette Cutruzzula ◽  
Daniel C. Edwards ◽  
David Cahn ◽  
Carmen Tong ◽  
Dana Kivlin ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Soft Tissue ◽  
Lower Extremity ◽  
Rare Case ◽  
Metastatic Prostate Cancer ◽  
Soft Tissue Mass ◽  
Tissue Mass ◽  
Case Presentation

Associations of pre-existing cardiovascular disease (CVD) with treatment patterns and survival outcomes in patients with metastatic prostate cancer: A real-world, population-based study.

2021 ◽  
Vol 39 (15_suppl) ◽  
pp. e17056-e17056
Author(s):  
Atul Batra ◽  
Shiying Kong ◽  
Winson Y. Cheung
Keyword(s):  
Prostate Cancer ◽  
Metastatic Prostate Cancer ◽  
Population Based ◽  
Treatment Patterns ◽  
Survival Outcomes ◽  
Administrative Claims ◽  
World Population ◽  
Cancer Treatments ◽  
Lower Likelihood ◽  
The Impact

e17056 Background: Prior cardio-oncology research has focused on examining the future risk of CVD as a result of cancer treatments. The impact of pre-existing CVD on cancer treatments is less clear. This study aimed to identify the associations of baseline CVD on treatment patterns and survival outcomes in metastatic prostate cancer where older age and exposure to androgen deprivation therapy can potentiate cardiac risks. Methods: We identified all patients diagnosed with metastatic prostate cancer in a large Canadian province from 2004 to 2017 using the population-based cancer registry. Administrative claims were linked to ascertain any diagnoses of pre-existing CVD, defined as any of arrythmias [AR], cerebrovascular accidents [CVAs], myocardial infarctions [MIs], or congestive heart failure [CHF] that preceded the diagnosis of metastatic prostate cancer. Logistic and Cox regression models were constructed to determine the associations of baseline CVD with receipt of cancer treatments (such as radiation, or systemic therapy) and overall survival (OS). Results: A total of 3,257 patients were included. The median age was 66 years (interquartile range, 46-95 years). At diagnosis of advanced prostate cancer, 993 (30.5%) had pre-existing CVD: 10.0% AR, 4.3% CVAs, 3.0% MIs, 2.8% CHF and 10.4% multiple CVDs. The Charlson comorbidity index (CCI) was 0, 1 and >1 in 53.4%, 27.3% and 19.3%, respectively. Overall, 2078 (63.8%) patients received chemotherapy, while 747 (22.9%) received radiotherapy. After adjusting for age and CCI, pre-existing CVD was associated with a lower likelihood of chemotherapy (odds ratio [OR], 0.67; 95% confidence interval [CI], 0.61-0.75; P=0.001) and radiotherapy (OR, 0.87; 95% CI, 0.85-0.91; P<0.001). Likewise, CVD was associated with worse OS, after adjusting for measured confounding variables (see table). Conclusions: One-third of patients with metastatic prostate cancer had pre-existing CVD, which was associated with a lower likelihood of chemotherapy and worse OS. In the context of an aging general population, early cardio-oncology consultations to optimize CVD management may lead to safer and broader uptake of appropriate prostate cancer treatments.[Table: see text]

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