Secondary Prevention of Bone Disease in Men on Androgen Deprivation Therapy for Prostate Cancer: Quality Improvement Through Implementation of Evidence-Based Bone Health Guidelines

Purpose Androgen-deprivation therapy is a commonly used treatment for men with prostate cancer; however, the adverse effects can be detrimental to patient health and quality of life. Exercise has been proposed as a strategy for ameliorating a range of these treatment-related adverse effects. We conducted a systematic review of the literature regarding the effects of exercise on treatment-related adverse effects in men receiving androgen-deprivation therapy for prostate cancer. Methods An online electronic search of the Cochrane Library, EMBASE, MEDLINE, CINAHL, SPORTDiscus, and Health Source databases was performed to identify relevant peer-reviewed articles published between January 1980 and June 2013. Eligible study designs included randomized controlled trials as well as uncontrolled trials with pre- and postintervention data. Information was extracted regarding participant and exercise intervention characteristics as well as the effects of exercise on bone health, body composition, physical performance, cardiometabolic risk, fatigue, and quality of life. Results Ten studies were included, with exercise interventions involving aerobic and/or resistance training. Exercise training demonstrated benefits in muscular strength, cardiorespiratory fitness, functional task performance, lean body mass, and fatigue, with inconsistent effects observed for adiposity. The impact of exercise on bone health, cardiometabolic risk markers, and quality of life are currently unclear. Conclusion Among patients with prostate cancer treated with androgen-deprivation therapy, appropriately prescribed exercise is safe and may ameliorate a range of treatment-induced adverse effects. Ongoing research of high methodologic quality is required to consolidate and expand on current knowledge and to allow the development of specific evidence-based exercise prescription recommendations.

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Practice Patterns Compared with Evidence-based Strategies for the Management of Androgen Deprivation Therapy–Induced Side Effects in Prostate Cancer Patients: Results of a European Web-based Survey

European Urology Focus ◽

10.1016/j.euf.2016.02.009 ◽

2016 ◽

Vol 2 (5) ◽

pp. 514-521 ◽

Cited By ~ 4

Author(s):

Renée Bultijnck ◽

Cristian Surcel ◽

Guillaume Ploussard ◽

Alberto Briganti ◽

Pieter De Visschere ◽

...

Keyword(s):

Prostate Cancer ◽

Side Effects ◽

Cancer Patients ◽

Androgen Deprivation Therapy ◽

Practice Patterns ◽

Androgen Deprivation ◽

Evidence Based ◽

Web Based

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Bone health in the prostate cancer patient receiving androgen deprivation therapy: a review of present and future management options

Canadian Urological Association Journal ◽

10.5489/cuaj.811 ◽

2013 ◽

Vol 4 (2) ◽

pp. 129 ◽

Cited By ~ 8

Author(s):

Blair Egerdie ◽

Fred Saad

Keyword(s):

Prostate Cancer ◽

Androgen Deprivation Therapy ◽

Bone Health ◽

Preventive Measures ◽

Prostate Cancer Patient ◽

Bone Fractures ◽

Vitamin D Supplementation ◽

Androgen Deprivation ◽

Management Options ◽

Future Management

Osteoporosis and bone fractures are frequently overlooked complicationsof androgen deprivation therapy in men with nonmetastaticprostate cancer. All such patients should have their bone mineraldensity (BMD) monitored and be offered preventive measures,such as calcium and vitamin D supplementation; patients withlow BMD should be offered treatment. Several agents, includingbisphosphonates, are available (although this use is currently offlabel),and upcoming treatments, such as denosumab and toremifene,have shown promise in reducing fracture risk in these patients.L’ostéoporose et les fractures osseuses sont des complications souventnégligées du traitement antiandrogénique chez les hommesatteints d’un cancer de la prostate non métastatique. La teneurminérale des os de ces patients devrait être surveillée, et des mesurespréventives, comme la prise de suppléments de calcium et de vita -mine D, devraient être offertes. Les patients présentant une faibleteneur minérale des os devraient se voir offrir un traitement approprié.Plusieurs agents, y compris des bisphosphonates, sont offertssur le marché (quoique cette indication ne soit pas officiellementapprouvée à l’heure actuelle), et des traitements en cours d’étude,comme le dénosumab et le torémifène, se sont révélés prometteursdans la réduction du risque de fracture chez ces patients.

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Physical exercise for bone health in men with prostate cancer receiving androgen deprivation therapy: a systematic review

Supportive Care in Cancer ◽

10.1007/s00520-020-05830-1 ◽

2020 ◽

Author(s):

Barbara Bressi ◽

Maribel Cagliari ◽

Massimiliano Contesini ◽

Elisa Mazzini ◽

Franco Antonio Mario Bergamaschi ◽

...

Keyword(s):

Prostate Cancer ◽

Systematic Review ◽

Physical Exercise ◽

Androgen Deprivation Therapy ◽

Bone Health ◽

Accidental Falls ◽

Androgen Deprivation ◽

Cochrane Library ◽

Mineral Density ◽

Significant Difference

Abstract Purpose Androgen deprivation therapy (ADT) is a treatment used in men with prostate cancer (PCa); however it is responsible for many adverse effects, with negative impact on quality of life. ADT causes loss of bone mineral density (BMD) and skeletal muscle mass, alteration of body composition, and cognitive function, which altogether lead to increased risk of accidental falls and fractures. This systematic review analyses the effectiveness of physical exercise (PE) in preventing accidental falls and fractures and reducing the loss of BMD in men with PCa receiving ADT. Methods We searched MEDLINE, EMBASE, CINAHL, and the Cochrane Library for articles between database inception and September 2, 2020. Eligible studies included randomized controlled trials (RCTs) investigating the effects of exercise on bone health in men with PCa receiving ADT. Results Nine RCTs were included. Experimental PE consisted in multicomponent programmes that involved aerobic, resistance, impact-loading exercise, and football training. None of the RCTs investigated the risk of accidental falls and fractures, while two trials reported beneficial effects of PE on lumbar spine, hip, and femoral shaft BMD. No further significant difference was detected in the outcomes investigated. Conclusion Evidence of the effectiveness of PE to prevent the risk of accidental falls and fractures and BMD loss is lacking. Nevertheless, clinical guidelines recommend PE as a part of the clinical management of men with PCa receiving ADT due to its known numerous health benefits. Research should focus on PE strategies to prevent accidental falls, a clinically relevant outcome in this vulnerable population. Trial registration The study protocol was registered with International Prospective Register of Systematic Reviews (PROSPERO, number CRD 42020158444) on 04/28/2020.

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