Does Use of Androgen Deprivation Therapy (ADT) in Men with Prostate Cancer Increase the Risk of Sarcopenia?

Abstract

Androgen deprivation therapy (ADT) for prostate cancer (PCa) can compromise muscle health. Hence, we aimed to quantify the prevalence of sarcopenia (i.e., compromised lean mass, muscle strength, and physical function) in ADT-treated (> 12 week) men (n = 70) compared to similarly aged non-ADT-treated PCa (n = 52) and healthy controls (n = 70). Lean and fat mass were quantified by dual-energy X-ray absorptiometry. Muscle strength and function were measured using handgrip dynamometry and gait speed, respectively. Sarcopenia was defined as low adjusted appendicular lean mass [ALM; heightadjusted (ALMI), body mass index-adjusted (ALM BMI ) and height and fat mass-adjusted (ALM HFM )] with weak handgrip strength and/or slow gait speed according to the following criteria: European Working Group on Sarcopenia in Older People [EWGSOP; both 2010 (EWGSOP1) and 2018 (EWGSOP2)], Foundation for the National Institutes of Health (FNIH) and International Working Group on Sarcopenia (IWGS). Overall the prevalence of sarcopenia was low and did not differ between the three groups. Only two (3.2%) ADT-treated men presented with sarcopenia as per EWGSOP1 and FNIH criteria, whereas no cases were observed using EWGSOP2 and IWGS criteria. The prevalence of low ALM BMI was greater in ADT-treated men (32%) compared to PCa (15%; P = 0.037) and healthy controls (7.1%; P < 0.001). Similarly, low ALM HFM was greater in ADT-treated men (29%) compared to healthy controls only (13%; P = 0.019). There was also a low prevalence of weak muscle strength and slow gait speed (0.0-11%) in all men, with no differences between the groups. Based on these findings, an adiposity-based adjustment of ALM is recommended to quantify risk of adverse outcomes associated with ADT in these men.

Bioimpedance phase angle and sarcopenia in older patients with prostate cancer

“…There have been growing interests in muscle health and sarcopenia in those with prostate cancer. Although previous studies have reported the adverse effect of androgen deprivation therapy on muscle mass and quality in patients with prostate cancer, 26,27 hormone therapy did not affect the presence of sarcopenia in our study. This was probably due to the clinical heterogeneity of the patients who had received hormone therapy.…”

Bone health effects of androgen-deprivation therapy and androgen receptor inhibitors in patients with nonmetastatic castration-resistant prostate cancer

“…The increased risk of fractures following androgen-inhibition is due to increased osteoclastic bone destruction in addition to muscle dysfunction and increased risk of fall [ 4 ]. Reduced testosterone has a negative impact on muscle mass, which may lead to less mobility, further contributing to decreased BMD [ 24 , 25 , 50 ].…”

Obesity and low levels of physical activity impact on cardiopulmonary fitness in older men after treatment for prostate cancer

“…Decline in skeletal muscle mass and function is a common problem in older cancer patients which can negatively affect physical function and cancer outcomes (Handforth et al, 2014;Owen et al, 2019;Williams et al, 2020). The significant difference between mean grip strength declined as a result of increasing age, when compared with normative data, 70% of the scores for men <65 years were below age-matched norms, compared to 53% in the >75 years group.…”