Quality of life issues in men undergoing androgen deprivation therapy: a review

Casey, Rowan G.; Corcoran, Niall M.; Goldenberg, Sheldon

doi:10.1038/aja.2011.108

Cited by 59 publications

(46 citation statements)

References 98 publications

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“…Another mediating mechanism may be the physiological changes resulting from ADT [4,6,11]. Gray and colleagues noted that most men with PC avoided disclosing their illness and tended to conceal their emotional difficulties or deny the support they needed [27].…”

Section: Discussionmentioning

confidence: 99%

“…Gray and colleagues noted that most men with PC avoided disclosing their illness and tended to conceal their emotional difficulties or deny the support they needed [27]. In addition, some studies suggested that psychological distress resulting from initiation of ADT might increase the depressive symptomatology of patients receiving ADT [4,6]. Consequently, physiological changes, interacting with the affective response to the PC diagnosis and ADT effects, may induce the development of DD.…”

Section: Discussionmentioning

confidence: 99%

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Patients receiving androgen deprivation therapy for prostate cancer have an increased risk of depressive disorder

et al. 2017

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Androgen deprivation therapy (ADT) results in testosterone suppression, a hypothesized mechanism linking ADT to depressive symptoms. This study investigated the relationship between ADT and the risk of subsequently being diagnosed with depressive disorder (DD) during a 3-year follow-up period. The patient sample for this population-based, retrospective cohort study was retrieved from the Taiwan Longitudinal Health Insurance Database 2005. We included all 1714 patients aged over 40 years with a first-time diagnosis of prostate cancer (PC) during 2001 to 2010 who did not have an orchiectomy. Among them, we defined 868 patients who received ADT during the 3-year follow-up period as the study group, and 846 patients who did not receive ADT as the comparison group. The incidence rates of DD per 1000 person-years were 13.9 (95% confidence interval (CI): 9.5~19.6) and 6.7 (95% CI: 3.7~11.0), respectively. Cox proportional hazard regressions showed that the adjusted hazard ratio for DD for ADT recipients was 1.93 (95% CI: 1.03~3.62) relative to the comparison group. This study presents epidemiological evidence of an association between ADT and a subsequent DD diagnosis.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Patients receiving androgen deprivation therapy for prostate cancer have an increased risk of depressive disorder

et al. 2017

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“…2,3 Although ADT is an effective way to manage PCa and allows many men to live their lives free of PCa symptoms, it is associated with significant adverse effects that reduce their quality of life (QOL). 4,5 Average survival time for patients treated with ADT after a primary treatment has failed has reached 7 years (median, 84 months). 6 Therefore, patients must cope with the adverse effects of treatment for a considerable amount of time.…”

Section: Introductionmentioning

confidence: 99%

Luteinizing Hormone–Releasing Hormone Agonists: A Quick Reference for Prevalence Rates of Potential Adverse Effects

Walker

Tran

Robinson

2013

Clinical Genitourinary Cancer

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“…Similarly, ADT has been associated with increased cardiometabolic risk via compromised blood lipid profiles, decreased insulin sensitivity and increased arterial stiffness [59,205,206] ; however, this elevated risk appears to be associated with cardiometabolic morbidity [207] , but not mortality within these men [208] . ADT is also associated with increased fatigue, depressive symptoms and sexual dysfunction may in part explain the lower health-related quality of life commonly reported in men treated with ADT [209] , which is of further concern given the susceptibility to suicide among these men [187] . Whilst each of these clinical implications notably contributes to the burden of disease associated with the treatment of PCa with ADT, the following sections will focus on outcomes that may in part be explained by ADT-related changes in muscle and fat and subsequent decrements in functional performance.…”

Section: The Clinical Implications Of Androgen Deprivation Therapy-rementioning

confidence: 99%

Muscle, fat and performance during androgen deprivation for prostate cancer

Owen¹

2018

Preprint

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Introduction: Prostate cancer (PCa) is one of the most frequently diagnosed male cancers worldwide. One treatment, androgen deprivation therapy (ADT), is often accompanied with a myriad of adverse effects, including those that negatively impact muscle, fat and performance outcomes. Therefore, ADT-treated men may be living longer, but are at risk of both age- and treatment-related complications. The overall aim of this thesis was to quantify outcomes of muscle, fat and performance in men treated with ADT when compared to PCa (men diagnosed with PCa, not treated with ADT) and healthy controls (men not diagnosed with PCa), and assess the feasibility of implementing a multi-component exercise program combined with protein, calcium and vitamin D supplementation (Ex+ProCaD) compared to usual care in ADT-treated men. Methods: This thesis presents two studies that form part of a larger 52-week randomised controlled trial (RCT), which examined the efficacy of Ex+ProCaD compared to usual care in men treated with ADT for PCa. The first study presented was a nested cross-sectional study performed parallel to the baseline assessment of the RCT and examined differences in muscle, fat and performance outcomes between men treated with ADT when compared to PCa and healthy controls. The second study presented examined the feasibility of implementing the first 26 weeks of the RCT. Results: The cross-sectional study showed that height, weight, body mass index and diet were similar between the three groups, but ADT-treated men were four years older and tended to be less physically active (23-30%; P=0.054). After adjusting for age and physical activity, total body fat mass was 3.3-5.0 kg (P < 0.05) greater in men treated with ADT compared to PCa controls, but there was no difference in total body and regional lean mass. When adiposity was considered, ADT-treated men had 10-12% (P < 0.05) lower appendicular lean mass adjusted for body mass index and 5.6-6.4% (P < 0.05) lower forearm percent muscle cross-sectional area compared to controls. Absolute muscle strength was similar between groups, but when expressed relative to body weight, men treated with ADT had 13-21% (P < 0.05) lower muscle strength compared to controls. Whilst only two ADT-treated men had sarcopenia, these men had a higher proportion (P < 0.001) of pre-sarcopenia when appendicular lean mass was adjusted for body mass index (42%) compared to PCa (15%) and healthy (7%) controls. Men treated with ADT had 15-36% (P < 0.05) greater storage of fat within subcutaneous depots when compared to controls, whereas visceral and intermuscular fat was similar. The majority of subcutaneous fat depots (excluding android region) were shown to be positively associated with ADT duration (P < 0.05). Forearm muscle density was shown to negatively correlate with ADT duration (P < 0.05). The RCT had a high participant retention rate (96%). Adherence was high for the supplement (mean, 92-93%) and modest for the exercise program (mean, 60%). A relatively high proportion (81%) of men in the intervention group reported an adverse event, although only 16% were confirmed to be related to the intervention and the vast majority (97%) were determined to be mild or moderate in terms of severity. Across the ten separate recruitment pathways considered, clinician referral (43%) and PCa support groups (29%) yielded the greatest proportion of enrolled participants. A total of 149 potential participants were screened, which resulted in 42 participants at the time of write up for this thesis. Among the first 28 participants to complete the 26-week intervention, 21-50% were unable to complete at least one measure of muscle strength due to pre-existing comorbidities. Data from the initial 28 participants tended to show that when compared to usual care, Ex+ProCaD led to net improvements in lean mass (0.2-1.4 kg), fat mass (-0.1 to -0.9 kg), muscle strength (8.0-19%), functional muscle power (8.6%) and functional capacity (12-14%). Conclusions: The following key themes emerged from this thesis and may be used to guide clinical practice guidelines and future research: 1) Men treated with ADT for PCa had greater amounts of fat when compared to non-ADT counterparts, 2) Current definitions of sarcopenia and sarcopenic obesity were limited in men treated with ADT for PCa, 3) The greater amounts of fat observed in men treated with ADT for PCa tended to be stored in subcutaneous depots and supersede age-related plateaus/losses, 4) The recruitment of men treated with ADT for PCa into a lifestyle intervention was challenging, and 5) Men treated with ADT for PCa tended to respond positively to a multi-modal exercise training combined with multi-nutrient supplementation.

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Quality of life issues in men undergoing androgen deprivation therapy: a review

Cited by 59 publications

References 98 publications

Patients receiving androgen deprivation therapy for prostate cancer have an increased risk of depressive disorder

Patients receiving androgen deprivation therapy for prostate cancer have an increased risk of depressive disorder

Luteinizing Hormone–Releasing Hormone Agonists: A Quick Reference for Prevalence Rates of Potential Adverse Effects

Muscle, fat and performance during androgen deprivation for prostate cancer

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