Supervised Physical Training Enhances Muscle Strength but Not Muscle Mass in Prostate Cancer Patients Undergoing Androgen Deprivation Therapy: A Systematic Review and Meta-Analysis

Abstract

Introduction: Androgen deprivation therapy (ADT) is considered the basic treatment for advanced prostate cancer, but it is highly associated with detrimental changes in muscle mass and muscle strength. The aim of this meta-analysis was to investigate the effects of supervised physical training on lean mass and muscle strength in prostate cancer patients undergoing ADT. Methods: A systematic literature search was performed using MEDLINE, Embase, and ScienceDirect until October 2018. Only studies that examined both muscle mass and strength in prostate cancer patients undergoing ADT were included. Outcomes of interest were changes in lean body mass (surrogate for muscle mass) as well as upper and lower body muscle strength. The meta-analysis was performed with fixed-effects models to calculate mean differences between intervention and no-training control groups. Results: We identified 8,521 publications through the search of the following key words: prostate cancer, prostate tumor, prostate carcinoma, prostate neoplasm, exercise, and training. Out of these studies, seven randomized controlled trials met the inclusion criteria and where included in the analysis. No significant mean differences for changes in lean mass were observed between the intervention and control groups (0.49 kg, 95% CI: −0.76, 1.74; P = 0.44). In contrast, the mean difference for muscle strength was significant both in chest (3.15 kg, 95% CI: 2.46, 3.83; P < 0.001) and in leg press (27.46 kg, 95% CI: 15.05, 39.87; p < 0.001). Conclusion: This meta-analysis provides evidence that low- to moderate-intensity resistance and aerobic training is effective for increasing muscle strength but may not be sufficient to affect muscle mass in prostate cancer patients undergoing ADT. The underlying mechanisms for this maladaptation may in part be explained by an insufficient stimulus induced by the training regimens as well as a delayed initiation of training in relation to the start of ADT. When interpreting the present findings, one should bear in mind that the overall number of studies included in this review was rather low, emphasizing the need for further studies in this field.

Transgender Women in the Female Category of Sport: Perspectives on Testosterone Suppression and Performance Advantage

“…Testosterone levels are typically reduced to castrate levels, and the loss of lean mass has typically ranged between − 2 and − 4% per year [ 77 ], consistent with the findings described previously in transgender women. A recent meta-analysis concluded that exercise interventions including resistance exercise were generally effective for maintaining muscle mass and increasing muscle strength in prostate cancer patients undergoing androgen deprivation therapy [ 94 ]. It is important to emphasize that the efficacy of the different training programs may vary.…”

What is the minimal dose for resistance exercise effectiveness in prostate cancer patients? Systematic review and meta-analysis on patient-reported outcomes

“…The terms used were: 'prostate cancer' and 'resistance training' in association with a list of sensitive terms (Supplementary Material Table S1). In addition, we also performed a manual search of the reference lists provided in the selected papers as well as previous systematic reviews and meta-analytic studies in patients with prostate cancer [14][15][16][17][18][19] to detect studies potentially eligible for inclusion.…”

“…This is important given the role of resistance exercise to counter treatment-related toxicities in men with prostate cancer [2,12]. Furthermore, despite several systematic reviews examining exercise effects in prostate cancer patients [14][15][16][17][18][19], none have addressed the minimal exercise dosage required for improvements in common patient-reported outcomes.…”

Does Physical Activity Regulate Prostate Carcinogenesis and Prostate Cancer Outcomes? A Narrative Review

“…A possible explanation for such discrepancy may be related to testosterone suppression. In fact, testosterone is the most important androgen that controls muscle protein synthesis; thus, in such patients the muscle growth induced by intensive training is abolished too [64].…”