The Adverse Effects of Androgen Deprivation Therapy in Prostate Cancer and the Benefits and Potential Anti-oncogenic Mechanisms of Progressive Resistance Training

Abstract

Prostate cancer has the second highest incidence of all cancers amongst men worldwide. Androgen deprivation therapy (ADT) remains a common form of treatment. However, in reducing serum testosterone to castrate levels and rendering men hypogonadal, ADT contributes to a myriad of adverse effects which can affect prostate cancer prognosis. Physical activity is currently recommended as synergistic medicine in prostate cancer patients to alleviate the adverse effects of treatment. Progressive resistance training (PRT) is an anabolic exercise modality which may be of benefit in prostate cancer patients given its potency in maintaining and positively adapting skeletal muscle. However, currently, there is a scarcity of RCTs which have evaluated the use of isolated PRT in counteracting the adverse effects of prostate cancer treatment. Moreover, although physical activity in general has been found to reduce relapse rates and improve survival in prostate cancer, the precise anti-oncogenic effects of specific exercise modalities, including PRT, have not been fully established. Thus, the overall objective of this article is to provide a rationale for the in-depth investigation of PRT and its biological effects in men with prostate cancer on ADT. This will be achieved by (1) summarising the metabolic effects of ADT in patients with prostate cancer and its effect on prostate cancer progression and prognosis, (2) reviewing the existing evidence regarding the metabolic benefits of PRT in this cohort, (3) exploring the possible oncological pathways by which PRT can affect prostate cancer prognosis and progression and (4) outlining avenues for future research.

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“…Most prostate cancer patients do not have obvious early symptoms, often in the physical examination accidentally found [ 15 ]. Worse, when prostate cancer progresses, surgical resection is no longer beneficial, due to its high recurrence; however, chemoradiotherapy has no significant effect on improving the prognosis of patients, and chemoradiotherapy has strong side effects [ 16 ]. In conclusion, targeted therapy is the most effective treatment for prostate cancer.…”

Resistance to Antiandrogens in Prostate Cancer: Is It Inevitable, Intrinsic or Induced?

“…However, such long-term use of hormone activity manipulators seems to be having undesirable effects in a number of health areas, including but not limited to libido [ 185 ]: around 15,000 post-finasteride adverse effects at a clinically relevant level have been reported to an online forum (pfsfoundation.org), perhaps implying a more widespread relevance of androgen signaling in man than just in the prostate, although the recent re-evaluation of the PCPT trial largely refuted a finasteride-based mechanism for these effects [ 182 ]. As the number of patients on long-term maintenance of prostate cancer remission with ADT increases, more evidence accumulates about potential physical effects of androgen suppression, including decreases in bone mineral density, metabolic changes such as weight gain, decreased muscle mass, and increased insulin resistance, decreased libido and sexual dysfunction, hot flashes, gynecomastia, reduced testicle size, anemia, and fatigue [ 186 ].…”

The management of sexual dysfunction resulting from radiotherapy and androgen deprivation therapy to treat prostate cancer: A comparison of uro‐oncology practice according to disease stage

“…Rates of implantation after prostate cancer treatment remain low despite high levels of satisfaction. 52 53,54 Simple measures can improve mental health and confidence, giving men a more positive outlook on rehabilitation. One study of men undergoing ADT, observed significantly higher levels of sexual interest in those who underwent a 12-week exercise programme.…”