The clinical relevance of adiposity when assessing muscle health in men treated with androgen deprivation for prostate cancer

Abstract

BackgroundAndrogen deprivation therapy (ADT) for prostate cancer (PCa) may prospectively decrease absolute lean mass (LM) and increase absolute fat mass (FM). Given that estimates of LM by dual‐energy X‐ray absorptiometry may be overestimated in obese people, this study examined the influence of adiposity on muscle health in men treated with ADT for PCa.MethodsThis cross‐sectional study examined the influence of adiposity on total and appendicular LM (ALM), muscle cross‐sectional (CSA), and muscle strength in 70 men treated with ADT [mean (standard deviation) age, 71 (6) years] for PCa compared with age‐matched PCa (n = 52) and healthy controls (n = 70). Total body LM, FM and ALM, and 66% tibia and radius muscle CSA were quantified by dual‐energy X‐ray absorptiometry and peripheral quantitative computed tomography, respectively. ALM was further divided by height (m2) or body mass index, with muscle CSA expressed as a per cent of total limb CSA. Upper and lower body and back (three‐repetition maximum and dynamometry) muscle strength were expressed per kilogram of body weight.ResultsOn average, ADT‐treated men had 4.4–6.4 kg greater FM compared with controls (P ≤ 0.014) and there were no differences in total body or ALM. Total body per cent LM and ALMBMI were 3.8–5.4% (P ≤ 0.001) and 7.8–9.4% (P ≤ 0.001) lower, respectively, in ADT‐treated men compared with both controls. Percentage muscle CSA at both sites and muscle strength (except leg) were 3.0–6.0% (P ≤ 0.031) and 15–17% (P ≤ 0.010) lower, respectively, in ADT‐treated men compared with both controls.ConclusionsThe findings from this study indicate muscle mass, size, and strength are compromised in men treated with ADT after accounting for their increased adiposity or body size.

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

“…This cross-sectional study was conducted parallel to baseline of a randomised controlled trial [27][28][29] and included 70 men treated with pharmacological (surgical orchiectomy excluded) ADT (with or without prior chemotherapy) for PCa, 52 PCa controls (diagnosed and/or treated with non-ADT therapies currently or previously) and 70 healthy controls (not diagnosed with PCa). Eligible participants were men aged 50-85 years.…”

Skeletal Muscle–Adipose Tissue–Tumor Axis: Molecular Mechanisms Linking Exercise Training in Prostate Cancer

“…In fact, both CiC and obesity share several underlying mechanisms that lead to severe skeletal muscle atrophy [ 106 ]. Concurrent gain of WAT and loss of skeletal muscle also occur during ADT [ 107 , 108 ], highlighting not only the importance of maintaining the skeletal muscle quality but also the clinical significance of adiposity, irrespective of CiC.…”

“…Studies conducted in PCa patients have shown that ET is an important strategy that can be used to mitigate PCa-related clinical features, such as lower circulating glucose and insulin levels, increased adipose tissue mass, and whole-body inflammatory markers as well as improving hormonal levels [ 15 , 16 , 108 ]. Furthermore, the impact of ET in skeletal muscle was observed by inducing phenotypic alterations mediated by transcriptional responses that occur during and following an exercise session [ 7 ].…”

Bone Health in Men with Prostate Cancer: Review Article

“…Another important consequence of exposure to ADT is sarcopenia, a degenerative loss of muscle mass that is in turn associated with frailty and increased falls risk [69]. When combined with the effects of ADT on BMD, these patients are at an even higher fracture risk with potentially lifethreatening complications [70].…”