The prognostic value of sarcopenia in patients with prostate cancer: a systematic review

Abstract

Purpose of review Sarcopenia is known to affect perioperative and oncologic outcomes in patients with different urological malignancies. Nevertheless, the use of pretreatment sarcopenia as a predictor of clinical outcomes in patients with prostate cancer is still poorly studied. Therefore, we aimed to conduct a systematic review summarizing the available evidence and identifying the prognostic value of sarcopenia in prostate cancer patients. Recent findings Sarcopenia was not predictive of biochemical recurrence in patients treated with radical prostatectomy. However, it was associated with worse long-term survival outcomes as well as the likelihood of developing postoperative complications after radical prostatectomy. In the context of radiotherapy, sarcopenia was a predictive factor for overall survival. In patients with hormone-sensitive prostate cancer treated with androgen deprivation, sarcopenia was associated with overall and cancer-specific survival. In patients with castration-resistant prostate cancer, sarcopenia was associated with poorer tolerance to docetaxel-based chemotherapy. Summary Most studies found sarcopenia to be a predictor for worse perioperative and oncologic outcomes in patients treated with radical surgery, radiotherapy, or systemic therapy for prostate cancer. However, there is significant heterogeneity across the studies in terms of sarcopenia definition. For a better understanding of the prognostic value of sarcopenia in patients with prostate cancer, large-scale prospective studies are needed.

Bioimpedance phase angle and sarcopenia in older patients with prostate cancer

“…The study group included a wide range of patients; for example, those who were taking androgen deprivation therapy at the time of enrollment, those who had undergone surgery as well as hormone therapy, and those who had previously completed hormone therapy. The presence of sarcopenia in patients with prostate cancer has been reported to result in worse perioperative outcomes after radical prostatectomy 28 . In addition, patients with sarcopenia and prostate cancer experience shorter survival after radiation therapy 28,29 .…”

“…28 In addition, patients with sarcopenia and prostate cancer experience shorter survival after radiation therapy. 28,29 Moreover, although controversial, those with sarcopenia appear to show a poor response to chemotherapy and more side effects. 28 The sarcopenic population also has falls and sustains bone fractures more frequently, 4 which are associated with poor outcomes.…”

“…28,29 Moreover, although controversial, those with sarcopenia appear to show a poor response to chemotherapy and more side effects. 28 The sarcopenic population also has falls and sustains bone fractures more frequently, 4 which are associated with poor outcomes. Therefore, early prediction of sarcopenia in patients with prostate cancer is important.…”

Opportunistic skeletal muscle metrics as prognostic tools in metastatic castration-resistant prostate cancer patients candidates to receive Radium-223

“…The occurrence of sarcopenia has also been related to the increased risk of postsurgical complications [ 43 ] and systemic treatment toxicity [ 44 ], leading to the notion that assessing the sarcopenic status before treatment may guide customised strategies and support tailored treatment decision-making. A robust prognostic impact of sarcopenia has also been shown in PC, in which this condition is present in over 60% of patients [ 21 , 45 , 46 ]. However, at the later stages of the disease (i.e., in heavily pre-treated mCRPC), the prevalence of sarcopenia can be considerably increased [ 21 , 45 ].…”

Muscle wasting assessment tools for prostate cancer

“…It is therefore necessary to include muscle wasting screening as a complementary physical examination to prevent clinical outcomes that may increase mortality rates among patients with PC 9 . Muscle wasting has been consistently associated with a decrement in long-term survival, along with perioperative and oncologic complications in patients receiving radical prostatectomy, radiotherapy, or systemic therapy for PC 10 . The inclusion of muscle wasting assessment procedures as complementary screening in patients undergoing PC is fundamental for preventing morbidity and mortality risks 11 .…”