Background Androgen deprivation therapy (ADT) can decrease the physical performance (PP) of older men with prostate cancer (PC). Methods We conducted a three-arm randomized pilot study (n = 19) comparing a home-based walking and resistance intervention (EXCAP) and a technology-mediated walking and resistance intervention using Wii-Fit to a usual-care-arm in men ≥ 70 years with PC receiving ADT. The intervention lasted for 6-weeks, with follow-up at 12-weeks. The primary pre-specified outcome was change in Short Physical Performance Battery (SPPB) score. Mixed effects regression models were used to assess change in outcomes over time. Results Mean participant age was 70 years (range: 67-93). Eight patients were randomized to the Wii-Fit-arm, 6 to EXCAP-arm, and 5 to usual-care-arm. SPPB scores remained nearly constant in the usual-care-arm (β=−0.12; p=0.79), while individuals in the EXCAP-arm had on average a 1.2 point increase at each follow-up (β=1.20; 95% CI: 0.36, 2.06). The Wii-fit-arm had a non-significant increase in SPPB score over time relative to usual-care (β=0.32; 95% CI −0.43,1.06; p=0.46). Individuals in the EXCAP-arm had an increase in steps per day over time compared to the usual-care-arm (p-value = 0.006); the EXCAP-arm had an increase of 2720 steps (95% CI: 1313, 4128) while the usual-care-arm had an increase of 97 steps (95% CI: −1140, 1333). Participants in the Wii-Fit-arm had an increase of 1020 steps (95% CI: −474, 1238, p=0.710). Other outcomes (i.e., handgrip strength, lean muscle mass, and chest press repetitions) were not statistically significant. Conclusions A home-based aerobic and resistance exercise program, EXCAP, shows promise for improving PP in older men with PC on ADT.

Objectives Early androgen deprivation therapy (ADT) has no proven survival advantage in older men with biochemical recurrence (BCR) of prostate cancer (PCa), and it may contribute to geriatric frailty; we tested this hypothesis. Methods We conducted a case-control study of men aged 60+ with BCR on ADT (n=63) versus PCa survivors without recurrence (n=71). Frailty prevalence, “obese” frailty, Short Physical Performance Battery (SPPB) scores and falls were compared. An exploratory analysis of frailty biomarkers (CRP, ESR, hemoglobin, albumin, and total cholesterol) was performed. Summary statistics, univariate and multivariate regression analyses were conducted. Results More patients on ADT were obese (BMI >30; 46.2% vs. 20.6%; p=0.03). There were no statistical differences in SPPB (p=0.41) or frailty (p=0.20). Using a proposed “obese” frailty criteria, 8.7% in ADT group were frail and 56.5% were “prefrail”, compared with 2.9% and 48.8% of controls (p=0.02). Falls in the last year were higher in ADT group (14.3% vs. 2.8%; p=0.02). In analyses controlling for age, clinical characteristics, and comorbidities, the ADT group trended toward significance for “obese” frailty (p = 0.14) and falls (OR = 4.74, p = 0.11). Comorbidity significantly increased the likelihood of “obese” frailty (p=0.01) and falls (OR 2.02, p = 0.01). Conclusions Men with BCR on ADT are frailer using proposed modified “obese” frailty criteria. They may have lower performance status and more falls. A larger, prospective trial is necessary to establish a causal link between ADT use and progression of frailty and disability.

OBJECTIVES: Ethnic minorities are disproportionately impacted by prostate cancer (PCa) and are at risk for not receiving informed decision making (IDM). We conducted a systematic literature review on interventions to improve: (1) IDM about PCa in screeningeligible minority men, and (2) quality of life (QOL) in minority PCa survivors. DATA SOURCES: MeSH headings for PCa, ethnic minorities, and interventions were searched in MED-LINE, Cochrane Database of Systematic Reviews, Cochrane Central Register of Controlled Trials, CINAHL, and PsycINFO. SUBJECT ELIGIBILITY CRITERIA: We identified U.S.-based, English-language articles (1985-2010) on interventions to improve PCa IDM and QOL that included 50 % or more minority patients or analyses stratified by race/ethnicity. STUDY APPRAISAL AND SYNTHESIS METHODS:Articles (n=19) were evaluated and scored for quality using a Downs and Black (DB) system. Interventions were organized by those enhancing 1) IDM about PCa screening and 2) improving QOL and symptom among PCa survivors. Outcomes were reported by intervention type (educational seminar, printed material, telephonebased, video and web-based). RESULTS: Fourteen studies evaluated interventions for enhancing IDM about PCa screening and five evaluated programs to improve outcomes for PCa survivors. Knowledge scores were statistically significantly increased in 12 of 13 screening studies that measured knowledge, with ranges of effect varying across intervention types: educational programs (13 %-48 % increase), print (11 %-18 %), videotape/DVD (16 %), and web-based (7 %-20 %). In the final screening study, an intervention to improve decision-making about screening increased decisional self-efficacy by 9 %. Five cognitive-behavioral interventions improved QOL among minority men being treated for localized PCa through enhancing problem solving and coping skills. LIMITATIONS: Weak study designs, small sample sizes, selection biases, and variation in follow-up intervals across studies. CONCLUSIONS: Educational programs were the most effective intervention for improving knowledge among screening-eligible minority men. Cognitive behavioral strategies improved QOL for minority men treated for localized PCa.

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