Association of Body Composition With Survival and Treatment Efficacy in Castration-Resistant Prostate Cancer

Abstract

Objectives: The association of body composition with survival and the efficacy of first-line treatment was investigated in patients with castration-resistant prostate cancer (CRPC). Methods: The records of CRPC patients treated with docetaxel or androgen receptor signaling inhibitors (ARSi) between 2005 and 2018 were reviewed. Skeletal muscle index (SMI), visceral fat index, and subcutaneous fat index were evaluated using pretreatment computed tomography images. Results: Of 230 eligible patients, 144 received docetaxel, and 86 received ARSi as the first-line treatment for CRPC. The SMI hi (based on median values) group had higher prostate-specific antigen (PSA) progression-free survival (median 13.5 vs. 8.3 months, p = 0.030), radiologic progression-free survival (14.9 vs. 9.1 months, p < 0.001), and overall survival (24.1 vs. 16.9 months, p = 0.015) than the SMI lo group. In docetaxel-treated patients, the SMI hi group had higher PSA progression-free survival (13.5 vs. 5.9 months, p = 0.016) and radiologic progression-free survival (14.6 vs. 6.7 months, p < 0.001) than the SMI lo group. However, PSA progression-free survival and radiologic progression-free survival were comparable between the two groups in ARSi-treated patients. SMI was independently associated with the risk of radiologic progression in patients treated with docetaxel but not in those treated with ARSi. Conclusions: High skeletal muscle mass may be associated with reduced risk of disease progression and mortality in patients with CRPC. However, the significance of these relationships is limited in patients treated with docetaxel. These results suggest that assessing skeletal muscle mass may be worthwhile when selecting treatments for CRPC; however, further prospective validation and large-scale studies are needed.

CT‐based assessment of body composition following neoadjuvant chemohormonal therapy in patients with castration‐naïve oligometastatic prostate cancer

“…It has been suggested that higher body fat composition is associated with improved survival in oncologic patients, possibly due to energy metabolism and better distribution and tolerance to chemotherapeutic agents. 20 The association of body composition with efficacy of first-line treatment and survival outcome in prostate cancer have been investigated in several studies, [5][6][7][8][9][10]21,22 predominantly in patients with castration-resistant metastatic disease, as well as three studies on patients with localized disease. 10,21,22 A detailed summary of these studies is provided in Table 3.…”

“…10,21,22 A detailed summary of these studies is provided in Table 3. [5][6][7][8][9][10]21,22 In almost all related studies except one, 23 the body composition was assessed at baseline (before the initiation of therapy). Thus, the effects of percentage change in body composition following therapy and survival outcomes remain to be evaluated.…”

“…21 Although the findings remain controversial, most studies on patients with castration-resistant prostate cancer showed high skeletal muscle mass, PMI, and subcutaneous fat index at the time of diagnosis of castration-resistant disease are associated with the efficacy of docetaxel treatment and higher progression-free and cancer-specific survival. 5,9 High pretreatment visceral to subcutaneous fat ratio has been shown to be associated with poor prognosis. 7,8 Published data on patients with metastatic hormone-naïve prostate cancer are limited to a recent retrospective study 11 and an abstract.…”

“…4 In recent years, several studies on castration-resistant prostate cancer patients have investigated the prognostic value and impact of body composition on disease progression and clinical outcomes, particularly in those who have received docetaxel or androgen deprivation therapy (ADT) as first-line treatment. [5][6][7][8][9][10] Data on the effect of neoadjuvant chemohormonal therapy on body composition and outcomes in patients with early-stage or oligometastatic castration-sensitive prostate cancer is scarce. 11,12 This study aims to assess the changes in body composition of recently diagnosed oligometastatic prostate cancer patients following neoadjuvant chemohormonal therapy with docetaxel and ADT.…”

Potential Role of Exercise Induced Extracellular Vesicles in Prostate Cancer Suppression

“…Exercise or physical activity has been receiving attention in patient care in the oncology setting (5) due to the increasing body of research in the field of exercise oncology. Multiple epidemiological studies (6,7) and clinical trials (8)(9)(10) consistently report improvements in health-related outcomes for PCa patients. In addition, preclinical murine model studies have also demonstrated a reduced PCa tumor volume and delayed tumor growth with an exercise stimulus (11,12), and provide a strong mechanistic case for clinical trials to be tested on cancer outcomes.…”