Body composition, physical function and quality of life in healthy men and across different stages of prostate cancer

Abstract

BACKGROUND: Androgen deprivation therapy (ADT) for prostate cancer (PC) has detrimental effects on physical function and quality of life (QoL), but the addition of androgen receptor signaling inhibitors (ARSI) on these outcomes is unclear. PURPOSE: To compare body composition, physical function, and QoL across progressive stages of PC and non-cancer controls (CON). METHODS: In men with hormone sensitive PC (HSPC, n=43) or metastatic castration-resistant PC (mCRPC, n=22) or CON (n=37), relative and absolute lean and fat mass, physical function (6m walk, chair stands, timed up and go [TUG], stair climb), and QoL were determined. RESULTS: Relative body composition differed amongst all groups, along with ~39% greater absolute fat mass in mCRPC vs. CON. TUG and chair stands were ~71% and ~33% slower in mCRPC compared to both CON and HSPC, whereas stair climb was ~29% and 6m walk was ~18% slower in mCRPC vs. CON. Relative body composition was correlated with physical function (r=0.259–0.385). Clinically relevant differences for mCRPC were observed for overall QoL and several subscales vs. CON, although body composition and physical function did not influence QoL. CONCLUSIONS: PC progression is associated with deteriorations in body composition and physical function. As ADT length was similar between groups, ARSI use for mCRPC likely contributed in part to these changes. Given the difficulties of improving lean mass during ADT, interventions that reduce adiposity may lessen the side effects of hormone therapy.

Body composition parameters were associated with response to abiraterone acetate and prognosis in patients with metastatic castration‐resistant prostate cancer

“…Fischer et al uncovered that skeletal muscle area of mCRPC patients exhibited a significant reduction after abiraterone or enzalutamide treatment 34 . Hanson et al demonstrated that percent lean of mCRPC was lower than HSPC 35 . However, up to date, there were no studies focusing on exploring whether body composition profiles before AA treatment could predict biochemical response to AA and prognosis in patients with mCRPC with prior chemohormonal therapy at hormone‐sensitive stage.…”

Androgen receptor pathway inhibitors, prostate cancer, and older adults: a global Young International Society of Geriatric Oncology drug review

“…Furthermore, men with mCRPC who were started on ARPis, as opposed to mCSPC patients on ADT alone, were noted to have the lowest functional performance in tasks against gravity, such as the timed up and go and stair climbing. 35 Hanson et al also noted that ADT duration was similar between mCSPC and mCRPC groups, which suggests that the addition of an ARPis contributes, in part, to further worsening of body composition and decline in physical function. Even so, changes in physical performance with ARPis like enzalutamide are not always negative and do not only impact tests against gravity.…”

“…Objective changes in physical function and body composition occur as the prostate cancer stage advances. 35 These changes may be key to understanding enzalutamide’s objective and physical consequences.…”

“…A cross-sectional analysis of previously published data on four cohorts of non-cancer controls, mCSPC, and mCRPC by Hanson et al has recently demonstrated that body composition and physical function change along the continuum of cancer, castrate sensitivity, and novel ARPi exposure. 35 Whole body dual-energy X-ray absorptiometry measured absolute and relative total fat and lean muscle mass. Physical function was evaluated using 6-meter rapid walk, five chair stands, stair climbing, and timed up and go tests.…”

“…Patients in the mCRPC cohort who had lost lean mass in Hanson et al’s study were on therapy for 6 months (std dev ± 5 months). 35 A separate Toronto cohort of mCRPC patients who had been on enzalutamide ( n = 29) for 24 months had evidence of an increase in the rate of loss of muscle mass/sarcopenia after 1 year of therapy by CT-derived Psoas Muscle Index (defined as the total contour area of the left and right psoas muscle at the inferior endplate of L3 divided by patients’ height in meters). 38 Unfortunately, how a longer duration of treatments like enzalutamide and castration status interacts with measures of body composition and physical performance remains to be determined.…”