Cardiovascular risk and bone loss in men undergoing androgen deprivation therapy for non‐metastatic prostate cancer: implementation of standardized management guidelines

Cheung, Ada S; Pattison, David A.; Bretherton, Ingrid; Hoermann, Rudolf; Joon, Daryl Lim; Ho, Emily; Jenkins, Trish; Hamilton, Emma; Bate, Katherine; Chan, Irene; Zajac, Jeffrey D; Grossmann, Mathis

doi:10.1111/j.2047-2927.2013.00093.x

Cited by 52 publications

(61 citation statements)

References 30 publications

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“…The lifetime risk of bone fractures secondary to osteoporosis is B20%. 14 Cheung et al 15 showed in an audit of 236 men that, at initiation of ADT, 11% had osteoporosis and 40% osteopenia. In addition, 61% of those with osteoporosis were unaware of it.…”

Section: Clinical Predisposing Factors For Bone Loss and Osteoporosismentioning

confidence: 99%

Androgen-deprivation therapy and bone loss in prostate cancer patients: a clinical review

Bienz¹,

Saad²

2015

BoneKEy Reports

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Androgen-deprivation therapy (ADT) has become a standard of care in the management of advanced prostate cancer or as an adjunct therapy. However, ADT is associated with a well-known deleterious effect on bone health, resulting in a decrease in bone-mass density (BMD) and increased risk for fracture. With the longer life expectancy of prostate cancer patients, improvement of the quality of life has become increasingly important. Therefore, adequate screening, prevention and treatment of BMD loss is paramount. Zoledronic acid and denosumab have shown promising results in recent studies, which has led to the Food and Drug Administration approval of these treatment options in various settings throughout the course of the disease, including the prevention of ADT-associated bone loss. This review focuses on the various parameters that impact BMD loss in men initiating ADT, on the specific effect of ADT on bone health and on various lifestyle modifications and treatment options such as bisphosphonates, osteoclast-targeted therapy and selective estrogen-receptor modulators that have shown promising results in recent studies.

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Section: Clinical Predisposing Factors For Bone Loss and Osteoporosismentioning

confidence: 99%

Androgen-deprivation therapy and bone loss in prostate cancer patients: a clinical review

Bienz¹,

Saad²

2015

BoneKEy Reports

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“…To date, only one set of guidelines [56] , which focussed on bone and metabolic outcomes of ADT, has been implemented and evaluated [220] . In a two year prospective study, 236 men with PCa commencing ADT attended a clinic visit and received diet and lifestyle advice with overweight and obese men offered referral to a dietitian [220] .…”

Section: Potential Interventions To Improve Muscle Fat and Performanmentioning

confidence: 99%

Muscle, fat and performance during androgen deprivation for prostate cancer

Owen¹

2018

Preprint

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Introduction: Prostate cancer (PCa) is one of the most frequently diagnosed male cancers worldwide. One treatment, androgen deprivation therapy (ADT), is often accompanied with a myriad of adverse effects, including those that negatively impact muscle, fat and performance outcomes. Therefore, ADT-treated men may be living longer, but are at risk of both age- and treatment-related complications. The overall aim of this thesis was to quantify outcomes of muscle, fat and performance in men treated with ADT when compared to PCa (men diagnosed with PCa, not treated with ADT) and healthy controls (men not diagnosed with PCa), and assess the feasibility of implementing a multi-component exercise program combined with protein, calcium and vitamin D supplementation (Ex+ProCaD) compared to usual care in ADT-treated men. Methods: This thesis presents two studies that form part of a larger 52-week randomised controlled trial (RCT), which examined the efficacy of Ex+ProCaD compared to usual care in men treated with ADT for PCa. The first study presented was a nested cross-sectional study performed parallel to the baseline assessment of the RCT and examined differences in muscle, fat and performance outcomes between men treated with ADT when compared to PCa and healthy controls. The second study presented examined the feasibility of implementing the first 26 weeks of the RCT. Results: The cross-sectional study showed that height, weight, body mass index and diet were similar between the three groups, but ADT-treated men were four years older and tended to be less physically active (23-30%; P=0.054). After adjusting for age and physical activity, total body fat mass was 3.3-5.0 kg (P < 0.05) greater in men treated with ADT compared to PCa controls, but there was no difference in total body and regional lean mass. When adiposity was considered, ADT-treated men had 10-12% (P < 0.05) lower appendicular lean mass adjusted for body mass index and 5.6-6.4% (P < 0.05) lower forearm percent muscle cross-sectional area compared to controls. Absolute muscle strength was similar between groups, but when expressed relative to body weight, men treated with ADT had 13-21% (P < 0.05) lower muscle strength compared to controls. Whilst only two ADT-treated men had sarcopenia, these men had a higher proportion (P < 0.001) of pre-sarcopenia when appendicular lean mass was adjusted for body mass index (42%) compared to PCa (15%) and healthy (7%) controls. Men treated with ADT had 15-36% (P < 0.05) greater storage of fat within subcutaneous depots when compared to controls, whereas visceral and intermuscular fat was similar. The majority of subcutaneous fat depots (excluding android region) were shown to be positively associated with ADT duration (P < 0.05). Forearm muscle density was shown to negatively correlate with ADT duration (P < 0.05). The RCT had a high participant retention rate (96%). Adherence was high for the supplement (mean, 92-93%) and modest for the exercise program (mean, 60%). A relatively high proportion (81%) of men in the intervention group reported an adverse event, although only 16% were confirmed to be related to the intervention and the vast majority (97%) were determined to be mild or moderate in terms of severity. Across the ten separate recruitment pathways considered, clinician referral (43%) and PCa support groups (29%) yielded the greatest proportion of enrolled participants. A total of 149 potential participants were screened, which resulted in 42 participants at the time of write up for this thesis. Among the first 28 participants to complete the 26-week intervention, 21-50% were unable to complete at least one measure of muscle strength due to pre-existing comorbidities. Data from the initial 28 participants tended to show that when compared to usual care, Ex+ProCaD led to net improvements in lean mass (0.2-1.4 kg), fat mass (-0.1 to -0.9 kg), muscle strength (8.0-19%), functional muscle power (8.6%) and functional capacity (12-14%). Conclusions: The following key themes emerged from this thesis and may be used to guide clinical practice guidelines and future research: 1) Men treated with ADT for PCa had greater amounts of fat when compared to non-ADT counterparts, 2) Current definitions of sarcopenia and sarcopenic obesity were limited in men treated with ADT for PCa, 3) The greater amounts of fat observed in men treated with ADT for PCa tended to be stored in subcutaneous depots and supersede age-related plateaus/losses, 4) The recruitment of men treated with ADT for PCa into a lifestyle intervention was challenging, and 5) Men treated with ADT for PCa tended to respond positively to a multi-modal exercise training combined with multi-nutrient supplementation.

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“…As many as 40% of patients suffer from osteopenia, and 11% -from osteoporosis [29], even before the beginning of hormonal treatment. Prostate cancer usually affects older patients and the loss of bone mass is related to the normal physiological ageing process.…”

Section: Osteoporosismentioning

confidence: 99%

Systemic complications in the hormonal treatment of prostate and breast cancer

Jagielska

Poniatowska²,

Tałasiewicz³

et al. 2017

Nowotwory. Journal of Oncology

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Oncological treatment is often associated with a wide range of adverse effects. The article focuses on systemic complications that may occur during the hormonal therapy of prostate and breast cancer. Considering that current treatments are increasingly effective, the number of patients suffering from early and remote complications of cancer therapy can be expected to rise. Many undergo radical treatment and in this group in particular, close attention should be paid to the prevention, early diagnosis, and treatment of adverse effects. Hormonal disorders and their complications considerably affect the quality of life and life expectancy by upsetting general systemic homeostasis. NOWOTWORY J Oncol 2017; 67, 3: 206-214

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Cardiovascular risk and bone loss in men undergoing androgen deprivation therapy for non‐metastatic prostate cancer: implementation of standardized management guidelines

Cited by 52 publications

References 30 publications

Androgen-deprivation therapy and bone loss in prostate cancer patients: a clinical review

Androgen-deprivation therapy and bone loss in prostate cancer patients: a clinical review

Muscle, fat and performance during androgen deprivation for prostate cancer

Systemic complications in the hormonal treatment of prostate and breast cancer

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