Staying Strong and Healthy: Minimizing Cardiovascular and Metabolic Effects of Androgen Deprivation Therapy: A Study in Transition

Abstract

Medical Center ver the past decade, use of androgen deprivation therapy (ADT) to treat prostate cancer has risen seven-fold, from 9.8% of patients in 1989-1992 to 74.6% in 1991-2001 (1). ADT is used as neoadjuvant and adjuvant treatment with radiation therapy (RT), to treat recurrence following primary treatment with surgery or RT, or when the cancer is in an advanced stage at diagnosis. While ADT has demonstrated survival benefits, it also is associated with increases in metabolic and cardiovascular risks. Men receiving ADT have been shown to develop dyslipidemia, decreased arterial compliance, increased insulin resistance, weight gain with increased visceral fat deposition, decreased bone mineral density, decreased libido and erectile dysfunction, fatigue, cognitive changes and depression (1-12)

Assessing the nutritional needs of men with prostate cancer

“…Reported reduction in lipid lowering and BP medication. Reported improvements in perceived stress and QOL.Takada [54]Group educationDietNRCTTo evaluated the efficacy of nutrition education on changes in daily rectal volume and dose during IMRT treatment.Patients who attended the nutrition education session had decreased variations in rectal volume and treatment dose compared to controls resulting in more reproducible results.Ongoing clinical trials:Goulart [55]Group educationDiet and exerciseRCTTo evaluate the multidisciplinary Living Well on Androgen Deprivation Therapy program on QoL, physical factors and biomarkers of secondary diseases in men with PC on ADT.N/AKellogg Parsons [56]Individual counsellingDietRCTTo assess the impact of a telephone based dietary intervention on disease progression in men with PC on active surveillance.N/AMcArdle [57]Individual counsellingDiet and exerciseRCTTo assess the feasibility of a nutrition and exercise counselling intervention on reducing the incidence of metabolic syndrome in men with PC on ADT.N/AMaliski [58]Individual counsellingDiet and exerciseRCTTo assess if counselling on lifestyle changes in addition to standard medical care can prevent heart problems and diabetes in men with PC on ADT.N/ALee [59]Home-basedComprehensive programRCTTo assess if the efficacy of a web and mobile based lifestyle intervention on physical function, strength, body composition and QoL.N/AAggarwal [49]Individual counsellingComprehensive programRCTTo assess if individualized counselling helps improve patient understanding, satisfaction, quality of life and anthropometrics.Abbreviations: ADT Androgen deprivation therapy, NRCT Non-randomized controlled trial, QOL Quality of life, RCT Randomized, controlled trial, PC Prostate cancer, WC Waist circumference, BP Blood pressure, IMRT Intensity-modulated radiotherapy. Grey shading indicates secondary analysis of a study that was also captured in the scoping review and were therefore not considered when calculating the type and focus of interventions…”