The clinical importance of quantifying body fat distribution during androgen deprivation therapy for prostate cancer

Abstract

Androgen deprivation therapy (ADT) is now considered a mainstay in the treatment of metastatic and locally advanced prostate cancer (PCa). Despite well-established benefits of ADT in relation to overall survival, this treatment has been associated with a number of adverse effects, particularly with regard to key cardiometabolic risk factors including the development of insulin resistance, dyslipidemia and increases in total and regional fat mass. In non-ADT populations, increased levels of visceral adipose tissue (VAT) are thought to be a key mediator of the increased cardiometabolic risk associated with weight gain, but this has received limited attention in men treated with ADT. VAT is best assessed using tools such as computed tomography or magnetic resonance imaging; however, these tools are not readily accessible for the majority of researchers or clinicians. Recent advances allow for a method of estimating VAT using a whole-body dual-energy X-ray absorptiometry (DXA) scan that shows promise as a practical tool for researchers to evaluate changes in body fat distribution during ADT. The aim of this narrative review is to (1) review the available evidence with regard to the relationship between ADT and cardiometabolic risk; (2) discuss the role of body fat distribution on cardiometabolic risk in non-ADT populations, with a particular emphasis on the importance of visceral adiposity; (3) examine the potential influence of ADT on body fat distribution and visceral adiposity and (4) provide an overview of current tools used to measure changes in body fat distribution in men treated with ADT, highlighting the potential utility of a recently developed DXA-derived measure of VAT.

Significant Associations Between Sun Exposure and Adiposity Were Not Observed in Breast and Prostate Cancer Patients in a Cross‐sectional Analysis

“…Suggested causes include the onset of premature menopause during treatment, predisposing women toward weight gain . Our results suggest that female participants had lower abdominal obesity (measured by waist‐hip ratio), and higher body fat percentage (measured by DXA) compared with male participants, which is consistent with known sex differences in fat distribution between men and women , the older age of the men and the use of androgen‐deprivation therapy to treat prostate cancer .…”

“…The risk of developing obesity is increased in breast and prostate cancer patients compared to the general population, and may be exacerbated by the effects of cancer treatments . Indeed, several studies have reported weight gain as a common phenomenon among breast cancer patients and survivors .…”

“…Individuals with breast or prostate cancer are at increased risk of developing obesity, compared to the general population (16)(17)(18). This may be caused by the modes of action of some cancer treatments, such as chemotherapy, surgery and radiotherapy for breast cancer (18) and hormonal treatments in both breast and prostate cancer (19). The aim of the present study was to examine the relationship between time spent outdoors (as a proxy for sun exposure) and adiposity in a convenience cohort of adults diagnosed with breast or prostate cancer.…”

Muscle, fat and performance during androgen deprivation for prostate cancer

“…total, regional and intramuscular fat mass [216] . For instance, potential increases in subcutaneous and visceral fat may contribute to the marked increase in cardiometabolic disorders in men treated with ADT [20,56,217] .…”

“…However, the high cost of CT and MRI scan acquisition and data processing, complications with claustrophobic and severely obese individuals (body mass index [BMI] ≥ 40 kg/m 2 ), and in the case of CT, high exposure to ionising radiation [76,111] , may in part explain why these techniques are less commonly used in the research setting. Advancements in the precision and availability of dual-energy xray absorptiometry (DXA) [118,119] and peripheral quantitative CT (pQCT) [117] for quantifying regional fat mass and CSA have led to suggestions that these measures may have the potential to be of clinical importance with regard to risk stratification and clinical decision making in men treated with ADT [216] .…”