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Clinical Research

Long-term effects of intermittent androgen suppression therapy on lean and fat mass: a 33-month prospective study

Prostate Cancer and Prostatic Diseases volume 16, pages 67–72 (2013)Cite this article

Subjects

Abstract

Background:

To examine changes to whole body and regional lean mass (LM) and fat mass (FM) over 33 months of intermittent androgen suppression therapy (IAST).

Methods:

Phase II cohort study of 72 prostate cancer patients without metastatic bone disease. Patients received flutamide 250 mg tid and leuprolide 22.5 mg three monthly depot for the 9-month initial treatment phase (iTREAT), at which point patients ceased therapy providing PSA <4 ng ml−1 with continued monitoring for further 2 years (POST). AST was recommenced when PSA exceeded pretreatment level or ⩾20 ng ml−1. Body composition was assessed using dual energy X-ray absorptiometry at baseline, completion of treatment phase, and 1 and 2 years post treatment phase (months 21 and 33).

Results:

LM decreased by 1.3 kg and FM increased by 2.3 kg (P<0.001) following iTREAT. During the POST period, there were no further adverse effects on LM or FM, but also no recovery to pretreatment levels. Patients who failed to recover testosterone by month 33 experienced a significant increase in FM compared with those who recovered eugonadal levels of testosterone (10 nmol ml−1; P=0.019). Change in testosterone was moderately correlated to changes in % FM (r=−0.314, P<0.028) and LM (r=0.300, P<0.036) during POST phase. Waist circumference progressively increased over time and by 2 years, POST had not recovered to baseline levels.

Conclusions:

Loss of LM and gain in FM during the 9-month iTREAT was not reversed during 2-year POST, although further deterioration was not observed. Subgroup analysis identified those recovering testosterone showed some body composition improvements. These findings suggest potential benefits of IAST, where testosterone levels are able to recover, to reduce the ongoing adverse effects on body composition, such as the acceleration of sarcopenia and risks associated with metabolic disease.

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Acknowledgements

We would like to thank Abbott Australasia and Schering-Plough for their financial support in running the study. DAG is funded by a Movember New Directions Development Award obtained through Prostate Cancer Foundation of Australia’s Research Program. We would also like to thank the Genito Urinary Oncology Group NSW and Urology Research Centre Perth for their support and direction, Spry JI and Leutenegger S (Perth) for data management and additional analysis, and the following doctors from Perth who contributed patients to the study: Joseph D, Rowling C, Stanley J, Low A, Vivian J, Cassidy B, Chelvanayagam D, Davies R, Harper CS, Hill I, La Bianca S, Mander J, McRae P, Shannon T and Weinstein S.

Clinical Trial Registry: a phase II study to assess the effect of intermittent androgen blockade in the treatment of advanced prostate cancer; ACTRN12608000170325; http://www.ANZCTR.org.au/ACTRN12608000170325.aspx

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Authors and Affiliations

  1. Department of Radiation Oncology, Sir Charles Gairdner Hospital, Nedlands, Australia

    N A Spry

  2. Faculty of Medicine, University of Western Australia, Nedlands, Australia

    N A Spry

  3. Edith Cowan University Health and Wellness Institute, School of Exercise and Health Sciences, Edith Cowan University, Joondalup, Australia

    N A Spry, D R Taaffe, C Peddle-McIntyre, M K Baker, R U Newton & D A Galvão

  4. School of Environmental and Life Sciences, University of Newcastle, Ourimbah, Australia

    D R Taaffe

  5. Western Urology, Leederville, Australia

    P J England

  6. Department of Urology, Joondalup Health Campus Hospital, Joondalup, Australia

    J S Judge

  7. Department of Urology, St John of God Hospital, Murdoch, Australia

    D A Stephens

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Correspondence to D A Galvão.

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Spry, N., Taaffe, D., England, P. et al. Long-term effects of intermittent androgen suppression therapy on lean and fat mass: a 33-month prospective study. Prostate Cancer Prostatic Dis 16, 67–72 (2013). https://doi.org/10.1038/pcan.2012.33

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