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Assessment of body composition in the advanced stage of castration-resistant prostate cancer: special focus on sarcopenia

Prostate Cancer and Prostatic Diseases volume 23, pages 309–315 (2020)Cite this article

Subjects

Abstract

Purpose

To assess the prevalence of sarcopenia and whether body composition parameters are associated with disease progression and overall survival (OS) in castration-resistant prostate cancer (CRPC) patients.

Materials and methods

This single-centre retrospective study evaluated data of 186 consecutive patients who underwent chemohormonal therapy between 2005 and 2016 as first-line systemic treatment for CRPC. Skeletal muscle and fat indices were determined using computerized tomography data before initiation of chemotherapy. Sarcopenia was defined as SMI of <55 cm2/m2. Visceral-to-subcutaneous fat ratio and skeletal muscle volume were calculated with body composition specific areas. Harrell’s concordance index was used for predictive accuracy.

Results

A total of 154 (82.8%) patients met the criteria for sarcopenia; 139 (74.7%) individuals completed at least six cycles of docetaxel. Within a median follow-up of 24.1 months, age (HR 1.03, 95% CI 1.01–1.06, p = 0.02), high PSA (1.55, 95% CI 1.07–2.25, p = 0.02) and low skeletal muscle volume (HR 1.61, 95% CI 1.10–2.35, p = 0.02) were the only independent prognostic factor for tumor progression. Overall, 93 (50%) patients died during the follow-up period. The established prognosticator, the prechemotherapy presence of liver metastases (HR 1.32, 95% CI 1.08–1.61, p < 0.01) was associated with shorter OS. Moreover, we noted that patients with an elevated visceral-to-subcutaneous fat ratio tended to have a shorter OS (p = 0.06).

Conclusion

The large majority of men with CRPC suffers from sarcopenia. In our cohort, low skeletal muscle volume was an independent adverse prognosticator for progression of disease. We could not detect a statistically significant body composition parameter for OS, although patients with a high proportion of visceral fat had a trend for shorter OS. However, we suggest that body composition parameters determined by CT data can provide useful objective prognostic factors that may support tailored treatment decision-making.

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Acknowledgements

We would like to thank G. Poglitsch for assistance with the collection of the data.

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Author notes

  1. These authors contributed equally: Judith Stangl-Kremser, Rodrigo Suarez‐Ibarrola

Authors and Affiliations

  1. Department of Urology and Comprehensive Cancer Center, Medical University of Vienna, Vienna General Hospital Vienna, Vienna, Austria

    Judith Stangl-Kremser, Rodrigo Suarez‐Ibarrola, David D’ Andrea, Stephan M. Korn, Mario Pones, Gero Kramer & Shahrokh F. Shariat

  2. Department for Internal Medicine I-Oncology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria

    Maximilian Marhold & Michael Krainer

  3. Institute for Urology and Reproductive Health, Sechenov University, Moscow, Russia

    Dmitry V. Enikeev, Petr V. Glybochko & Shahrokh F. Shariat

  4. Department of Biomedical Imaging and Image-guided Therapy, Division of Molecular and Gender Imaging, Medical University of Vienna, Vienna, Austria

    Dietmar Tamandl & Pascal Baltzer

  5. Karl Landsteiner Institute of Urology and Andrology, Vienna, Austria

    Shahrokh F. Shariat

  6. Department of Urology, Weill Cornell Medical College, New York, NY, USA

    Shahrokh F. Shariat

  7. Department of Urology, University of Texas Southwestern Medical Center, Dallas, TX, USA

    Shahrokh F. Shariat

  8. Department of Urology, Motol Hospital, 2nd faculty of medicine, Charles University, Prague, Czech Republic

    Shahrokh F. Shariat

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  1. Judith Stangl-Kremser
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Corresponding author

Correspondence to Shahrokh F. Shariat.

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Conflict of interest

SFS: advisory board of and/or speaker for Astellas, Astra Zeneca, Bayer, BMS, Cepheid, Ferring, Ipsen, Jansen, Lissy, MSD, Olympus, Pfizer, Pierre Fabre, Roche, Sanochemia, Sanofi, and Wolff. GK: advisory board of and/or speaker for Astellas, Bayer AG, BMS, Ipsen, Janssen, MSD, Roche, Takeda, and Sanofi. All other authors declare that they have no conflict of interest.

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Stangl-Kremser, J., Suarez‐Ibarrola, R., Andrea, D.D. et al. Assessment of body composition in the advanced stage of castration-resistant prostate cancer: special focus on sarcopenia. Prostate Cancer Prostatic Dis 23, 309–315 (2020). https://doi.org/10.1038/s41391-019-0186-6

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