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Body composition, physical function and quality of life in healthy men and across different stages of prostate cancer

Abstract

Background

Androgen deprivation therapy (ADT) for prostate cancer (PC) has detrimental effects on physical function and quality of life (QoL), but the addition of androgen receptor signalling inhibitors (ARSI) on these outcomes is unclear.

Purpose

To compare body composition, physical function, and QoL across progressive stages of PC and non-cancer controls (CON).

Methods

In men with hormone sensitive PC (HSPC, n = 43) or metastatic castration-resistant PC (mCRPC, n = 22) or CON (n = 37), relative and absolute lean and fat mass, physical function (6 m walk, chair stands, timed up and go [TUG], stair climb), and QoL were determined.

Results

Relative body composition differed amongst all groups, along with ~39% greater absolute fat mass in mCRPC vs. CON. TUG and chair stands were ~71% and ~33% slower in mCRPC compared to both CON and HSPC, whereas stair climb was ~29% and 6 m walk was ~18% slower in mCRPC vs. CON. Relative body composition was correlated with physical function (r = 0.259–0.385). Clinically relevant differences for mCRPC were observed for overall QoL and several subscales vs. CON, although body composition and physical function did not influence QoL.

Conclusions

PC progression is associated with deteriorations in body composition and physical function. As ADT length was similar between groups, ARSI use for mCRPC likely contributed in part to these changes. Given the difficulties of improving lean mass during ADT, interventions that reduce adiposity may lessen the side effects of hormone therapy.

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Fig. 1: Body composition in men with and without prostate cancer.
Fig. 2: Physical function in men with and without prostate cancer.
Fig. 3: Quality of life (QoL) in men with and without prostate cancer.

Data availability

The datasets analysed during the current study are available from the corresponding author on reasonable request.

References

  1. Siegel RL, Miller KD, Jemal A. Cancer statistics, 2020. CA Cancer J Clin. 2020;70:7–30.

    PubMed  Article  Google Scholar 

  2. Sharifi N, Gulley JL, Dahut WL. Androgen deprivation therapy for prostate cancer. JAMA. 2005;294:238–44.

    CAS  PubMed  Article  Google Scholar 

  3. Galvao DA, Spry NA, Taaffe DR, Newton RU, Stanley J, Shannon T, et al. Changes in muscle, fat and bone mass after 36 weeks of maximal androgen blockade for prostate cancer. BJU Int. 2008;102:44–7.

    PubMed  Article  Google Scholar 

  4. Greenspan SL, Coates P, Sereika SM, Nelson JB, Trump DL, Resnick NM. Bone loss after initiation of androgen deprivation therapy in patients with prostate cancer. J Clin Endocrinol Metab. 2005;90:6410–7.

    CAS  PubMed  Article  Google Scholar 

  5. Levy ME, Perera S, van Londen GJ, Nelson JB, Clay CA, Greenspan SL. Physical function changes in prostate cancer patients on androgen deprivation therapy: a 2-year prospective study. Urology. 2008;71:735–9.

    PubMed  Article  Google Scholar 

  6. Smith MR, Saad F, Egerdie B, Sieber PR, Tammela TL, Ke C, et al. Sarcopenia during androgen-deprivation therapy for prostate cancer. J Clin Oncol. 2012;30:3271–6.

    PubMed  PubMed Central  Article  Google Scholar 

  7. van Londen GJ, Levy ME, Perera S, Nelson JB, Greenspan SL. Body composition changes during androgen deprivation therapy for prostate cancer: a 2-year prospective study. Crit Rev Oncol Hematol. 2008;68:172–7.

    PubMed  PubMed Central  Article  Google Scholar 

  8. Clay CA, Perera S, Wagner JM, Miller ME, Nelson JB, Greenspan SL. Physical function in men with prostate cancer on androgen deprivation therapy. Phys Ther. 2007;87:1325–33.

    PubMed  Article  Google Scholar 

  9. Galvao DA, Taaffe DR, Spry N, Joseph D, Turner D, Newton RU. Reduced muscle strength and functional performance in men with prostate cancer undergoing androgen suppression: a comprehensive cross-sectional investigation. Prostate Cancer Prostatic Dis. 2009;12:198–203.

    CAS  PubMed  Article  Google Scholar 

  10. Gonzalez BD, Jim HSL, Small BJ, Sutton SK, Fishman MN, Zachariah B, et al. Changes in physical functioning and muscle strength in men receiving androgen deprivation therapy for prostate cancer: a controlled comparison. Support Care Cancer. 2016;24:2201–7.

    PubMed  Article  Google Scholar 

  11. Joly F, Alibhai SM, Galica J, Park A, Yi QL, Wagner L, et al. Impact of androgen deprivation therapy on physical and cognitive function, as well as quality of life of patients with nonmetastatic prostate cancer. J Urol. 2006;176:2443–7.

    CAS  PubMed  Article  Google Scholar 

  12. Chi KN, Protheroe A, Rodriguez-Antolin A, Facchini G, Suttman H, Matsubara N, et al. Patient-reported outcomes following abiraterone acetate plus prednisone added to androgen deprivation therapy in patients with newly diagnosed metastatic castration-naive prostate cancer (LATITUDE): an international, randomised phase 3 trial. Lancet Oncol. 2018;19:194–206.

    CAS  PubMed  Article  Google Scholar 

  13. Dacal K, Sereika SM, Greenspan SL. Quality of life in prostate cancer patients taking androgen deprivation therapy. J Am Geriatr Soc. 2006;54:85–90.

    PubMed  Article  Google Scholar 

  14. Gagliano-Juca T, Travison TG, Nguyen PL, Kantoff PW, Taplin ME, Kibel AS, et al. Effects of androgen deprivation therapy on pain perception, quality of life, and depression in men with prostate cancer. J Pain Symptom Manag. 2018;55:307–17 e1.

    Article  Google Scholar 

  15. Karantanos T, Corn PG, Thompson TC. Prostate cancer progression after androgen deprivation therapy: mechanisms of castrate resistance and novel therapeutic approaches. Oncogene. 2013;32:5501–11.

    CAS  PubMed  PubMed Central  Article  Google Scholar 

  16. Jin JK, Dayyani F, Gallick GE. Steps in prostate cancer progression that lead to bone metastasis. Int J Cancer. 2011;128:2545–61.

    CAS  PubMed  PubMed Central  Article  Google Scholar 

  17. Crawford ED, Higano CS, Shore ND, Hussain M, Petrylak DP. Treating patients with metastatic castration resistant prostate cancer: a comprehensive review of available therapies. J Urol. 2015;194:1537–47.

    PubMed  Article  Google Scholar 

  18. Beer TM, Armstrong AJ, Rathkopf D, Loriot Y, Sternberg CN, Higano CS, et al. Enzalutamide in men with chemotherapy-naive metastatic castration-resistant prostate cancer: extended analysis of the phase 3 PREVAIL study. Eur Urol. 2017;71:151–4.

    CAS  PubMed  Article  Google Scholar 

  19. de Bono JS, Logothetis CJ, Molina A, Fizazi K, North S, Chu L, et al. Abiraterone and increased survival in metastatic prostate cancer. N Engl J Med. 2011;364:1995–2005.

    PubMed  PubMed Central  Article  Google Scholar 

  20. Pezaro C, Mukherji D, Tunariu N, Cassidy AM, Omlin A, Bianchini D, et al. Sarcopenia and change in body composition following maximal androgen suppression with abiraterone in men with castration-resistant prostate cancer. Br J Cancer. 2013;109:325–31.

    CAS  PubMed  PubMed Central  Article  Google Scholar 

  21. Chowdhury S, Oudard S, Uemura H, Joniau S, Pilon D, Lefebvre P, et al. Matching-adjusted indirect comparison of health-related quality of life and adverse events of apalutamide versus enzalutamide in non-metastatic castration-resistant prostate cancer. Adv Ther. 2020;37:512–26.

    CAS  PubMed  Article  Google Scholar 

  22. Ning YM, Brave M, Maher VE, Zhang L, Tang S, Sridhara R, et al. U.S. Food and Drug Administration Approval summary: enzalutamide for the treatment of patients with chemotherapy-naive metastatic castration-resistant prostate cancer. Oncologist. 2015;20:960–6.

    CAS  PubMed  PubMed Central  Article  Google Scholar 

  23. Khalaf DJ, Sunderland K, Eigl BJ, Kollmannsberger CK, Ivanov N, Finch DL, et al. Health-related quality of life for abiraterone plus prednisone versus enzalutamide in patients with metastatic castration-resistant prostate cancer: results from a phase II randomized trial. Eur Urol. 2019;75:940–7.

    CAS  PubMed  Article  Google Scholar 

  24. Campbell KL, Winters-Stone KM, Wiskemann J, May AM, Schwartz AL, Courneya KS, et al. Exercise guidelines for cancer survivors: consensus statement from international multidisciplinary roundtable. Med Sci Sports Exerc. 2019;51:2375–90.

    PubMed  Article  PubMed Central  Google Scholar 

  25. Hayes SC, Newton RU, Spence RR, Galvao DA. The Exercise and Sports Science Australia position statement: exercise medicine in cancer management. J Sci Med Sport. 2019;22:1175–99.

    PubMed  Article  Google Scholar 

  26. Hanson ED, Sakkal S, Evans WS, Violet JA, Battaglini CL, McConell GK, et al. Altered stress hormone response following acute exercise during prostate cancer treatment. Scand J Med Sci Sports. 2018;28:1925–33.

    CAS  PubMed  Article  Google Scholar 

  27. Hanson ED, Sheaff AK, Sood S, Ma L, Francis JD, Goldberg AP, et al. Strength training induces muscle hypertrophy and functional gains in black prostate cancer patients despite androgen deprivation therapy. J Gerontol A Biol Sci Med Sci. 2013;68:490–8.

    CAS  PubMed  Article  Google Scholar 

  28. Hanson ED, Srivatsan SR, Agrawal S, Menon KS, Delmonico MJ, Wang MQ, et al. Effects of strength training on physical function: influence of power, strength, and body composition. J Strength Cond Res. 2009;23:2627–37.

    PubMed  PubMed Central  Article  Google Scholar 

  29. Hanson ED, Sakkal S, Que S, Cho E, Spielmann G, Kadife E, et al. Natural killer cell mobilization and egress following acute exercise in men with prostate cancer. Exp Physiol. 2020;105:1524–39.

    CAS  PubMed  Article  Google Scholar 

  30. Cella D, Nichol MB, Eton D, Nelson JB, Mulani P. Estimating clinically meaningful changes for the Functional Assessment of Cancer Therapy–Prostate: results from a clinical trial of patients with metastatic hormone-refractory prostate cancer. Value Health. 2009;12:124–9.

    PubMed  Article  Google Scholar 

  31. Cormie P, Newton RU, Spry N, Joseph D, Taaffe DR, Galvao DA. Safety and efficacy of resistance exercise in prostate cancer patients with bone metastases. Prostate Cancer Prostatic Dis. 2013;16:328–35.

    CAS  PubMed  Article  Google Scholar 

  32. Galvao DA, Taaffe DR, Spry N, Cormie P, Joseph D, Chambers SK, et al. Exercise preserves physical function in prostate cancer patients with bone metastases. Med Sci Sports Exerc. 2018;50:393–9.

    PubMed  Article  Google Scholar 

  33. Smith MR, Finkelstein JS, McGovern FJ, Zietman AL, Fallon MA, Schoenfeld DA, et al. Changes in body composition during androgen deprivation therapy for prostate cancer. J Clin Endocrinol Metab. 2002;87:599–603.

    CAS  PubMed  Article  Google Scholar 

  34. Hamilton EJ, Gianatti E, Strauss BJ, Wentworth J, Lim-Joon D, Bolton D, et al. Increase in visceral and subcutaneous abdominal fat in men with prostate cancer treated with androgen deprivation therapy. Clin Endocrinol. 2011;74:377–83.

    CAS  Article  Google Scholar 

  35. Alibhai SM, Breunis H, Timilshina N, Johnston C, Tomlinson G, Tannock I, et al. Impact of androgen-deprivation therapy on physical function and quality of life in men with nonmetastatic prostate cancer. J Clin Oncol. 2010;28:5038–45.

    CAS  PubMed  Article  Google Scholar 

  36. Storer TW, Miciek R, Travison TG. Muscle function, physical performance and body composition changes in men with prostate cancer undergoing androgen deprivation therapy. Asian J Androl. 2012;14:204–21.

    CAS  PubMed  PubMed Central  Article  Google Scholar 

  37. Pondal M, del Ser T. Normative data and determinants for the timed “up and go” test in a population-based sample of elderly individuals without gait disturbances. J Geriatr Phys Ther. 2008;31:57–63.

    PubMed  Article  Google Scholar 

  38. Barry E, Galvin R, Keogh C, Horgan F, Fahey T. Is the Timed Up and Go test a useful predictor of risk of falls in community dwelling older adults: a systematic review and meta-analysis. BMC Geriatr. 2014;14:14.

    PubMed  PubMed Central  Article  Google Scholar 

  39. Beer TM, Armstrong AJ, Rathkopf DE, Loriot Y, Sternberg CN, Higano CS, et al. Enzalutamide in metastatic prostate cancer before chemotherapy. N Engl J Med. 2014;371:424–33.

    PubMed  PubMed Central  Article  CAS  Google Scholar 

  40. Cesari M, Kritchevsky SB, Penninx BW, Nicklas BJ, Simonsick EM, Newman AB, et al. Prognostic value of usual gait speed in well-functioning older people—results from the Health, Aging and Body Composition Study. J Am Geriatr Soc. 2005;53:1675–80.

    PubMed  Article  Google Scholar 

  41. Studenski S, Perera S, Wallace D, Chandler JM, Duncan PW, Rooney E, et al. Physical performance measures in the clinical setting. J Am Geriatr Soc. 2003;51:314–22.

    PubMed  Article  Google Scholar 

  42. Chen L, Nelson DR, Zhao Y, Cui Z, Johnston JA. Relationship between muscle mass and muscle strength, and the impact of comorbidities: a population-based, cross-sectional study of older adults in the United States. BMC Geriatr. 2013;13:74.

    PubMed  PubMed Central  Article  Google Scholar 

  43. Bean JF, Leveille SG, Kiely DK, Bandinelli S, Guralnik JM, Ferrucci L. A comparison of leg power and leg strength within the InCHIANTI study: which influences mobility more? J Gerontol A Biol Sci Med Sci. 2003;58:728–33.

    PubMed  Article  Google Scholar 

  44. Ramage MI, Skipworth RJE. The relationship between muscle mass and function in cancer cachexia: smoke and mirrors? Curr Opin Support Palliat Care. 2018;12:439–44.

    PubMed  Article  Google Scholar 

  45. Hanson ED, Wagoner CW, Anderson T, Battaglini CL. The independent effects of strength training in cancer survivors: a systematic review. Curr Oncol Rep. 2016;18:31.

    PubMed  Article  Google Scholar 

  46. Brucker PS, Yost K, Cashy J, Webster K, Cella D. General population and cancer patient norms for the Functional Assessment of Cancer Therapy-General (FACT-G). Eval Health Prof. 2005;28:192–211.

    PubMed  Article  Google Scholar 

  47. Fizazi K, Tran N, Fein L, Matsubara N, Rodriguez-Antolin A, Alekseev BY, et al. Abiraterone acetate plus prednisone in patients with newly diagnosed high-risk metastatic castration-sensitive prostate cancer (LATITUDE): final overall survival analysis of a randomised, double-blind, phase 3 trial. Lancet Oncol. 2019;20:686–700.

    CAS  PubMed  Article  Google Scholar 

  48. Chen Z, Zhang Y, Lu C, Zeng H, Schumann M, Cheng S. Supervised physical training enhances muscle strength but not muscle mass in prostate cancer patients undergoing androgen deprivation therapy: a systematic review and meta-analysis. Front Physiol. 2019;10:843.

    PubMed  PubMed Central  Article  Google Scholar 

  49. Hanson ED, Betik AC, Timpani CA, Tarle J, Zhang X, Hayes A. Testosterone suppression does not exacerbate disuse atrophy and impairs muscle recovery that is not rescued by high protein. J Appl Physiol. (1985) 2020;129:5–16.

    CAS  Article  Google Scholar 

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Acknowledgements

This study was supported by funding from the National Institute of Health grants AG018336, CA127784 and AG000268; the Claude D. Pepper Older Americans Independence Center (P30 AG028747); the Department of Veterans Affairs; Department of Industry, Innovation, and Science of Australia; Research Development grant scheme from Victoria University; the Oded Bar-Or International Scholar Award from the American College of Sports Medicine; and the Physical Activity and Cancer Survivorship pilot funding from the UNC Lineberger Comprehensive Cancer Center, Duke Cancer Institute and the Wake Forest Baptist Comprehensive Cancer Center.

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Correspondence to Erik D. Hanson.

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Hanson, E.D., Stopforth, C.K., Alzer, M. et al. Body composition, physical function and quality of life in healthy men and across different stages of prostate cancer. Prostate Cancer Prostatic Dis 24, 725–732 (2021). https://doi.org/10.1038/s41391-020-00317-w

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