Physical Function in Men With Prostate Cancer on Androgen Deprivation Therapy

Background and Purpose: Androgen deprivation therapy (ADT) has become an increasingly standard intervention for both early and advanced stages of prostate cancer; however, decreased physical function and hypogonadism have been reported in men receiving ADT. The objectives of this study were: (1) to determine whether ADT (and hypogonadism) resulted in decreased strength and mobility and (2) to examine the effect of ADT on an associated test of cognitive and motor function by assessing visuomotor performance. Subjects and Methods: Physical function, walking speed, visuomotor performance, gonadal status, body composition, and Comorbidity Disease Index (CMDI) scores were assessed in a cohort of 100 participants that included: (1) men with prostate cancer who were not on ADT, (2) men with prostate cancer who were on short-term ADT (<6 months), (3) men with prostate cancer who were on long-term ADT (≥6 months), and (4) control subjects who did not have prostate cancer. Results: Walking speed varied significantly across the 4 groups, even after adjusting for age, CMDI, and percentage of body fat. Age and CMDI were significantly associated with measurements of physical performance. Adjusted for covariates, men on long-term ADT walked 0.18 m/s slower than the control subjects. Physical function also varied significantly across the 4 groups. Androgen deprivation therapy did not have a significant effect on visuomotor performance. Discussion and Conclusion: The results suggest that ADT has a significant effect on walking speed and physical performance in men with prostate cancer.

[1]  L. Ferrucci,et al.  A short physical performance battery assessing lower extremity function: association with self-reported disability and prediction of mortality and nursing home admission. , 1994, Journal of gerontology.

[2]  J. Cauley,et al.  Correlates of decline in lower extremity performance in older women: A 10-year follow-up study. , 2006, The journals of gerontology. Series A, Biological sciences and medical sciences.

[3]  L. Parvinen,et al.  Androgen deprivation and cognition in prostate cancer , 2003, British Journal of Cancer.

[4]  E. Evans,et al.  In vivo validation of whole body composition estimates from dual-energy X-ray absorptiometry. , 1997, Journal of applied physiology.

[5]  Kazunori Nosaka,et al.  Resistance training and reduction of treatment side effects in prostate cancer patients. , 2006, Medicine and science in sports and exercise.

[6]  S. Asthana,et al.  Testosterone supplementation improves spatial and verbal memory in healthy older men , 2001, Neurology.

[7]  S. Rubin,et al.  Prognostic Value of Usual Gait Speed in Well‐Functioning Older People—Results from the Health, Aging and Body Composition Study , 2005, Journal of the American Geriatrics Society.

[8]  R. Gardiner,et al.  Altered cognitive function in men treated for prostate cancer with luteinizing hormone‐releasing hormone analogues and cyproterone acetate: a randomized controlled trial , 2002, BJU international.

[9]  S. Heymsfield,et al.  Total-body skeletal muscle mass: estimation by a new dual-energy X-ray absorptiometry method. , 2002, The American journal of clinical nutrition.

[10]  J. Nelson,et al.  Bone loss after initiation of androgen deprivation therapy in patients with prostate cancer. , 2005, The Journal of clinical endocrinology and metabolism.

[11]  W. Morton Hair,et al.  Activational effects of testosterone on cognitive function in men , 2001, Neuropsychologia.

[12]  S. Studenski,et al.  Meaningful Change and Responsiveness in Common Physical Performance Measures in Older Adults , 2006, Journal of the American Geriatrics Society.

[13]  F. J. Fowler,et al.  The impact of androgen deprivation on quality of life after radical prostatectomy for prostate carcinoma , 2002, Cancer.

[14]  Anthony L Zietman,et al.  Changes in body composition during androgen deprivation therapy for prostate cancer. , 2002, The Journal of clinical endocrinology and metabolism.

[15]  D G Lloyd,et al.  The effect of exercise on gait patterns in older women: a randomized controlled trial. , 1996, The journals of gerontology. Series A, Biological sciences and medical sciences.

[16]  B. Sternfeld,et al.  Associations of body composition with physical performance and self-reported functional limitation in elderly men and women. , 2002, American journal of epidemiology.

[17]  J. Stanford,et al.  Quality-of-life outcomes after primary androgen deprivation therapy: results from the Prostate Cancer Outcomes Study. , 2001, Journal of clinical oncology : official journal of the American Society of Clinical Oncology.

[18]  N. Mauras,et al.  Journal of Clinical Endocrinology and Metabolism Printed in U.S.A. Copyright © 1998 by The Endocrine Society Testosterone Deficiency in Young Men: Marked Alterations in Whole Body Protein Kinetics, Strength, and Adiposity* , 2022 .

[19]  M. Bolanowski,et al.  Assessment of human body composition using dual-energy x-ray absorptiometry and bioelectrical impedance analysis. , 2001, Medical science monitor : international medical journal of experimental and clinical research.

[20]  J. Montie,et al.  Trends in the utilization of androgen‐deprivation therapy for patients with prostate carcinoma suggest an effect on mortality , 2001, Cancer.

[21]  R. Schilsky,et al.  Gonadal dysfunction in patients receiving chemotherapy for cancer. , 1980, Annals of internal medicine.

[22]  T. DeWeese,et al.  Long‐term effects of androgen deprivation therapy in prostate cancer patients , 2002, Clinical endocrinology.

[23]  R. Parker,et al.  Bone loss in men with prostate cancer treated with gonadotropin-releasing hormone agonists. , 2001, The Journal of clinical endocrinology and metabolism.

[24]  K. Pienta,et al.  The Current State of Hormonal Therapy for Prostate Cancer , 2002, CA: a cancer journal for clinicians.

[25]  K. Courneya,et al.  Resistance exercise in men receiving androgen deprivation therapy for prostate cancer. , 2003, Journal of clinical oncology : official journal of the American Society of Clinical Oncology.

[26]  S. Studenski,et al.  The impact of self-reported cumulative comorbidity on stroke recovery. , 2004, Age and ageing.

[27]  I. Tannock,et al.  Impact of androgen deprivation therapy on physical and cognitive function, as well as quality of life of patients with nonmetastatic prostate cancer. , 2006, The Journal of urology.

[28]  Suzanne G. Leveille,et al.  Exploring How Peak Leg Power and Usual Gait Speed Are Linked to Late-Life Disability: Data from the National Health and Nutrition Examination Survey (NHANES), 1999–2002 , 2006, American journal of physical medicine & rehabilitation.

[29]  A. Jemal,et al.  Cancer Statistics, 2007 , 2007, CA: a cancer journal for clinicians.

[30]  R. Gardiner,et al.  Quality of life compared during pharmacological treatments and clinical monitoring for non‐localized prostate cancer: a randomized controlled trial , 2004, BJU international.

[31]  Yong Gu,et al.  Visual Responses of Neurons in the Pretectal Nucleus lentiformis mesencephali to Moving Patterns Within and Beyond Receptive Fields in Pigeons , 2001, Brain, Behavior and Evolution.

[32]  V. Mathiowetz,et al.  Adult Norms for the Nine Hole Peg Test of Finger Dexterity , 1985 .

[33]  P. Stone,et al.  Fatigue in patients with prostate cancer receiving hormone therapy. , 2000, European journal of cancer.

[34]  S. Gogov,et al.  Long-term side effects of androgen deprivation therapy in men with non-metastatic prostate cancer: a systematic literature review. , 2006, Critical reviews in oncology/hematology.

[35]  S. Sereika,et al.  Quality of Life in Prostate Cancer Patients Taking Androgen Deprivation Therapy , 2006, Journal of the American Geriatrics Society.

[36]  J. Sibilia,et al.  Bone mineral density in men treated with synthetic gonadotropin-releasing hormone agonists for prostatic carcinoma. , 1999, The Journal of urology.

[37]  A. Kenny,et al.  Effects of transdermal testosterone on bone and muscle in older men with low bioavailable testosterone levels. , 2001, The journals of gerontology. Series A, Biological sciences and medical sciences.

[38]  Suzanne G. Leveille,et al.  Lower extremity function and subsequent disability: consistency across studies, predictive models, and value of gait speed alone compared with the short physical performance battery. , 2000, The journals of gerontology. Series A, Biological sciences and medical sciences.

[39]  J. Patrie,et al.  Single and combined effects of growth hormone and testosterone administration on measures of body composition, physical performance, mood, sexual function, bone turnover, and muscle gene expression in healthy older men. , 2002, The Journal of clinical endocrinology and metabolism.