Abnormal physical performance and frailty in older men with biochemical recurrence of prostate cancer (PCa) on androgen deprivation therapy (ADT)

Abstract

e20578 Background: ADT has recognized toxicities including osteoporosis, muscle weakness and wasting, anemia, and fatigue. ADT is increasingly being used in men with biochemical recurrence (BCR) despite the fact that earlier initiation has not been shown to improve overall survival in this setting. Little is known about the impact of ADT on physical performance or the development of frailty in older patients. Methods: A case-control study (n=119) of men age 65+ with BCR on ADT ≥ 6 months with stable PSA (n=56) compared to controls with history of PCa status post radiation or surgery with no evidence of recurrence (n=63) was conducted. Frailty prevalence per Fried's criteria (validated measures of weight loss, exhaustion, grip strength, walking speed, and physical activity), Short Physical Performance Battery scores (SPPB: validated measure of balance, walking speed and timed chair stands) and falls were compared between groups. Exploratory analyses of proposed biomarkers of frailty (CRP, ESR, hemoglobin, albumin, and total cholesterol) were conducted. Results: Age, ethnicity and socioeconomic status were not different between groups. Total score on the SPPB was significantly lower in the ADT group (9.1 vs. 10.2, p = .01), indicating higher risk of incident morbidity and mortality. 7.2% of men in ADT group met Fried's criteria for frailty compared to 3.2% in control group and 58.9% met criteria for “prefrail” in ADT group compared to 41.9% controls (p=0.03 for trend). Quadriceps strength, as measured by chair stands in SPPB, was significantly worse for ADT group (p<.01). Incident falls were higher in ADT group (14.3% vs. 3.2%, p=.05). With the exception of hemoglobin (12.7 vs 14.4 g/dl, p< .01), putative frailty biomarkers were not significantly different between groups. Conclusions: Men with BCR of PCa on ADT have worse physical performance, are more frail, and have a higher incidence of falls than controls, but biomarkers suggest that mechanism of frailty is different than in the geriatric syndrome. A prospective trial is needed to establish a temporal link between initiation of ADT and frailty. No significant financial relationships to disclose.