Outcomes, frailty status, and body composition of men with hormone-sensitive prostate cancer treated with bicalutamide and dutasteride.

Abstract

122 Background: Prostate cancer is often a disease of the frail in which androgen withdrawal can further the risk of morbidity and mortality. This study aimed to describe a single institution experience with peripheral androgen blockade using bicalutamide and dutasteride (B+D) in men with hormone-sensitive prostate cancer (HSPC) in the context of body composition and frailty. Methods: Patients with HSPC treated with B+D at MD Anderson Cancer Center between 2010 and 2022 were retrospectively identified. Baseline and post-B+D frailty scores were calculated using the G8 geriatric score. Body composition was objectively measured from pre-treatment CT imaging. Differences in patient and disease characteristics between frail vs. not frail patients were compared with Kruskal Wallis tests or chi-square tests. Time on treatment (ToT), time to next treatment (TTnT) and overall survival (OS) were calculated by Kaplan-Meier methods, and comparisons by frailty status were made with the log rank test. Results: Forty-four patients were evaluable: median G8 frailty score was 13.5 with 22 patients classified as frail (G8 score ≤ 14) at baseline and after 6 months of B+D. ToT was shorter in frail individuals than non-frail (18.9 vs 38.2 months, p=0.03). TTNT was also shorter in frail individuals (20.9 vs 38.2 months, p=0.03). Only 3 patients have died, and 5-year OS is 81.3% for the entire cohort. Sarcopenia was found in 11 patients (52%) and sarcopenic obesity in 3 (14%). Conclusions: Bicalutamide and dutasteride was generally safe and feasible in a cohort of HSPC with increased pre-treatment frailty and sarcopenia. These findings suggest that peripheral androgen blockade is a eugonad treatment option that may warrant prospective study in at-risk populations and the application of frailty scores and measures of body composition can refine the relevant population. [Table: see text]