Abstract
PurposeAndrogen deprivation therapy (ADT) is a treatment used in men with prostate cancer (PCa); however it is responsible for many adverse effects, with negative impact on quality of life. ADT causes loss of bone mineral density (BMD) and skeletal muscle mass, alteration of body composition, and cognitive function, which altogether lead to increased risk of accidental falls and fractures. This systematic review analyses the effectiveness of physical exercise (PE) in preventing accidental falls and fractures and reducing the loss of BMD in men with PCa receiving ADT.MethodsWe searched MEDLINE, EMBASE, CINAHL, and the Cochrane Library for articles between database inception and September 2, 2020. Eligible studies included randomized controlled trials (RCTs) investigating the effects of exercise on bone health in men with PCa receiving ADT.ResultsNine RCTs were included. Experimental PE consisted in multicomponent programmes that involved aerobic, resistance, impact-loading exercise, and football training. None of the RCTs investigated the risk of accidental falls and fractures, while two trials reported beneficial effects of PE on lumbar spine, hip, and femoral shaft BMD. No further significant difference was detected in the outcomes investigated.ConclusionEvidence of the effectiveness of PE to prevent the risk of accidental falls and fractures and BMD loss is lacking. Nevertheless, clinical guidelines recommend PE as a part of the clinical management of men with PCa receiving ADT due to its known numerous health benefits. Research should focus on PE strategies to prevent accidental falls, a clinically relevant outcome in this vulnerable population.Trial registrationThe study protocol was registered with International Prospective Register of Systematic Reviews (PROSPERO, number CRD 42020158444) on 04/28/2020.
Highlights
Prostate cancer (PCa) is the most prevalent cancer among men worldwide, with 3.724.658 cases in 2018 [1].Androgen deprivation therapy (ADT) is currently the standard systemic treatment in patients with metastatic or more aggressive PCa [2]
The study protocol was registered with International Prospective Register of Systematic Reviews (PROSPERO, number CRD 42020158444)
Thirty-six full texts were reviewed for eligibility, 27 of which were excluded for the following reasons: three conference abstracts and six study protocols referred to published full texts already retrieved [24,25,26,27,28,29,30,31]; four studies did not meet inclusion criteria with respect to the outcome, as one measured only pathological fractures [32], and the others did not report data on bone health [31, 33, 34]; one study did not test a structured physical exercise intervention, focusing instead on patient education [35]; two studies compared different structured physical exercise interventions, without comparison to standard care [36, 37]
Summary
Androgen deprivation therapy (ADT) is currently the standard systemic treatment in patients with metastatic or more aggressive PCa [2]. ADT is used in combination with radiotherapy for localized advanced PCa with the aim to increase survival and control disease progression [2]. Apart from the increased risk for cardiovascular events and metabolic syndrome [4, 5], ADT alters the body composition, with loss in skeletal muscle mass that leads to a decrease in muscle strength [6, 7]. Patients on ADT manifest significant loss of bone mineral density (BMD), which occurs especially within the first year of treatment [8] and is associated with higher osteoporosis rates and risk of fractures [9]. ADT seems responsible for cognitive dysfunction, this finding has not been completely clarified and needs further investigation [10]
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callMore From: Supportive care in cancer : official journal of the Multinational Association of Supportive Care in Cancer
Disclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
