Psychological Distress In Men With Prostate Cancer Undertaking ADT: Results From A 12-month RCT

Abstract

Prostate cancer patients are subject to psychological distress which may be exacerbated for those undertaking androgen deprivation therapy (ADT) due to treatment-related adverse effects. Exercise is one strategy to counter a range of treatment toxicities in men with prostate cancer and to improve overall physical function and quality of life. PURPOSE: To assess the effect of up to 12 months of exercise on psychological distress in men with prostate cancer on ADT. METHODS: Of 163 men (43-90 years) with prostate cancer on ADT and undertaking a 12-month RCT of various exercise modes, 135 had psychological distress assessed using the Brief Symptom Inventory-18 (BSI-18). Patients were randomized to twice weekly impact loading and resistance training (ILRT, n=49), aerobic and resistance training (ART, n=50), and usual care/delayed aerobic exercise (DEL, n=36). ILRT was supervised for 12 months, ART was supervised for 6 months and home-based for 6 months, and DEL underwent supervised aerobic exercise in the second 6 months. The BSI-18 provides three subscales for anxiety, depression, and somatisation, as well as the global severity index (GSI) where higher scores indicate higher distress. Intention-to-treat was utilised for the analyses which included group x time repeated measures ANOVA using log transformed (ln) data. RESULTS: There were no differences among groups at baseline. Somatisation did not change over the study period, however, there were significant interactions (p<0.01) for depression, anxiety, and the GSI. In ILRT, depression was reduced at 12 months compared to baseline and 6 months (0.78 ± 1.39 vs. 1.88 ± 3.24 and 1.48 ± 2.65, respectively), as was the GSI (3.67 ± 4.34 vs. 5.94 ± 7.46 and 4.64 ± 4.73, respectively) with anxiety reduced compared to baseline (1.08 ± 1.54 vs. 1.98 ± 2.56). Depression and the GSI decreased in ART at 6 months but increased by 12 months, while in DEL the GSI was reduced following exercise at 12 months (3.78 ± 3.94 vs. 5.25 ± 4.22 at 6 months). CONCLUSION: Various exercise modes (when supervised) are effective in reducing psychological distress in men with prostate cancer on ADT. As a result, supervised exercise should be prescribed to not only improve physical but also psychological health in this patient group.