Prostate Cancer Undergoing Androgen Deprivation Research Articles

Reduced Cardiovascular Capacity and Resting Metabolic Rate in Men with Prostate Cancer Undergoing Androgen Deprivation: A Comprehensive Cross-Sectional Investigation.

Objectives. To investigate if androgen deprivation therapy exposure is associated with additional risk factors for cardiovascular disease and metabolic treatment-related toxicities. Methods. One hundred and seven men (42–89 years) with prostate cancer undergoing androgen deprivation therapy completed a maximal graded objective exercise test to determine maximal oxygen uptake, assessments for resting metabolic rate, body composition, blood pressure and arterial stiffness, and blood biomarker analysis. A cross-sectional analysis was undertaken to investigate the potential impact of therapy exposure with participants stratified into two groups according to duration of androgen deprivation therapy (<3 months and ≥3 months). Results. Maximal oxygen uptake (26.1 ± 6.0 mL/kg/min versus 23.2 ± 5.8 mL/kg/min, p = 0.020) and resting metabolic rate (1795 ± 256 kcal/d versus 1647 ± 236 kcal/d, p = 0.005) were significantly higher in those with shorter exposure to androgen deprivation. There were no differences between groups for peripheral and central blood pressure, arterial stiffness, or metabolic profile. Conclusion. Three months or longer exposure to androgen deprivation therapy was associated with reduced cardiorespiratory capacity and resting metabolic rate, but not in a range of blood biomarkers. These findings suggest that prolonged exposure to androgen deprivation therapy is associated with negative alterations in cardiovascular outcomes. Trial registry is: ACTRN12609000200280.

The Prevalence of Cardiac Risk Factors in Men with Localized Prostate Cancer Undergoing Androgen Deprivation Therapy in British Columbia, Canada.

Background. While androgen deprivation therapy (ADT) reduces the risk of prostate cancer-specific mortality in high-risk localized prostate cancer, it adversely affects cardiovascular (CV) risk factor profiles in treated men. Methods. We retrospectively reviewed the charts of 100 consecutive men with intermediate- or high-risk localized prostate cancer referred to the British Columbia Cancer Agency for ADT. Data on CV risk factors and disease were collected and Framingham risk scores were calculated. Results. The median age of the study cohort was 73 years. Established cardiovascular disease was present in 25% of patients. Among patients without established CV disease, calculated Framingham risk was high in 65%, intermediate in 33%, and low in 1%. Baseline hypertension was present in 58% of patients, dyslipidemia in 51%, and diabetes or impaired glucose tolerance in 24%. Hypertension was more prevalent in the study cohort than in an age- and sex-matched population sample (OR 1.74, P = 0.006); diabetes had a similar prevalence (OR 0.93, P = 0.8). Conclusions. Patients receiving ADT have a high prevalence of cardiovascular disease and risk factors and are more likely to be hypertensive than population controls. Low rates of CV risk screening suggest opportunities for improved primary and secondary prevention of CV disease in this population.

Maximal Exercise Testing of Men with Prostate Cancer Being Treated with Androgen Deprivation Therapy

Exercise is being increasingly established as a key adjuvant therapy in clinical oncology. As research has demonstrated the beneficial effect of exercise for cancer management, a growing number of patients with cancer are undertaking structured exercise programs. This study aimed to determine the safety and feasibility of formal exercise testing in clinical settings as it is becoming increasingly used as a screening tool and for exercise prescription purposes. One hundred and twelve patients with prostate cancer undergoing androgen deprivation therapy (ADT) took part in a physician-supervised multistage maximal stress test (Bruce protocol). Sixty patients had been on ADT for <3 months (acute), whereas 52 had been on ADT for >3 months (chronic). Of these men, 85% were able to meet the criteria for the attainment of V˙O2max, whereas three positive tests (3.2%) were observed. The three participants who recorded a positive stress test underwent further medical examination and were subsequently cleared of clinically significant cardiovascular disease. Apart from the relatively low V˙O2max (24.7 ± 6.0 mL·kg·min, 10th-15th percentile), compared with normative data in healthy age-matched controls, the cardiovascular response to exercise was similar in this cancer population. Moreover, treatment duration did not seem to influence cardiovascular responses to exercise. This early evidence suggests that risk of adverse events during maximal exercise testing is relatively low in this population and certainly no higher than that in ages-matched, apparently healthy individuals. Maximal exercise testing was demonstrated to be feasible and safe, providing a direct assessment of V˙O2max. The relatively low number of positive tests in this study suggests that the risk of adverse events is relatively low in this population and certainly no higher than that in age-matched, apparently healthy individuals.

Sexual bother in men with advanced prostate cancer undergoing androgen deprivation therapy.

Men with advanced prostate cancer (APC) undergoing androgen deprivation therapy (ADT) often experience distressing sexual side effects. Sexual bother is an important component of adjustment. Factors associated with increased bother are not well understood. This study sought to describe sexual dysfunction and bother in APC patients undergoing ADT, identify socio-demographic and health/disease-related characteristics related to sexual bother, and evaluate associations between sexual bother and psychosocial well-being and quality of life (QOL). Baseline data of a larger psychosocial intervention study was used. Pearson's correlation and independent samples t-test tested bivariate relations. Multivariate regression analysis evaluated relations between sexual bother and psychosocial and QOL outcomes. The Expanded Prostate Cancer Index Composite sexual function and bother subscales, Center for Epidemiologic Studies Depression Scale, Functional Assessment of Cancer Therapy--General, and Dyadic Adjustment Scale were the main outcome measures. Participants (N = 80) were 70 years old (standard deviation [SD] = 9.6) and reported 18.7 months (SD = 17.3) of ADT. Sexual dysfunction (mean = 10.1; SD = 18.0) was highly prevalent. Greater sexual bother (lower scores) was related to younger age (β = 0.25, P = 0.03) and fewer months of ADT (β = 0.22, P = 0.05). Controlling for age, months of ADT, current and precancer sexual function, sexual bother correlated with more depressive symptoms (β = -0.24, P = 0.06) and lower QOL (β = 0.25, P = 0.05). Contrary to hypotheses, greater sexual bother was related to greater dyadic satisfaction (β = -0.35, P = 0.03) and cohesion (β = -0.42, P = 0.01). The majority of APC patients undergoing ADT will experience sexual dysfunction, but there is variability in their degree of sexual bother. Psychosocial aspects of sexual functioning should be considered when evaluating men's adjustment to ADT effects. Assessment of sexual bother may help identify men at risk for more general distress and lowered QOL. Psychosocial interventions targeting sexual bother may complement medical treatments for sexual dysfunction and be clinically relevant, particularly for younger men and those first starting ADT.

Positive and negative mood in men with advanced prostate cancer undergoing androgen deprivation therapy: considering the role of social support and stress.

Advanced prostate cancer patients often undergo androgen deprivation therapy (ADT). Advanced disease and adverse ADT side effects are often debilitating and negatively impact mood. Social support has been shown to mitigate detrimental effects of stress on mood. This study sought to characterize positive and negative mood in this select patient population and determine whether social support moderated relations between stress and mood. Participants (N = 80) completed the Interpersonal Support Evaluation List, Perceived Stress Scale, and Derogatis Affect Balance Scale at a single time point. Hierarchical regression models evaluated relations among social support, stress, and mood controlling for relevant covariates. Standard moderation analyses were performed. Participants reported higher levels of negative and positive mood compared with published means of localized prostate cancer patients. Overall, mood was more positive than negative. Stress levels were comparable to cancer populations with recurrent disease. Moderated regression analyses showed that social support partially buffered the effects of stress on positive mood; men with high stress and low support reported the lowest levels of positive mood. The model with negative mood as the dependent measure did not support moderation; that is, the relationship between stress and negative mood did not differ by level of social support. Among individuals living with advanced prostate cancer, social support may be an important factor that sustains positive mood in the presence of stress. Future work should examine the extent to which social support prospectively impacts health-related quality of life by promoting positive mood. Limitations include cross-sectional design, which precludes causal inferences.

Sexual Function in Men with Castrate Levels of Testosterone: Observations of a Subgroup of Sexually Active Men with Prostate Cancer Undergoing Androgen Deprivation Therapy

Purpose: To identify possible factors that influence sexual function in men undergoing maximal androgen deprivation therapy (ADT). Patients and Methods: A descriptive exploration was performed looking at characteristics of twenty-two men reporting sexual activity after nine months of maximal ADT. This previously published Phase II study, involved 250 prostate cancer patients undergoing intermittent ADT. An analysis between this cohort and the group that did not maintain sexual function was performed to ascertain if age, testosterone level, functional status or maintenance of quadriceps strength had an impact upon sexual function. Results: There was no difference in age, testosterone level or ECOG performance status between the sexually active and non-sexually active groups. Over the course of 9 months of ADT, the sexually active group appeared to maintain quadriceps muscle strength as measured with physical stands, and maintained overall health as measured by quality of life questionaries, compared to the non-sexually active group. Conclusions: This retrospective study suggests that exercise during ADT may reduce the impact of ADT on sexual function. This warrants further testing, and could be the focus of future randomised controlled trials.

Effects of recreational soccer in men with prostate cancer undergoing androgen deprivation therapy: study protocol for the 'FC Prostate' randomized controlled trial.

BackgroundAndrogen deprivation therapy (ADT) is a cornerstone in the treatment of advanced prostate cancer. Adverse musculoskeletal and cardiovascular effects of ADT are widely reported and investigations into the potential of exercise to ameliorate the effects of treatment are warranted. The ‘Football Club (FC) Prostate’ study is a randomized trial comparing the effects of soccer training with standard treatment approaches on body composition, cardiovascular function, physical function parameters, glucose tolerance, bone health, and patient-reported outcomes in men undergoing ADT for prostate cancer.Methods/DesignUsing a single-center randomized controlled design, 80 men with histologically confirmed locally advanced or disseminated prostate cancer undergoing ADT for 6 months or more at The Copenhagen University Hospital will be enrolled on this trial. After baseline assessments eligible participants will be randomly assigned to a soccer training group or a control group receiving usual care. The soccer intervention will consist of 12 weeks of training 2–3 times/week for 45–60 min after which the assessment protocol will be repeated. Soccer training will then continue bi-weekly for an additional 20 weeks at the end of which all measures will be repeated to allow for additional analyses of long-term effects. The primary endpoint is changes in lean body mass from baseline to 12 weeks assessed by dual X-ray absorptiometry scan. Secondary endpoints include changes of cardiovascular, metabolic, and physical function parameters, as well as markers of bone metabolism and patient-reported outcomes.DiscussionThe FC Prostate trial will assess the safety and efficacy of a novel soccer-training approach to cancer rehabilitation on a number of clinically important health outcomes in men with advanced prostate cancer during ADT. The results may pave the way for innovative, community-based interventions in the approach to treating prostate cancer.Trial registrationClinicalTrials.gov: NCT01711892

Nephrotoxicity of recent anti-cancer agents.

Cancer patients may develop a variety of kidney lesions that impair not only their immediate survival but also limit the adequate treatment of the underlying malignant process. This review summarizes the nephrotoxic potential of some of the most recently developed anti-cancer drugs, focusing on those interfering with the vascular endothelial growth factor and epidermal growth factor receptor pathways and mammalian target of rapamycin inhibitors. Thrombotic microangiopathy (haemolytic-uraemic syndrome), proteinuria, hypertension and magnesium depletion are the most common side effects. Also the risk for developing acute kidney injury in patients with advanced prostate cancer undergoing androgen deprivation therapy is discussed.

Mediators of the resistance and aerobic exercise intervention effect on physical and general health in men undergoing androgen deprivation therapy for prostate cancer

The objective of the current study was to identify mediators of the effects of a combined resistance and aerobic exercise program on perceived physical and general health in men undergoing androgen deprivation therapy for prostate cancer. In total, 57 patients with prostate cancer undergoing androgen deprivation therapy were randomly assigned to 12 weeks of resistance and aerobic exercise or usual care. The outcome measures of physical and general health were assessed by standardized questionnaires. Linear regression analyses were conducted on the residual change scores of the variables. The mediating effects of fatigue, muscle strength, and functional performance on the intervention's effect on physical and general health were examined using the product of coefficients method. Bootstrapping was used to calculate the 95% confidence intervals (95% CIs). The exercise intervention was found to significantly improve physical (beta, 5.03; 95% CI, 1.01-9.04) and general health (beta, 12.89; 95% CI, 2.24-23.54). Upper body muscle strength and walking speed significantly mediated the intervention effect on physical health (beta, 2.65; 95% CI, 0.64-5.54), accounting for 53% of the total effect. Walking speed and fatigue were found to be mediators in the intervention effect on general health (beta, 7.52; 95% CI, 2.16-16.92), accounting for 51% of the total effect. The intervention effects on physical and general health were explained by different mediating mechanisms. Walking speed mediated the intervention effect on both physical and general health. The intervention effect on physical health was further mediated by upper body strength, whereas the effect on general health was mediated by fatigue.

775 THE AUSTRALIAN EXPERIENCE OF THE ‘MAN PLAN' EXERCISE PROGRAM FOR PATIENTS WITH PROSTATE CANCER ON ANDROGEN DEPRIVATION THERAPY

You have accessJournal of UrologyProstate Cancer: Advanced (II)1 Apr 2013775 THE AUSTRALIAN EXPERIENCE OF THE ‘MAN PLAN' EXERCISE PROGRAM FOR PATIENTS WITH PROSTATE CANCER ON ANDROGEN DEPRIVATION THERAPY Lawrence Kim and Prem Rashid Lawrence KimLawrence Kim Port Macquarie, Australia More articles by this author and Prem RashidPrem Rashid Port Macquarie, Australia More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2013.02.339AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Patients who receive androgen deprivation therapy are at an increased risk of cardiovascular, musculoskeletal and metabolic complications. Studies have shown that exercise can ameliorate the toxicity and provide a multitude of benefits to patients with prostate cancer. To the best of our knowledge, there has been no evaluation of a formal community based exercise program for patients with prostate cancer undergoing androgen deprivation therapy. We sought to investigate the effect of the Lupron® (Leuprorelin acetate) ‘Man Plan' exercise program in Australia on exercise outcome measures. Our secondary aims included: 1) the assessment of the potential association between the duration of Leuprorelin acetate prior to commencement of the ‘Man Plan' program and the outcomes; and 2) the comparison of the cohorts living in regional or metropolitan areas. METHODS The following prospectively collected variables were retrospectively analysed. - Demographic data (Metropolitan or non-metropolitan residence was determined by the patient's residential postcode) - Duration of Leuprorelin acetate administration - Naivety to Leuprorelin acetate (defined as receiving less than three months prior to the commencement of the ‘Man Plan' program) - Body composition, cardiovascular, activity and strength parameters were measured at initial and final visits - Covariance analysis and paired t-tests were performed for statistical analysis. RESULTS 379 patients were recruited from May 2010 through to August 2012. There was a small but statistically significant improvement in the majority of the outcome parameters. There was no significant difference in the exercise parameters between Leuprorelin acetate naive and experienced groups, and between regional and metropolitan groups. CONCLUSIONS The ‘Man Plan' program appears to counter the negative health effects of androgen deprivation therapy and improve the measured exercise outcomes. The outcomes do not appear to be affected by the duration of Leuprorelin acetate administration or the area of residence. Long term follow up study is required to assess clinical significance. Variable Lower Upper Pr > t Mean STD 95% CI 95% CI Weight (kg) -0.12 2.41 -0.46 0.21 0.466 * Hip (cm) -0.59 3.36 -1.07 -0.11 0.0155 *Waist (cm) -1.05 3.51 -1.54 -0.56 <.0001 *Systolic BP (mmHg) -3.37 16.59 -5.68 -1.06 0.0044 *Diastolic BP (mmHg) -3.06 10.24 -4.48 -1.63 <.0001 Heart Rate (bpm) -0.79 10.27 -2.23 0.65 0.2818 *400m Walk (seconds) -31.9 54.35 -40.2 -23.6 <.0001 *X30mindays 0.53 1.64 0.22 0.84 0.0009 *Chair (Number) -2.22 4.59 -2.9 -1.54 <.0001 *Legs (kg) 21.27 30.29 15.57 26.97 <.0001 *Chest (kg) 7.29 7.63 5.9 8.68 <.0001 *Abs Strength (Seconds) 0.56 0.82 0.37 0.74 <.0001 *Balance Test (Seconds) 0.68 0.83 0.55 0.8 <.0001 *Plank Hold (Seconds) 16.1 35.38 8.85 23.34 <.0001 *Row (kg) 9.73 10.83 7.95 11.52 <.0001 *Sit and Reach (number) 3.01 7.74 1.54 4.48 <.0001 *Push Up Toes (number) 4.39 4.35 2.92 5.86 <.0001 *Push Up Knees (number) 4.78 6.98 3.28 6.27 <.0001 © 2013 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 189Issue 4SApril 2013Page: e319 Advertisement Copyright & Permissions© 2013 by American Urological Association Education and Research, Inc.MetricsAuthor Information Lawrence Kim Port Macquarie, Australia More articles by this author Prem Rashid Port Macquarie, Australia More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Management of cancer treatment-induced bone loss

The survival prospects for many patients with cancer are steadily improving. As a result, survivorship issues are of increasing importance as attempts are made to minimize the long-term adverse effects of cancer treatments. Cancer therapies can adversely affect bone health, particularly in women with breast cancer and men with prostate cancer. Strategies for screening patients at increased risk for fragility fracture, and treatment algorithms using both bone-targeted treatments and other therapeutic interventions, are being developed. Both bisphosphonates and denosumab have been evaluated as treatments to prevent or reverse the bone loss associated with cancer treatments. Zoledronic acid is the most extensively assessed agent and has been shown to prevent bone loss in patients with breast cancer experiencing a premature menopause, in postmenopausal women receiving an aromatase inhibitor and in patients with prostate cancer undergoing androgen deprivation therapy (ADT). To date, the improvements in bone mineral density have not translated into a reduced fracture rate. However, in a large phase III trial, denosumab has been shown to reduce vertebral fractures in men receiving ADT for prostate cancer. These bone-targeted treatments have also been shown to modify the course of the underlying cancer and prevent metastasis, although the beneficial effects are confined to patients with low levels of circulating reproductive hormones.

Calcium and vitamin D supplementation during androgen deprivation therapy for prostate cancer: a critical review.

Loss of bone mineral density is an unintended consequence of androgen deprivation therapy in men with prostate cancer. Supplementation with calcium and/or vitamin D in these men seems logical and is advocated by many lay and professional groups. We reviewed guidelines for calcium and vitamin D supplementation and the results of clinical trials of calcium and vitamin D supplementation on bone mineral density in men with prostate cancer undergoing androgen deprivation therapy. Whether supplementation of men undergoing androgen deprivation therapy with calcium and/or vitamin D results in higher bone mineral density than no supplementation has not been tested. The results of 12 clinical trials show that, at the doses commonly recommended, 500-1,000 mg calcium and 200-500 IU vitamin D per day, men undergoing androgen deprivation lose bone mineral density. The doses of calcium and vitamin D that have been tested are inadequate to prevent loss of bone mineral density in men undergoing androgen deprivation therapy. In light of evidence that high levels of dietary calcium and calcium supplement use are associated with higher risks for cardiovascular disease and advanced prostate cancer, intervention studies should evaluate the safety as well as the efficacy of calcium and vitamin D supplementation in these men.

Germline Predictors of Androgen Deprivation Therapy Response in Advanced Prostate Cancer

ObjectiveTo evaluate whether germline variations in genes involved in sex steroid biosynthesis and metabolic pathways predict time to treatment failure for patients with advanced prostate cancer undergoing androgen deprivation therapy (ADT), because there are few known clinical predictors of response. Patients and MethodsIn a cohort of 304 patients with advanced prostate cancer undergoing ADT, we genotyped 746 single-nucleotide polymorphisms (SNPs) from 72 genes from germline DNA (680 tagSNPs from 58 genes and 66 candidate SNPs from 20 genes [6 genes common in both]). Association with the primary end point of time to ADT failure was assessed using proportional hazards regression models at the gene level (for genes with tagging SNPs) and at the SNP level. False discovery rates (FDRs) of 0.10 or less were considered noteworthy to account for multiple testing. ResultsAt the gene level, TRMT11 showed the strongest association with time to ADT failure (P<.001; FDR=0.008). Two of 4 TRMT11 tagSNPs were associated with time to ADT failure. Median time to ADT failure for rs1268121 (A>G) was 3.05 years for the AA, 4.27 years for the AG, and 6.22 years for the GG genotypes (P=.002), and for rs6900796 (G>A), it was 2.42 years for the GG, 3.52 years for the AG, and 4.18 years for the AA genotypes (P<.001). No other gene level or SNP level tests had an FDR of 0.10 or less. ConclusionGenetic variation in TRMT11 was associated with time to ADT failure. Confirmation of these preliminary findings in an independent cohort is needed.

Muscle function, physical performance and body composition changes in men with prostate cancer undergoing androgen deprivation therapy

Prostate cancer (PCa) is the most common visceral malignancy in men with androgen deprivation therapy (ADT) the preferred therapy to suppress testosterone production and hence tumor growth. Despite its effectiveness in lowering testosterone, ADT is associated with side effects including loss of muscle mass, diminished muscle strength, decrements in physical performance, earlier fatigue and declining quality of life. This review reports a survey of the literature with a focus on changes in muscle strength, physical function and body composition, due to short-term and long-term ADT. Studies in these areas are sparse, especially well-controlled, prospective randomized trials. Cross-sectional and longitudinal data (up to 2 years) for men with PCa treated with ADT as well as patients with PCa not receiving ADT and age-matched healthy men are presented when available. Based on limited longitudinal data, the adverse effects of ADT on muscle function, physical performance and body composition occur shortly after the onset of ADT and tend to persist and worsen over time. Exercise training is a safe and effective intervention for mitigating these changes and initial guidelines for exercise program design for men with PCa have been published by the American College of Sports Medicine. Disparities in study duration, types of studies and other patient-specific variables such as time since diagnosis, cancer stage and comorbidities may all affect an understanding of the influence of ADT on health, physical performance and mortality.

Lack of an Effect of High Dose Isoflavones in Men With Prostate Cancer Undergoing Androgen Deprivation Therapy

The profound hypogonadism due to androgen deprivation therapy for prostate cancer results in complications such as sexual dysfunction, poor quality of life, vasomotor symptoms and altered cognition. Since estrogen is associated with cardiovascular risks, phytoestrogens are being increasingly evaluated as a potential treatment for these adverse effects. We evaluated the effects of high dose isoflavones, equivalent to that consumed by Asian populations, on the aforementioned consequences of androgen deprivation therapy. A total of 33 men undergoing androgen deprivation therapy for prostate cancer were enrolled in this randomized, double-blind, placebo controlled, 12-week pilot trial. Participants were randomly assigned to receive 20 gm soy protein containing 160 mg total isoflavones (17) vs taste matched placebo, that is 20 gm whole milk protein (16). The study was performed at a tertiary care center in the United States. At baseline the groups were well matched in demographic parameters, sleep quality, cognition and overall quality of life. However, men in the isoflavone group had a higher baseline prevalence of hot flashes and poor intercourse satisfaction compared to those on placebo. At 12 weeks there were no significant differences between the 2 groups in any outcome measure. This pilot study of high dose isoflavones in androgen deprived men showed no significant improvement in cognition, vasomotor symptoms or any other aspect of quality of life measures compared to placebo. Future studies should use variable doses of isoflavones for a longer period before ruling out beneficial isoflavone effects in this population.

A Large Proportion of Patients with Prostate Cancer Undergoing Androgen Deprivation Therapy Continue to Die from Non-Cancer Causes in the PSA Era

Objective: This study was conducted to determine the cause of death in patients receiving ADT for PCa in the PSA era. Patients and methods: We followed 618 patients (mean age 73 years) with PCa initiating ADT from October 1999 to October 2007. Patients were recruited from urology clinics. Patients were regularly reviewed in a dedicated PCa clinic. Cause of death was recorded prospectively, after review of medical case notes and biochemical parameters. Results: At median follow-up of 6.7 years, there were 377 deaths (61% mortality). Of these, 176 (47%) were attributable to PCa. Non-cancer deaths ( n = 201) were predominantly cardiovascular ( n = 125) and respiratory ( n = 43). Overall median presenting PSA was 37 ng/ml (range 0.4–5599), significantly higher ( P &lt; 0.001) in those dying from PCa (115 ng/ml) than from other causes (18 ng/ml). PCa specific mortality increased with PSA at presentation (14% for PSA &lt; 50 ng/ml, 45% for 50–100 ng/ml and 69% for &gt; 100 ng/ml). When stratified for presenting age, PCa deaths were 70% (46/66) for men 60–69 years, 47% (85/180) for 70–79 years and 34% (45/131) for &gt;80 years. Conclusions: Many patients with PCa initiating ADT continue to die from non-cancer causes in an era of widespread PSA testing, the proportion increasing with older age at presentation. This may justify deferring hormonal treatment in suitable older asymptomatic men, sparing the burden of long-term ADT. Patients with PCa who require hormonal therapy should be assessed for cardiovascular and respiratory risk factors at the time of presentation.

Predictors of declining bone mineral density in men aged 50+ with prostate cancer undergoing androgen deprivation therapy

poietin (EPO) was indicated if haemoglobin 2 pts with a durable loss 1 point of ADL related to CT and validated by a geriatrician. Results: Between 06/02 and 07/11, 40 pts were enrolled: mean age 74.6 (70–82), 50% pN0. One patient with violation of inclusion criteria (bone metastasis) was included and treated, eligible for safety analysis. All but 1 received the 4 planned Cy of CT (1 exclusion >Cy 1 with denial to go on treatment) totalizing 157Cy. We did not observe any deleterious impact of CT on ADL: 4 pts lost 0.5 point between inclusion to end of CT. Main side effects (% pts): febrile neutropenia 15%, grade (gr) 1/2/3 mucositis 27.5%/20%/5%, gr 3–4 asthenia 5%; no palmar-plantar erythrosysethesia or cardiac event grade 2–4. 11 hospitalizations. Gr 3–4 neutropenia occurred in 79% of Cy (day 15). 12% of dose reduction or treatment delays (q4w vs q3w) were observed for all Cy. GCSF and EPO were prescribed in 10% and 7% of Cy respectively. Conclusions: Liposomal DXR-based adjuvant CT is feasible in elderly pts without negative impact on ADL, as long as initial selection is adequate and careful follow-up is undertaken.

Falls and Physical Performance Deficits in Older Patients With Prostate Cancer Undergoing Androgen Deprivation Therapy

Men experience a decrease in lean muscle mass and strength during the first year of androgen deprivation therapy (ADT). The prevalence of falls and physical and functional impairment in this population have not been well described. A total of 50 men aged 70 years and older (median 78) receiving ADT for systemic prostate cancer (80% biochemical recurrence) underwent functional and physical assessments. The functional assessments included Katz's Activities of Daily Living (ADLs) and Lawton's Instrumental Activities of Daily Living (IADLs). Patients completed the Vulnerable Elder's Survey-13, a short screening tool of self-perceived functional and physical performance ability. Physical performance was assessed using the Short Physical Performance Battery. The history of falls was recorded. Of the 50 patients, 40 underwent follow-up assessment with the same instruments 3 months after the initial assessment. Of the 50 men, 24% had impairment in the ADLs, 42% had impairment in the IADLs, 56% had abnormal Short Physical Performance Battery findings, and 22% reported falls within the previous 3 months. Within the Short Physical Performance Battery, deficits occurred within all subcomponents (balance, walking, and chair stands). On univariate analysis, age, deficits in ADLs and IADLs, and abnormal cognitive and functional screen findings were associated with an increased risk of abnormal physical performance. ADL deficits, the use of an assistive device, and abnormal functional screen findings were associated with an increased risk of falling. The results of our study have shown that older men with prostate cancer receiving long-term ADT exhibit significant functional and physical impairment and are at risk of falls that is greater than that for similar-aged cohorts. Careful assessment of the functional and physical deficits in older patients receiving ADT is warranted.

The Effect of Androgen Deprivation Therapy on Periodontal Disease in Men With Prostate Cancer

We tested the hypothesis that men undergoing androgen deprivation therapy as treatment for prostate cancer are at greater risk for periodontitis and tooth loss. A total of 81 men with a mean age of 68.5 years who had prostate cancer were consecutively recruited among 325 enrolled in an academic osteoporosis study. Of these men 68 were eligible to participate in the research. The prevalence of periodontal disease in 41 men with prostate cancer undergoing androgen deprivation for a mean of 1.5 years was compared to that in 27 with prostate cancer not undergoing androgen deprivation, who served as controls. The prevalence of periodontal disease was examined in relation to bone mineral density in men with prostate cancer with and without androgen deprivation therapy. A periodontist (PF) blinded to androgen deprivation status recorded probing depth, clinical attachment level, bleeding, plaque scores, gingival recession, missing teeth and calculus. Logistic regression models were used to test the association between androgen deprivation therapy and periodontal disease. Linear regression models were used to assess the association between periodontal disease and bone mineral density in the 2 groups with prostate cancer (treated/untreated). We adjusted for variables known to influence periodontal disease, including patient age, race, smoking and periodontal disease history. The prevalence of periodontal disease was 80.5% in men on androgen deprivation therapy compared with 3.7% in those not on androgen deprivation therapy (OR 3.33, 95% CI 1.07-10.35). Men on androgen deprivation therapy had significantly greater probing depth and higher plaque scores (p<0.001 and <0.09, respectively). A total of 81 men (76.9%) completed bone mineral density examinations. There was no relationship between bone mineral density and periodontal disease. Men with prostate cancer undergoing androgen deprivation therapy were more likely to have periodontal disease than men not on androgen deprivation therapy. If confirmed in larger studies, this observation could have important public health implications, given the increasing use of androgen deprivation therapy to treat prostate cancer.

Benefits of a Physical Activity Intervention for Men with Prostate Cancer

The purpose of the current study was to examine the viability of conducting a theory-based physical activity (PA) intervention on men with prostate cancer, and the impact of PA on quality of life (QOL). Participants were 31 men, average age of 67 years, with localized or metastatic prostate cancer undergoing androgen deprivation therapy (ADT). Global QOL, fatigue, and PA measures were conducted at baseline and following the 12-week intervention. An additional follow-up testing was conducted 4 months following the intervention (n = 18). Both moderate and strenuous bouts of exercise, as well as functional capacity, increased significantly from pre- to posttest. Both fatigue severity and resting heart rate decreased significantly at posttest. A trend toward improved global QOL was also noted. It was concluded that a 12-week home-based PA intervention may provide health and QOL benefits for prostate cancer patients undergoing ADT. Practitioners are encouraged to promote PA for prostate cancer survivors.