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Reduced muscle strength and functional performance in men with prostate cancer undergoing androgen suppression: a comprehensive cross-sectional investigation

Prostate Cancer and Prostatic Diseases volume 12, pages 198–203 (2009)Cite this article

Abstract

This study examined the effects of androgen suppression therapy (AST) on upper and lower body muscle strength and a range of direct measures of physical performance using a cross-sectional design with 118 men (48 men undertaking AST for prostate cancer and 70 healthy aged-matched controls) from a single tertiary center. Primary end points included muscle strength for the upper- and lower-body; functional performance—repeated chair rise, usual and fast 6-m walk, 6-m backwards walk and 400-m walk time; and dual-energy X-ray absorptiometry assessment—whole body, regional soft tissue composition and bone mineral density (BMD). Men on AST had significantly reduced muscle strength for the upper- and lower-body and impaired functional performance compared to controls (P<0.05). As expected, AST patients had significantly lower whole-body and hip BMD and higher percent of body fat than controls (P<0.05), and tended to have lower whole-body lean mass (−2.3 kg, P=0.077). Appendicular skeletal muscle was positively associated with upper-body (r=0.400–0.606, P<0.001) and lower-body (r=0.549–0.588, P<0.001) muscle strength, and strength was related to functional performance. Men undertaking AST were consistently impaired across a broad range of physical and functional musculoskeletal performance assessments compared with their age-matched normal controls. These findings are relevant for those patients considering AST for subclinical disease management, but whose physical reserve is marginal. Strategies to counter these adverse effects of AST need to be initiated so that independent living and quality of life can be maintained.

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References

  1. Jemal A, Siegel R, Ward E, Hao Y, Xu J, Murray T et al. Cancer statistics, 2008. CA Cancer J Clin 2008; 58: 71–96.

    Article  PubMed  Google Scholar 

  2. Cooperberg MR, Grossfeld GD, Lubeck DP, Carroll PR . National practice patterns and time trends in androgen ablation for localized prostate cancer. J Natl Cancer Inst 2003; 95: 981–989.

    Article  PubMed  Google Scholar 

  3. Keating NL, O’Malley AJ, Smith MR . Diabetes and cardiovascular disease during androgen deprivation therapy for prostate cancer. J Clin Oncol 2006; 24: 4448–4456.

    Article  CAS  PubMed  Google Scholar 

  4. Tsai HK, D’Amico AV, Sadetsky N, Chen MH, Carroll PR . Androgen deprivation therapy for localized prostate cancer and the risk of cardiovascular mortality. J Natl Cancer Inst 2007; 99: 1516–1524.

    Article  PubMed  Google Scholar 

  5. Smith MR, Boyce SP, Moyneur E, Duh MS, Raut MK, Brandman J . Risk of clinical fractures after gonadotropin-releasing hormone agonist therapy for prostate cancer. J Urol 2006; 175: 136–139; discussion 139.

    Article  CAS  PubMed  Google Scholar 

  6. Smith MR, Lee H, Nathan DM . Insulin sensitivity during combined androgen blockade for prostate cancer. J Clin Endocrinol Metab 2006; 91: 1305–1308.

    Article  CAS  PubMed  Google Scholar 

  7. Galvão DA, Spry NA, Taaffe DR, Newton RU, Stanley J, Shannon T et al. Changes in muscle, fat and bone mass after 36 weeks of maximal androgen blockade for prostate cancer. BJU Int 2008; 102: 44–47.

    Article  PubMed  Google Scholar 

  8. Smith MR, Finkelstein JS, McGovern FJ, Zietman AL, Fallon MA, Schoenfeld DA et al. Changes in body composition during androgen deprivation therapy for prostate cancer. J Clin Endocrinol Metab 2002; 87: 599–603.

    Article  CAS  PubMed  Google Scholar 

  9. Greenspan SL, Coates P, Sereika SM, Nelson JB, Trump DL, Resnick NM . Bone loss after initiation of androgen deprivation therapy in patients with prostate cancer. J Clin Endocrinol Metab 2005; 90: 6410–6417.

    Article  CAS  PubMed  Google Scholar 

  10. Rosenberg IH . Sarcopenia: origins and clinical relevance. J Nutr 1997; 127: 990S–991S.

    Article  CAS  PubMed  Google Scholar 

  11. Galvão DA, Taaffe DR, Spry N, Newton RU . Exercise can prevent and even reverse adverse effects of androgen suppression treatment in men with prostate cancer. Prostate Cancer Prostatic Dis 2007; 10: 340–346.

    Article  PubMed  Google Scholar 

  12. Yancik R, Ganz PA, Varricchio CG, Conley B . Perspectives on comorbidity and cancer in older patients: approaches to expand the knowledge base. J Clin Oncol 2001; 19: 1147–1151.

    Article  CAS  PubMed  Google Scholar 

  13. Taaffe DR, Duret C, Wheeler S, Marcus R . Once-weekly resistance exercise improves muscle strength and neuromuscular performance in older adults. J Am Geriatr Soc 1999; 47: 1208–1214.

    Article  CAS  PubMed  Google Scholar 

  14. Galvão DA, Taaffe DR . Resistance exercise dosage in older adults: single- versus multiset effects on physical performance and body composition. J Am Geriatr Soc 2005; 53: 2090–2097.

    Article  PubMed  Google Scholar 

  15. Fiatarone MA, Marks EC, Ryan ND, Meredith CN, Lipsitz LA, Evans WJ . High-intensity strength training in nonagenarians. Effects on skeletal muscle. JAMA 1990; 263: 3029–3034.

    Article  CAS  PubMed  Google Scholar 

  16. Taaffe DR, Simonsick EM, Visser M, Volpato S, Nevitt MC, Cauley JA et al. Lower extremity physical performance and hip bone mineral density in elderly black and white men and women: cross-sectional associations in the Health ABC Study. J Gerontol A Biol Sci Med Sci 2003; 58: M934–M942.

    Article  PubMed  Google Scholar 

  17. Simonsick EM, Fan E, Fleg JL . Estimating cardiorespiratory fitness in well-functioning older adults: treadmill validation of the long distance corridor walk. J Am Geriatr Soc 2006; 54: 127–132.

    Article  PubMed  Google Scholar 

  18. Newman AB, Simonsick EM, Naydeck BL, Boudreau RM, Kritchevsky SB, Nevitt MC et al. Association of long-distance corridor walk performance with mortality, cardiovascular disease, mobility limitation, and disability. JAMA 2006; 295: 2018–2026.

    Article  CAS  PubMed  Google Scholar 

  19. Simonsick EM, Montgomery PS, Newman AB, Bauer DC, Harris T . Measuring fitness in healthy older adults: the Health ABC Long Distance Corridor Walk. J Am Geriatr Soc 2001; 49: 1544–1548.

    Article  CAS  PubMed  Google Scholar 

  20. Taaffe DR, Lewis B, Marcus R . Quantifying the effect of hand preference on upper limb bone mineral and soft tissue composition in young and elderly women by dual-energy X-ray absorptiometry. Clin Physiol 1994; 14: 393–404.

    Article  CAS  PubMed  Google Scholar 

  21. Heymsfield SB, Smith R, Aulet M, Bensen B, Lichtman S, Wang J et al. Appendicular skeletal muscle mass: measurement by dual-photon absorptiometry. Am J Clin Nutr 1990; 52: 214–218.

    Article  CAS  PubMed  Google Scholar 

  22. Clay CA, Perera S, Wagner JM, Miller ME, Nelson JB, Greenspan SL . Physical function in men with prostate cancer on androgen deprivation therapy. Phys Ther 2007; 87: 1325–1333.

    Article  PubMed  Google Scholar 

  23. Levy ME, Perera S, van Londen GJ, Nelson JB, Clay CA, Greenspan SL . Physical function changes in prostate cancer patients on androgen deprivation therapy: a 2-year prospective study. Urology 2008; 71: 735–739.

    Article  PubMed  Google Scholar 

  24. Myers J, Prakash M, Froelicher V, Do D, Partington S, Atwood JE . Exercise capacity and mortality among men referred for exercise testing. N Engl J Med 2002; 346: 793–801.

    Article  PubMed  Google Scholar 

  25. Saigal CS, Gore JL, Krupski TL, Hanley J, Schonlau M, Litwin MS . Androgen deprivation therapy increases cardiovascular morbidity in men with prostate cancer. Cancer 2007; 110: 1493–1500.

    Article  CAS  PubMed  Google Scholar 

  26. D’Amico AV, Denham JW, Crook J, Chen MH, Goldhaber SZ, Lamb DS et al. Influence of androgen suppression therapy for prostate cancer on the frequency and timing of fatal myocardial infarctions. J Clin Oncol 2007; 25: 2420–2425.

    Article  PubMed  Google Scholar 

  27. Basaria S, Lieb II J, Tang AM, DeWeese T, Carducci M, Eisenberger M et al. Long-term effects of androgen deprivation therapy in prostate cancer patients. Clin Endocrinol (Oxf) 2002; 56: 779–786.

    Article  CAS  Google Scholar 

  28. Smith MR . Osteoporosis during androgen deprivation therapy for prostate cancer. Urology 2002; 60: 79–85.

    Article  PubMed  Google Scholar 

  29. Lee H, McGovern K, Finkelstein JS, Smith MR . Changes in bone mineral density and body composition during initial and long-term gonadotropin-releasing hormone agonist treatment for prostate carcinoma. Cancer 2005; 104: 1633–1637.

    Article  CAS  PubMed  Google Scholar 

  30. Wolfson L, Judge J, Whipple R, King M . Strength is a major factor in balance, gait, and the occurrence of falls. J Gerontol A Biol Sci Med Sci 1995; 50 (Spec No): 64–67.

    PubMed  Google Scholar 

  31. Pande I, Scott DL, O’Neill TW, Pritchard C, Woolf AD, Davis MJ . Quality of life, morbidity, and mortality after low trauma hip fracture in men. Ann Rheum Dis 2006; 65: 87–92.

    Article  CAS  PubMed  Google Scholar 

  32. Galvão DA, Nosaka K, Taaffe DR, Peake J, Spry N, Suzuki K et al. Endocrine and immune responses to resistance training in prostate cancer patients. Prostate Cancer Prostatic Dis 2008; 11: 160–165.

    Article  PubMed  Google Scholar 

  33. Galvão DA, Nosaka K, Taaffe DR, Spry N, Kristjanson LJ, McGuigan MR et al. Resistance training and reduction of treatment side effects in prostate cancer patients. Med Sci Sports Exerc 2006; 38: 2045–2052.

    Article  PubMed  Google Scholar 

  34. Galvão DA, Newton RU, Taaffe DR, Spry N . Can exercise ameliorate the increased risk of cardiovascular disease and diabetes associated with ADT? Nat Clin Pract Urol 2008; 5: 306–307.

    Article  PubMed  Google Scholar 

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Acknowledgements

We thank The Cancer Council of Western Australia for their financial support in running the study. We also thank exercise physiologists Greg Levin, Kyle Smith and Zoe Gibbs, who contributed to the study.

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Authors and Affiliations

  1. School of Exercise, Biomedical and Health Sciences, Edith Cowan University, Joondalup, Western Australia, Australia

    D A Galvão, D Turner & R U Newton

  2. School of Human Movement Studies, University of Queensland, Brisbane, Queensland, Australia

    D R Taaffe

  3. Department of Radiation Oncology, Sir Charles Gairdner Hospital, Nedlands, Western Australia, Australia

    N Spry & D Joseph

  4. Faculty of Medicine, University of Western Australia, Nedlands, Western Australia, Australia

    N Spry & D Joseph

Authors
  1. D A Galvão
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  2. D R Taaffe
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  3. N Spry
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  4. D Joseph
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  5. D Turner
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  6. R U Newton
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Corresponding author

Correspondence to D A Galvão.

Additional information

Clinical Trial Registry: Resistance and aerobic exercise for reducing treatment side effects in men receiving androgen deprivation therapy for prostate cancer; ACTRN12607000263493; http://www.anzctr.org.au/trialSearch.aspx

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Galvão, D., Taaffe, D., Spry, N. et al. Reduced muscle strength and functional performance in men with prostate cancer undergoing androgen suppression: a comprehensive cross-sectional investigation. Prostate Cancer Prostatic Dis 12, 198–203 (2009). https://doi.org/10.1038/pcan.2008.51

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  • DOI: https://doi.org/10.1038/pcan.2008.51

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