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Impact of androgen deprivation therapy on weight gain differs by age in men with nonmetastatic prostate cancer, "Beyond the Abstract," by Narhari Timilshina and Shabbir M.H. Alibhai

BERKELEY, CA (UroToday.com) - Our group recently published an article in the December 2012 issue of the Journal of Urology on the impact of androgen deprivation therapy (ADT) on weight gain in men with non-metastatic prostate cancer.[1] In our study, we not only confirmed the weight gain associated with ADT that was shown in prior studies, but we also demonstrated, for the first time, that the weight gain with ADT appears to differ by age group in men on ADT for over 36 months.

Prostate cancer is the most common cancer among Canadian men and nearly 50% of prostate cancer survivors receive ADT at some point after diagnosis, usually for 2-3 years, or longer.[2, 3] A few studies have previously reported the effects of ADT on weight change in men with prostate cancer. However, these studies have had significant methodological limitations, such as small sample sizes, relatively short follow-up, and lack of appropriate controls, which makes it difficult to draw firm conclusions about the longer-term changes in weight associated with ADT use.[4, 5, 6]

Our study findings suggest that in men with prostate cancer, ADT use was associated with significant weight gain over 3 years compared with men with prostate cancer who were not on ADT, and compared with healthy cohorts without prostate cancer. An important and novel finding of our study is that younger men (< 65 years) on ADT had significantly greater weight gain over 36 months compared to older men (4.7 kg versus 1.4 kg, P=0.005). This difference in weight gain may be related to physiologic changes in appetite or energy regulation with age.[7] However, our study was unable to examine reasons for differences in weight change among younger versus older men. Hence, additional research is needed to explore reasons for greater weight gain among younger men (< 65 years).

Previous studies indicate that weight gain and obesity are associated with higher risks of aggressive prostate cancer, prostate cancer-specific mortality, biochemical recurrence, cardiovascular disease, diabetes mellitus, hypertension, stroke, and some other cancers.[8, 9, 10, 11] Additionally, obesity in men, with and without prostate cancer, is associated with an increased risk of multiple comorbidities which may affect the patient’s health and long-term survival.[12] Several authors have suggested that exercise, diet, and lifestyle intervention can improve quality of life and reduce ADT-related adverse effects, including a modest effect on weight reduction during ADT use in men with prostate cancer.[13, 14, 15, 16] These interventions should therefore be recommended to men on ADT.

Our findings should be helpful to primary care physicians and prostate cancer specialists who monitor the adverse effects of ADT during the long-term follow-up of men with prostate cancer.

References:

  1. Timilshina N, Breunis H, Alibhai SM. Impact of androgen deprivation therapy on weight gain differs by age in men with nonmetastatic prostate cancer. Journal of Urology 2012; 188 (6): 2183-9.
  2. Shahinian, V. B., Kuo, Y. F., Freeman, J. L. et al.: Increasing use of gonadotropin-releasing hormone agonists for the treatment of localized prostate carcinoma. Cancer. 2005; 103 (8): 1615-24.
  3. Cooperberg, M. R., Grossfeld, G. D., Lubeck, D. P. et al.: National practice patterns and time trends in androgen ablation for localized prostate cancer. Journal of the National Cancer Institute 2003; 95 (13):981-9.
  4. Strom SS, Wang X, Pettaway CA, Logothetis CJ et al. obesity, weight gain, and risk of biochemical failure among prostate cancer patietns following prostatectomy. Clinical Cancer Research, 11 (19 pt 1): 6886-94.
  5. Kim, H. S., Moreira, D. M., Smith, M. R. et al.: A natural history of weight change in men with prostate cancer on androgen-deprivation therapy (ADT): results from the Shared Equal Access Regional Cancer Hospital (SEARCH) database. BJU International 2011; 107 (6): 924-8.
  6. Smith, M. R., Finkelstein, J. S., McGovern, F. J. et al.: Changes in body composition during androgen deprivation therapy for prostate cancer. Journal of Clinical Endocrinology and Metabolism 2002; 87 (2): 599-603.
  7. Roberts SB and Rosenberg. Nutrition and aging: changes in the regulation of energy metabolism with aging. Physiol Rev 2006, 86 (2):651-67.
  8. Cao Y and Ma J. Body mass index, prostate cancer specific mortality, and biochemical recurrence: a systematic review and meta-analysis. Cancer Prev Res 2011, 4 (4): 486-501.
  9. Campeggi A, Xylinas E, Ploussard G, Ouzaid I et al. Impact of body mass index on perioperative morbidity, oncological, and functional outcomes after extraperitoneal laparoscopic radical prostatectomy. Urology 2012; 80 (3): 576-84.
  10. Smith MR, Lee H, McGovern F. et al.: Metabolic changes during gonadotropin releasing hormone agonist therapy for prostate cancer: differences from the classic metabolic syndrome. Cancer 2012; 112 (10):2188-94.
  11. Alibhai SM., Duong-Hua, M., Sutradhar, R. et al.: Impact of Androgen Deprivation Therapy on Cardiovascular Disease and Diabetes. Journal of Clinical Oncology 2009; 27 (21): 3452-8.
  12. Fitzpatrick, J. M.: Management of localized prostate cancer in senior adults: the crucial role of comorbidity. BJU International 2008, 101 suppl 2: 16-22.
  13. Schmitz KH, Holtzman J, Courneya KS, Masse LC, Duval S, Kane R: Controlled physical activities trails in cancer survivors: a systematic review and meta-analysis. Cancer Epidemiol Biomarkers Prev 2005, 14 : 1588-1595.
  14. Murphy R, Wasersug RJ, Dechman G. The role of exercise in managing the adverse effects of androgen deprivation therapy in men with prostate cancer. Phys Therapy Rev, 2011, 16:269:277.
  15. Bourke L, Doll H, Crank H, Daley A, Rosario D, Daxton JM. Lifestyle intervention in men with advanced prostate cancer receiving androgen suppression therapy: a feasibility study. Cancer Epidemiol. Biomarkers Prev, 2011, 20 (4):647-57.
  16. Alberga AS, Segal RJ, Reid RD, Scott CG et al. Age and androgen deprivation therapy on exercise outcomes in men with prostate cancer. Support Care Cancer 2012 20 (5):971-81.

Written by:
Narhari Timilshinaa and Shabbir M.H. Alibhaia, b, c, d as part of Beyond the Abstract on UroToday.com. This initiative offers a method of publishing for the professional urology community. Authors are given an opportunity to expand on the circumstances, limitations etc... of their research by referencing the published abstract.

Author Affiliations:

  1. Department of Medicine, University Health Network
  2. Geriatric Program, Toronto Rehabilitation Institute
  3. Department of Medicine, University of Toronto
  4. Institute of Health Policy, Management, and Evaluation, University of Toronto

Corresponding Author & Address: Shabbir M.H. Alibhai, University Health Network, Room EN14-214, 200 Elizabeth Street, Toronto, ON, Canada. M5G 2C4. E-mail: .

Impact of androgen deprivation therapy on weight gain differs by age in men with nonmetastatic prostate cancer - Abstract

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