Article type
Abstract
Background
Prostate cancer (PCa) is the second most common cancer in men worldwide and a leading cause of cancer-related deaths. Despite declining mortality rates, androgen deprivation therapy (ADT) remains central to PCa management. ADT delays disease progression but poses significant side effects, including muscle loss known as sarcopenia, a negative prognostic factor for disease progression and survival in advanced PCa.
Objectives
To assess the effectiveness and safety of available interventions for the prevention and treatment of sarcopenia in patients with PCa in advance stage or undergoing ADT.
Methods
Medline, EMBASE, and WOS were searched up to January 2023. Randomized and non-randomized controlled trials, and longitudinal observational studies with control group assessing interventions for sarcopenia prevention or treatment on patients aged ≥60 with advanced PCa or receiving ADT were included. Outcomes considered were sarcopenia, overall survival (OS), disease-specific survival (DSS), muscle mass (MMas), muscle strength (MStr), and health-related quality-of-life (HRQoL). Risk-of-bias was assessed using Cochrane Collaboration tools. Meta-analyses were conducted. Certainty of evidence was assessed using GRADE.
Results
The search yielded 987 unique references, of which 106 were selected for full-text assessment. Twenty studies assessing exercise training (ET), supplementation, lifestyle, and pharmacological interventions (PhIs) were finally included. None of the studies reported findings on sarcopenia or OS. PhIs may have little to no effect on DSS, however, the administration of antimyostatin peptibody and testosterone may lead to an increase in MMas. ET may result in a modest increase in MStr for leg press and sexual function (QLQ-25 domain), with little to no effect on HRQoL, MMas or other strength measures. Furthermore, resistance ET (RET) and ET combined with protein supplementation (ET+PRO) may result in an increase in MMas compared to usual care. ET+PRO may also increase MStr.
Conclusions
RET or ET+PRO may potentially mitigate muscle loss, and ET+PRO could also potentially improve MStr in advanced PCa patients. Evidence regarding the effectiveness of PhIs is inconclusive. Further research is needed to elucidate optimal strategies for preventing and treating sarcopenia in these patients. Our application of rigorous methods underscores the importance of generating high-quality evidence to inform clinical decision-making, ultimately improving patient outcomes.
Prostate cancer (PCa) is the second most common cancer in men worldwide and a leading cause of cancer-related deaths. Despite declining mortality rates, androgen deprivation therapy (ADT) remains central to PCa management. ADT delays disease progression but poses significant side effects, including muscle loss known as sarcopenia, a negative prognostic factor for disease progression and survival in advanced PCa.
Objectives
To assess the effectiveness and safety of available interventions for the prevention and treatment of sarcopenia in patients with PCa in advance stage or undergoing ADT.
Methods
Medline, EMBASE, and WOS were searched up to January 2023. Randomized and non-randomized controlled trials, and longitudinal observational studies with control group assessing interventions for sarcopenia prevention or treatment on patients aged ≥60 with advanced PCa or receiving ADT were included. Outcomes considered were sarcopenia, overall survival (OS), disease-specific survival (DSS), muscle mass (MMas), muscle strength (MStr), and health-related quality-of-life (HRQoL). Risk-of-bias was assessed using Cochrane Collaboration tools. Meta-analyses were conducted. Certainty of evidence was assessed using GRADE.
Results
The search yielded 987 unique references, of which 106 were selected for full-text assessment. Twenty studies assessing exercise training (ET), supplementation, lifestyle, and pharmacological interventions (PhIs) were finally included. None of the studies reported findings on sarcopenia or OS. PhIs may have little to no effect on DSS, however, the administration of antimyostatin peptibody and testosterone may lead to an increase in MMas. ET may result in a modest increase in MStr for leg press and sexual function (QLQ-25 domain), with little to no effect on HRQoL, MMas or other strength measures. Furthermore, resistance ET (RET) and ET combined with protein supplementation (ET+PRO) may result in an increase in MMas compared to usual care. ET+PRO may also increase MStr.
Conclusions
RET or ET+PRO may potentially mitigate muscle loss, and ET+PRO could also potentially improve MStr in advanced PCa patients. Evidence regarding the effectiveness of PhIs is inconclusive. Further research is needed to elucidate optimal strategies for preventing and treating sarcopenia in these patients. Our application of rigorous methods underscores the importance of generating high-quality evidence to inform clinical decision-making, ultimately improving patient outcomes.