Oral Presentation ESA-SRB-AOTA 2019

ADT in prostate cancer patients: the benefits of a 12-month home-based progressive resistance training program   (#127)

Teresa Lam 1 2 3 , Bobby Cheema 4 , Amy Hayden 5 6 , Stephen Lord 7 , Howard Gurney 6 , Shivanjini Gounden 4 , Navneeta Reddy 2 , Haleh Shahidipour 2 3 7 8 , Scott Read 2 3 , Glenn Stone 9 , Mark Mclean 2 3 , Vita Birzniece 2 3 7 8 10
  1. Department of Diabetes and Endocrinology, Westmead Hospital, Sydney, NSW, Australia
  2. Department of Diabetes and Endocrinology, Blacktown Hospital, Blacktown, NSW, Australia
  3. School of Medicine, Western Sydney University, Penrith, NSW, Australia
  4. School of Science and Health, Western Sydney University, Penrith, NSW, Australia
  5. Department of Radiation Oncology, Westmead Hospital, Westmead, NSW, Australia
  6. Crown Princess Mary Cancer Centre Westmead Hospital, Westmead, NSW, Australia
  7. School of Medicine, University of New South Wales, Randwick, NSW, Australia
  8. Translational Health Research Institute, Sydney, NSW, Australia
  9. School of Computing, Engineering and Mathematics, Western Sydney University, Penrith, NSW, Australia
  10. Garvan Institute of Medical Research, Sydney, NSW, Australia

Introduction

Treatment with Androgen Deprivation Therapy (ADT) has detrimental effects on body composition and quality of life (QOL). Exercise interventions, including progressive resistance training (PRT) may ameliorate these effects. Existing studies focus on reversing established changes using supervised programs which have their limitations. In prostate cancer, IGFBP-3 is a proapoptotic protein and IGF-1 mediates tumour cell growth. We investigated the effect of ADT on growth factors, and whether a home-based PRT program, instituted at the start of ADT, could prevent adverse effects over a 12-month period.

Patients and Methods

Twenty-five patients scheduled to receive at least 12 months of ADT were assigned to either usual care (UC) (n=12) or PRT (n=13) starting after their first ADT injection. Body composition, body cell mass (BCM; a functional component of lean body mass), insulin sensitivity, QOL, muscle function, metabolic biomarkers and growth factors were measured at 6 weeks, 6- and 12 months. 

Results

In the total cohort at 12 months, PSA decreased from 9.6±1.6 to 0.4±0.2 nmol/L (p<0.001) indicating a biochemical response to ADT. This was associated with an increase in IGFBP-3 (r=0.27; p=0.01). The IGF-1/IGFBP-3 ratio decreased (p=0.02), whereas serum leptin (p<0.01) and adiponectin (p=0.03) increased. PRT patients preserved BCM (% total mass) compared to UC (-2.3±0.5% vs -4.6±0.5%; p=0.02). Gains in fat mass were lower in the PRT versus UC group (2.1±0.9% vs 5.5±0.8%; p<0.01). QOL improved in PRT patients at 12 months compared to UC, particularly in the mental health (3.6 ±1.6 vs -3.0±1.9; p=0.01) and vitality (2.2±1.5 vs -4.2±1.8; p=0.02) domains.

Conclusion

A biochemical response to ADT is associated with an increase in serum IGFBP-3, involved in suppression of prostate cancer metastasis. Conversely, its toxic effects on body composition and QOL can be reduced with the use of a home-based PRT program instituted at the start of treatment.