The effect of exercise on men with prostate cancer treated with androgen deprivation therapy

Summary: Many men with prostate cancer—up to 50%—will require androgen deprivation therapy (ADT). Since ADT completely blocks testosterone, it often causes significant side effects, including increased fat gain and the loss of muscle mass. Such a side effect combination is an unfortunate recipe for the development, or exacerbation of, sarcopenia, a condition known to increase the risk of falls and fractures and decrease the quality of one’s life. Especially worrisome is the fact that sarcopenia occurs as we age, and generally prostate cancer is a disease found most often in older adults. This review examines ways in which exercise might mitigate the sarcopenic changes induced by testosterone blocking therapy. A systematic search strategy was employed, whereby randomized controlled trials from 2003-2023 were selected. We employed Medical Subject Headings for prostate cancer treatment with ADT and aerobic and resistance training programs. We also included journal articles that we felt would be of general importance and interest to a general medical readership as to add depth to this review. Seven randomized control trials were included. These trials looked at different exercise regimens, such as resistance training, steady-state aerobic training, and high intensity interval training. When examining these trials, there appears to be a consistent pattern that shows how resistance training improves strength and quality of life metrics without significant changes in global lean mass in men receiving ADT as part of their care for prostate cancer. The same cannot be said about steady-state aerobic regimens, as similar to controls, body composition worsens while on ADT. In fact, aerobic fitness might be improved more with weight training compared to steady-state aerobic exercise. However, high intensity training may induce similar improvements in aerobic fitness as resistance training, suggesting that it may be the intensity of the aerobic activity, and not the volume, that might enhance aerobic fitness in men receiving ADT. In general, for men with prostate cancer on ADT, resistance training appears to offer the highest yield when choosing an exercise prescription, as weight training consistently shows an improvement in strength, quality of life, and maybe somewhat surprisingly, aerobic fitness. Timothy Dougherty, MD (Presenting Author) - Allegheny Health Network