Sarcopenia during androgen-deprivation therapy for prostate cancer

Abstract

Purpose: To characterize changes in lean body mass (LBM) in men with prostate cancer receiving androgen-deprivation therapy (ADT).

Patients and methods: We prospectively evaluated LBM in a prespecified substudy of a randomized controlled trial of denosumab to prevent fractures in men receiving ADT for nonmetastatic prostate cancer. LBM was measured by total-body dual-energy x-ray absorptiometry at study baseline and at 12, 24, and 36 months. The analyses included 252 patients (132, denosumab; 120, placebo) with a baseline and at least one on-study LBM assessment. Patients were stratified by age (< 70 v ≥ 70 years) and by ADT duration (≤ 6 v > 6 months).

Results: Median ADT duration was 20.4 months at study baseline. Mean LBM decreased significantly from baseline, by 1.0% at month 12 (95% CI, 0.4% to 1.5%; P < .001; n = 248), by 2.1% at month 24 (95% CI, 1.5% to 2.7%; P < .001; n = 205), and by 2.4% at month 36 (95% CI, 1.6% to 3.2%; P < .001; n = 168). Men age ≥ 70 years (n = 127) had significantly greater changes in LBM at all measured time points than younger men. At 36 months, LBM decreased by 2.8% in men age ≥ 70 years and by 0.9% in younger men (P = .035). Men with ≤ 6 months of ADT at study entry (n = 36) had a greater rate of decrease in LBM compared with men who had received more than 6 months of ADT at study entry (3.7% v 2.0%; P = .0645).

Conclusion: In men receiving ADT, LBM decreased significantly after 12, 24, and 36 months.

Fig 1.

CONSORT diagram.

Fig 2.

Median serum testosterone levels from study baseline to month 36 among all randomly assigned patients in substudy (n = 309). Q, quartile.

Fig 3.

(A) Mean changes in lean body mass from study baseline to month 36 for the overall study population (*P < .001 v baseline); (B) according to patients' age (*P < .001 v baseline; †P < .05 v < 70 years); and (C) according to androgen-deprivation therapy (ADT) duration at study entry (*P < .01 v baseline; †P < .05 v baseline; ‡P < .05 v > 6 months).

Fig 4.

(A, B) Waterfall plots for changes in lean body mass from study baseline to month 12 according to patients' age and (C, D) androgen-deprivation therapy (ADT) duration at study entry.

Fig 5.

Mean changes in lean body mass from study baseline to month 36 according to body mass index at each visit (*P < .01 for change from baseline; †P < .001 for change from baseline).