Initiation of androgen deprivation therapy (ADT) has long been associated with the loss of lean muscle mass and a gain in mass of fatty tissue, leading toward an overall weight gain over time. However, data from the “real world” on the degree to which ADT actually affects body mass has been very limited.
Kim et al. used data from the Shared Equal Access Regional Cancer Hospital (SEARCH) database to identify 132 patients who received ADT after radical prostatectomy. They defined “weight change” as the difference in weight 6 months before starting ADT and weight between 6 and 18 months after starting ADT.
They showed the following results from an analysis of data on these patients:
- 92/132 patients (70 percent) gained weight.
- 40/132 patients (30 percent) lost weight or maintained a stable weight.
- On average, weight on ADT was 4.8 lbs (2.2 kg) higher than the weight before ADT.
- The average (mean) change for weight-gainers was + 9.2 lbs (+ 4.2 kg).
- The average (mean) change for weight-losers was – 5.3 lbs (– 2.4 kg).
- In a subset of 84 of the 132 patients
- There was no significant weight change in the year before starting ADT.
- There was no significant weight change in the second year on ADT.
What is interesting in this study is that there appears to be a significant minority of patients for whom weight gain is not inevitable and that where weight gain does occur it is most likely to occur within the first 12 months or so after initiation of ADT. These data would seem to confirm much of the individual patient experience that we have seen reported on forums like the Prostate Problems Mailing List and our own social network over the years.
Filed under: Living with Prostate Cancer, Management, Treatment | Tagged: ADT, androgen deprivation therapy, gain, loss, weight |
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These results are in line with my own experience over three cycles of intermittent triple ADT.
I’m just 6 months into the off-therapy vacation period from my third cycle of triple blockade (Lupron, 50 mg bicalutamide, 10 mg finasteride), and my weight is becoming easier to control. I would say that most of the time during the 19 months I was on full blockade during this third cycle my weight was 5 to as much as 8-10 pounds (briefly) higher than it is now. (I’m 5’6″ and weigh 157 first thing in the morning; I would like to lose another 5 to 9 pounds, especially from the gut.) I kept careful track but have not yet compiled numbers.
As Dr. Mark Scholz, Dr. Strum, and Dr. Myers have been advocating for many years, weight gain can be minimized or neutralized and muscle mass maintained by a program of regular and vigorous aerobic and strength exercise. With such a program (though not as frequent as I was aiming for), I was able to actually increase muscle mass during the 19 months of full blockade. That contrasts to my first cycle when I did not do strength exercise and lost some upper body muscle, with my aerobic exercise sufficient to maintain lower body muscle.
I have been of the view that weight gain, which is clearly not a universal outcome, may perhaps be associated with the reported mental issues that often accompany ADT therapies.
Depression, for example, can reduce the initiative to exercise — and of course the lack of exercise, weight gain, etc., then reinforce the feeling of depresskion — a slippery slope indeed.
It would be interesting to see if there was any correlation between mental state and weight gain.
Hi Terry,
I’ve been on (and off) triple blockade (Lupron, 50 mg bicalutamide, 10 mg finasteride) three times now, for 31 months, 19 months and 19 months for my 1st, 2nd and 3rd cycles respectively.
Each time I’ve gained a modest amount of weight — 5 to 10 pounds, fluctuating, but usually closer to 5 I think. I’ve found it hard to keep weight down and to actually lose weight while on blockade, despite aerobic exercise during all three cycles and strength exercise also during the previous two. I did not feel low or depressed during these cycles.
I realize I am a scientific sample of just one. It seems likely that depression does affect exercise in a way that increases weight gain and loss of muscle mass for some men, but I’m convinced that LHRH agonists themselves contribute directly to an increased tendency to weight gain. I believe I’ve heard that the LHRH agonists slow metabolism a bit, and Dr. Myers has noticed an increased craving for carbohydrates among his patients on LHRH agonists. I’ve experienced that myself, but have tried to counter it by not giving in and by substituting other kinds of food. Insulin effects from LHRH agonists for some of us may also be a factor in weight gain.
G’day Jim. I think we are all an experiment of one! I’m on my second round of ADT — simply Zoladex — and I’m putting on some weight for sure.
BUT … on my first round I was going to the gym and went on a Weight Watchers program because I was so concerned about weight gain — and actually lost about 20 lbs!
I really should get off my backside and do something but I am finding it difficult to do that. Mentally impaired by ADT as an unkind poster termed me on a prostate cancer forum when I disagreed with zomething he said. I don’t think I’m that bad, but there is no doubt that my mental faculties change when on ADT.