Degree of loss of muscle mass among men on long-term ADT

Unsurprisingly, according to a new article in the Journal of Clinical Oncology, long-term androgen deprivation therapy (ADT) is closely associated with loss of lean muscle mass (known as sarcopenia) in men being treated for prostate cancer. However, this appears to be the first time anyone has shown there is an age-related factor that is relevant to the degree of loss of lean muscle.

Smith et al. conducted a prospective evaluation of levels of lean muscle mass in a pre-specified subset of participants in a large, randomized, controlled clinical trial of denosumab to prevent fractures in men already receiving ADT for treatment of non-metastatic prostate cancer. Their study was based on an analysis of data from 252 patients — of whom 132 had been randomized to treatment with denosumab and 120 were randomized to a placebo.

All patients were scheduled to have their lean muscle mass measured at baseline and at 12, 24, and 36 months after initiation of treatment with ADT. To be eligible for evaluation, patients had to have a baseline lean muscle mass assessment and  least one on-study assessment. In addition, patients were stratified by age (< 70 as opposed to ≥ 70 years) and by duration of ADT duration (≤ 6 as opposed to> 6 months) prior to trial enrollment.

Here are the key study findings:

  • Average (median) duration of ADT was 20.4 months at study baseline.
  • Average (mean) levels of lean muscle mass decreased significantly over time
    • By 1 percent from baseline at month 12 (in 248 evaluable patients)
    • By 2.1 percent from baseline at month 24 (in 205 evaluable patients)
    • By 2.4 percent from baseline at month 36 (in 168 evaluable patients)
  • Men ≥ 70 years of age (n= 127) had significantly greater changes in lean muscle mass than men < 70 years of age at all study time points.
    • At 36 months, lean muscle mass decreased by 2.8 percent in men age ≥ 70 years and by 0.9 percent in men < 70 years. (P = .035).
  • Prior time of exposure to ADT also affected the rate of loss of lean muscle mass during the course of the study.
    • Men with ≤ 6 months of ADT at study entry (n = 36) lost 3.7 percent of lean muscle mass.
    • Men with > 6 months of ADT at study lost only 0.9 percent of lean muscle mass.

The “New” Prostate Cancer InfoLink is actually surprised that the amount of lean muscle mass lost during the course of this study was as low as that reported. This would appear to confirm other data suggesting the importance of a good, regular exercise regimen for men on long-term ADT. Although other studies have shown loss of muscle mass over time among men with prostate cancer being treated with ADT, this study by Smith et al. appears to be a more thorough assessment of the risks than older studies.

Smith and his colleagues are careful to note that, since this study did not include a comparable group of men who did not receive ADT, it is impossible to determine how much of this loss of muscle mass is actually caused by the ADT and how much may be due to the simple fact (but complex effects) of aging.

4 Responses

  1. I’m surprised too. Last May 2 I completed 3 years of ADT, using the large-sized Zoladex shot. I noticed last week that I do not seem weaker than I did 3 years ago. The only exercise that I took was my usual walking, nearly every day for at least 35 minutes — a standard part of my shopping and walk uphill to the University. Of course this is merely subjective, so I cannot be sure.

  2. I completed a 3 year course of Zoladex injections November 2011. I was a fitness instructor of 69 years of age at time of starting 3-monthly injections and a regular 5 mile walker. I retired after the first year of injections as I found my muscle loss was affecting my ability to work out as I would expect my clients to do. I have maintained a regular workout program at a level I could cope with but my ability to walk a significant distance without a rest has increased over the last 2 years. I am now having regular massage and using pilates and callanetics to improve my muscle tone but it has not improved significantly yet. How long after my final injection can I expect to see a recovery of any significance?

  3. Dear Dave:

    Individual levels of recovery of muscle mass after 3 years of LHRH therapy are extremely difficult to predict, especially in a man of your age (because there is a natural loss of physical function associated with the aging process).

    What I can tell you is that, by maintaining a regular exercise regimen at whatever level you can reasonably manage, you will both maximize your level of good physicial health and optimize the potential to regain at least some of your lost muscle mass, but actual predictions for any one individual are just not possible. Keep doing what you are doing and make sure that your diet is one that is cloasely correlated to your exercise level.

  4. Thanks for that.

    Another point of interest. I suffered from the after-effects of radiation, called radiation proctitis, which resulted in regular loss of blood, sometimes very heavy and requiring the use of sanitary towels. The hospital treating me for cancer said the cause was burning of the colon and gave me a course of laser/burning treatment this was ineffectual and they then recommended a formaldehyde treatment, which I was not happy with.

    I was recommended to a London hospital consultant who told me the previous treatments would not work and recommended a change of diet. The diet is similar to the given to colon cancer patients, i.e., low/no high fiber foods including fruit and vegetables, plus the use of Normacol daily.
    This treatment appears to be working and i only get the odd spotting of blood now. Hope this is of help to any other sufferers.

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