Does Androgen-Deprivation Therapy Accelerate The Development Of Frailty In Older Men With Prostate Cancer? A Conceptual Review (p NA)

Main Category: Prostate / Prostate Cancer
Also Included In: Men's health;  Seniors / Aging
Article Date: 16 Dec 2007 - 0:00 PDT

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UroToday.com- Frailty in the geriatric field is defined as >3 of the following; unintentional weight loss >10 pounds in the past year, weakness measured by grip strength, slow walking speed, self-reported exhaustion, and low physical activity. Many of these toxicities occur in men receiving androgen-deprivation therapy (ADT) for prostate cancer (CaP). In addition, biomarkers such as c-reactive protein (CRP), interleukin-6 (IL-6), and tumor necrosis factor- are evidence of frailty. Frailty is associated with adverse outcomes including falls, disability, hospitalization, and death. In the online version of Cancer, Dr. Bylow and associates present the evidence that ADT accelerates the development of frailty in older men with CaP.

Hypogonadism occurs in 50-80% of men age 80 years or older and is associated with decreased bone mineral density, decreased muscle mass, increased risk of falls, and increased risk of impaired static balance. ADT is an immediate and extreme form of hypogonadism and thus the authors point out has the same associations. They reviewed the 5 criteria for frailty and whether evidence demonstrates that ADT meets the criteria.

Regarding weight loss (lean), ADT actually results in weight increase but this is due to gaining fat and losing lean muscle mass. Numerous studies support this finding and while increased inflammatory biomarkers are reported following ADT in laboratory studies, no correlative data in clinical trials is provided in this paper. Weakness is also documented in clinical studies of aging men and those undergoing ADT. While the authors cite references that biomarkers are elevated in the elderly they do not present citations of elevated biomarkers for men undergoing ADT although it seems to be a reasonable assumption. Objective measures of mobility and falls in CaP patients receiving ADT have not been reported. There is good evidence that ADT is clinically associated with patient self-reported fatigue and low physical activity.

While there is actually evidence to support that ADT adversely affects most of the criteria consistent with frailty, good level I or II evidence for mobility or biomarkers is lacking. The authors present a paper that raises the awareness of ADT as accelerating the properties of frailty. It is hypothesis generating that biomarkers may be a useful marker for following these adverse events.

Bylow K, Mohile SG, Stadler WM, Dale W

Cancer. ePub: October 24, 2007

DOI: 10.1002/cncr.23084

Reported by UroToday.com Contributing Editor Christopher P. Evans, M.D

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