Body composition, fatigue and exercise in patients with prostate cancer undergoing androgen deprivation therapy

To investigate the association between lean mass (LM) and fat mass (FM) with fatigue and vitality before and following exercise in patients with prostate cancer already undergoing androgen deprivation therapy (ADT).

Cross-sectional associations between lean and fat mass with fatigue and/or vitality measures were examined in 229 patients (43-90 years). Prospective analysis was undertaken in 129 patients who underwent 3-6 months exercise (predominantly resistance + aerobic). Whole body and appendicular LM and total and trunk FM were assessed by dual X-ray absorptiometry. Fatigue was assessed using the European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire-Core 36 (EORTC QLQ-30) and vitality using the Short Form-36.

Based on the EORTC QLQ-30, 19% of patients had clinically relevant fatigue. There was no association between LM and fatigue, however, total (p=0.013), trunk (p=0.015) and percent (p=0.008) FM were higher in fatigued than non-fatigued patients, with total and trunk FM 5.0 kg and 2.6 kg higher, respectively. For quartiles of vitality, a similar pattern emerged for FM with those in the lowest quartile of vitality having the highest FM values (p=0.014-0.034). In contrast, following exercise, change in fatigue and vitality were associated with change in total LM (r=-0.182, p=0.042 and r=0.309, p=0.001, respectively) but not FM. Patients fatigued at baseline but not fatigued following exercise gained a median of 2.1 kg (IQR 0.7-3.2) LM.

In prostate cancer patients treated with ADT, body composition is associated with fatigue, with higher total and trunk FM in those with clinically relevant fatigue. However, following exercise those no longer fatigued had an accompanying substantial increase in LM. Modifying a prostate cancer patient's body composition, both lean and fat mass, may favourably alter cancer-related fatigue levels and should be a target of exercise medicine in this population. This article is protected by copyright. All rights reserved.

BJU international. 2018 May 11 [Epub ahead of print]

Robert U Newton, Emily Jeffery, Daniel A Galvão, Carolyn McIntyre, Nigel Spry, David Joseph, Jim Denham, Dennis R Taaffe

Exercise Medicine Research Institute, Edith Cowan University, Joondalup, WA, Australia., School of Medicine and Public Health, University of Newcastle, Callaghan, NSW, Australia.