13 Dec Prostate Cancer: Reducing the side effects of ADT

What is Androgen Deprivation Therapy (ADT)

Prostate cancer needs male hormones (androgens such as testosterone) to thrive. This means that one of the main types of drug therapy for this disease is androgen deprivation therapy (ADT). These medications aim to reduce or block the effect of these hormones. Whilst it can be an effective treatment, reducing the amount of testosterone in a man’s body has significant side effects. Symptoms can include weight gain, loss of muscle mass and menopause-like symptoms.

It’s not all bad news. Research has shown exercise can help to reduce side effects of this treatment, without influencing the effectiveness of the drug.

Five ways that exercise can help:

1. It can help to treat excessive fatigue

Due to the decline in androgen production (ie: testosterone) and other cancer-related issues, you may notice an increase in fatigue levels. Whilst it may be counterintuitive, research shows that progressive exercise (building up to 150mins per week) is arguably the BEST medical management strategy to reduce fatigue. It’s important to learn how to regulate how much exercise you do depending on how you feel.

2. It can impact your strength and endurance

ADT and the lack of testosterone can impact day-to-day capacity and endurance. This affects your ability to do the “fun” things, like playing with grandchildren, working in the shed or catching up with friends. The great news is exercise can help! Whilst it is not new that exercise can help keep everyone feeling fit and capable, the interesting thing is that the sooner men start once ADT is commenced, the less ADT related capacity you stand to lose.

3. It improves body composition whilst on ADT

Increased abdominal fat and reduced muscle mass are typical side effects of ADT. Exercise can lessen these changes. Research shows that men who complete 2-3 sessions of progressive resistance training per week will minimise the loss in muscle mass and strength. For men taking ADT for a short time (3 months), a combination of moderate to high intensity aerobic and resistance training will help prevent changes in fat mass. However, for men are using ADT over a long period of time, they will have to also make changes with their diet to see changes in your fat mass.

4. It keeps your bones strong

Another side effect of ADT is a possible reduction in bone mineral density. This can lead to osteoporosis and bone fractures. Preliminary research shows that at least 2 sessions of resistance training per week may mitigate losses in bone density. That being said, including high impact exercises such as jumping and hopping may preserve bone more effectively. It is important to note that there are some contraindications (such as metastatic disease or musculoskeletal injury) to jumping so it is important to seek support from an exercise physiologist.

5. It reduces your risk of other diseases whilst on ADT

Due to changes in hormone levels and a combination of other factors, there’s an increased risk of developing other metabolic conditions such as type 2 diabetes, cardiovascular disease and high blood pressure in men on ADT. There is preliminary research showing that exercise elicits positive changes in blood sugar, cholesterol and triglyceride levels. In other cancer populations, exercise has been shown to protect against cardiometabolic diseases.

But wait, there’s more.

Evidence suggests that exercise may help to preserve sexual activity and libido and lessen decline in sexual function. It may also improve mood and reduce psychological distress, anxiety and depression.

Finally, observational data suggests that exercise may even improve overall lifespan reduce the risk of dying from prostate cancer. If we could put all these benefits into a pill, would you take it?

The when, where and how of exercise for men undergoing ADT

For many men, they are not exactly sure where to start. Much of the literature prescribes 2-3 resistance training exercise sessions per week, plus building up to 150 minutes of moderate intensity aerobic exercise per week. But remember – you do not want to go too hard to quickly!

For the best results, visit an accredited exercise physiologist who specialises in treating those with cancer. They can set you up with an individualized program that will give you the tools and knowledge to exercise safely and effectively.

To find an Accredited Exercise Physiologist, ask your doctor for a referral or click here to find one near you.

Holly Evans is an Accredited Exercise Physiologist at iNform Health and Fitness Solutions, and is currently completing a PHD in Exercise Oncology.

References:

Segal RJ, Reid RD, Courneya KS, Malone SC, Parliament MB, Scott CG, Venner PM, Quinney HA, Jones LW, Slovinec D’Angelo ME, Wells GA. Resistance exercise in men receiving androgen deprivation therapy for prostate cancer. Journal of Clinical Oncology. 2003 May 1;21(9):1653-9.

Cormie P, Zopf EM. Exercise medicine for the management of androgen deprivation therapy-related side effects in prostate cancer. InUrologic Oncology: Seminars and Original Investigations 2018 Nov 13. Elsevier.

Gardner JR, Livingston PM, Fraser SF. Effects of exercise on treatment-related adverse effects for patients with prostate cancer receiving androgen-deprivation therapy: a systematic review. J Clin Oncol. 2014 Feb 1;32(4):335-46.

Cormie P, Galvão DA, Spry N, Joseph D, Chee R, Taaffe DR, Chambers SK, Newton RU. Can supervised exercise prevent treatment toxicity in patients with prostate cancer initiating androgen‐deprivation therapy: a randomised controlled trial. BJU international. 2015 Feb;115(2):256-66.

Haseen F, Murray LJ, O’Neill RF, O’Sullivan JM, Cantwell MM. A randomised controlled trial to evaluate the efficacy of a 6 month dietary and physical activity intervention for prostate cancer patients receiving androgen deprivation therapy. Trials. 2010 Dec;11(1):86.