Does Use of Androgen Deprivation Therapy (ADT) in Men with Prostate Cancer Increase the Risk of Sarcopenia?

Androgen deprivation therapy (ADT) for prostate cancer (PCa) can compromise muscle health. Hence, we aimed to quantify the prevalence of sarcopenia (i.e., compromised lean mass, muscle strength, and physical function) in ADT-treated (> 12 week) men (n = 70) compared to similarly aged non-ADT-treated PCa (n = 52) and healthy controls (n = 70). Lean and fat mass were quantified by dual-energy X-ray absorptiometry. Muscle strength and function were measured using handgrip dynamometry and gait speed, respectively. Sarcopenia was defined as low adjusted appendicular lean mass [ALM; height-adjusted (ALMI), body mass index-adjusted (ALM_BMI) and height and fat mass-adjusted (ALM_HFM)] with weak handgrip strength and/or slow gait speed according to the following criteria: European Working Group on Sarcopenia in Older People [EWGSOP; both 2010 (EWGSOP1) and 2018 (EWGSOP2)], Foundation for the National Institutes of Health (FNIH) and International Working Group on Sarcopenia (IWGS). Overall the prevalence of sarcopenia was low and did not differ between the three groups. Only two (3.2%) ADT-treated men presented with sarcopenia as per EWGSOP1 and FNIH criteria, whereas no cases were observed using EWGSOP2 and IWGS criteria. The prevalence of low ALM_BMI was greater in ADT-treated men (32%) compared to PCa (15%; P = 0.037) and healthy controls (7.1%; P < 0.001). Similarly, low ALM_HFM was greater in ADT-treated men (29%) compared to healthy controls only (13%; P = 0.019). There was also a low prevalence of weak muscle strength and slow gait speed (0.0-11%) in all men, with no differences between the groups. Based on these findings, an adiposity-based adjustment of ALM is recommended to quantify risk of adverse outcomes associated with ADT in these men.