Background: ADT increases fat body mass (FBM), decreases lean body mass (LBM); and decreases bone mineral density (BMD) in men with prostate carcinoma. No data are actually available regarding the relationship between treatment-related changes in body composition and patient outcome. Methods: Using dual energy x-ray absorptiometry (DEXA) we determined BMD, FBM and LBM at baseline and after 1 and 2 years in 50 consecutive patients with high risk non metastatic prostate cancer submitted to luteinizing hormone relasing hormone analogues (LHRH-A), recruited between 1997 and 2000. Results: patient median age (range) was 71 yrs (44–83). Nineteen patients had AUA stage B disease, 27 patients stage C and 4 patients stage D1. BMD (gm/cm2) at lumbar spine [mean, 95% Confidence Interval (CI)] was 0.943 (0.874–1.013) at baseline, 0.933 (0.866–1.00) after 1 year, and 0.927 (0.863–0.991) after 2 years (p<0.03); the corresponding LBM data (gm) were 50216 (48068–52364), 49553 (47314–51791), and 49377 (47247–51507), respectively (p<0.03); while FBM data (gm) were 19463 (17143–21783), 21028 (18964–23093), and 21680 (19427–23932), respectively (p=0.000). After a median follow-up of 76 months 11 patients (22.0%) underwent adverse skeletal related events (SREs), 20 (40.0%) had PSA progression, and 22 (44.0%) died. Changes in BMD after 1 year failed to show any relationship with time to SRE onset (TTSRE), PSA recurrence and death. LBM decrease below the median change after 1 year did not correlate with either TTSRE or survival while was predictive for lower risk of PSA recurrence just failing to attain the statistical significance [Hazard Ratio (HR) 0.40, 95% CI 0.15–1.08, p=0.07]. FBM increase above the median change after 1 year was a significant predictor of higher risk of SREs [HR 5.40, 95% CI: 1.09–26.8, p<0.04], higher risk of death [HR 3.45, 95% CI: 1.29–9.23, p<0.02] and lower (not significant) risk of PSA progression [HR 2.07, 95% CI: 0.80–5.40, p=0.13]. Conclusions: this explorative analysis suggest that changes in body composition, FBM in particular, assessed by DEXA, may provide predictive information of outcome in prostate cancer patients given ADT. More mature data will be provided at the meeting.
Changes in body composition after androgen deprivation therapy (ADT) in prostate cancer patients. Relationship with disease outcome
BERRUTI, Alfredo;SAINI, Andrea;P. Perotti;TAMPELLINI, MARCO;DOGLIOTTI, Luigi
2008-01-01
Abstract
Background: ADT increases fat body mass (FBM), decreases lean body mass (LBM); and decreases bone mineral density (BMD) in men with prostate carcinoma. No data are actually available regarding the relationship between treatment-related changes in body composition and patient outcome. Methods: Using dual energy x-ray absorptiometry (DEXA) we determined BMD, FBM and LBM at baseline and after 1 and 2 years in 50 consecutive patients with high risk non metastatic prostate cancer submitted to luteinizing hormone relasing hormone analogues (LHRH-A), recruited between 1997 and 2000. Results: patient median age (range) was 71 yrs (44–83). Nineteen patients had AUA stage B disease, 27 patients stage C and 4 patients stage D1. BMD (gm/cm2) at lumbar spine [mean, 95% Confidence Interval (CI)] was 0.943 (0.874–1.013) at baseline, 0.933 (0.866–1.00) after 1 year, and 0.927 (0.863–0.991) after 2 years (p<0.03); the corresponding LBM data (gm) were 50216 (48068–52364), 49553 (47314–51791), and 49377 (47247–51507), respectively (p<0.03); while FBM data (gm) were 19463 (17143–21783), 21028 (18964–23093), and 21680 (19427–23932), respectively (p=0.000). After a median follow-up of 76 months 11 patients (22.0%) underwent adverse skeletal related events (SREs), 20 (40.0%) had PSA progression, and 22 (44.0%) died. Changes in BMD after 1 year failed to show any relationship with time to SRE onset (TTSRE), PSA recurrence and death. LBM decrease below the median change after 1 year did not correlate with either TTSRE or survival while was predictive for lower risk of PSA recurrence just failing to attain the statistical significance [Hazard Ratio (HR) 0.40, 95% CI 0.15–1.08, p=0.07]. FBM increase above the median change after 1 year was a significant predictor of higher risk of SREs [HR 5.40, 95% CI: 1.09–26.8, p<0.04], higher risk of death [HR 3.45, 95% CI: 1.29–9.23, p<0.02] and lower (not significant) risk of PSA progression [HR 2.07, 95% CI: 0.80–5.40, p=0.13]. Conclusions: this explorative analysis suggest that changes in body composition, FBM in particular, assessed by DEXA, may provide predictive information of outcome in prostate cancer patients given ADT. More mature data will be provided at the meeting.
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