Can Lifestyle Interventions Control Side Effects of ADT Treatment for Prostate Cancer?
August 23, 2010
Christian McEvoy, MPH
When I worked for one of the leading prostate cancer experts in the world at Johns Hopkins, I heard a good description of prostate cancer risk. “If a man lives long enough, he will probably get prostate cancer.” About 189,000 cases are detected each year in the US (SEER 2002 data). Prostate cancer comes in varying degrees of intensity – in other words, prostate cancer can be a very aggressive cancer, or it can be a slow-growing non-aggressive cancer. It can call for aggressive treatment, or it can call for simple watching and waiting treatment.
Androgen Deprivation Therapy (ADT) is one treatment option often employed in cases of advanced stage and grade prostate cancer. Some medical professionals and researchers have argued that ADT is overused – in other words, some have argued that ADT is used to treat less aggressive prostate cancers and those voices suggest that ADT has too many risks to be used in those less aggressive cases. Many men who undergo ADT experience quick and significant weight gain. Obesity is often associated with increased fatigue and serious co-morbidities such as diabetes and heart disease.
At the center of the debate surrounding ADT use is the question: can the side effects be controlled through lifestyle changes? A recent article published in the journal Trials announced a new study that will examine the effect of diet modification and exercise on ADT side effects, specifically weight gain. I found the proposed study interesting because the suggested lifestyle change is broken into eight simple pieces, and I thought the advice from the researchers in these eight pillars of behavior change is sage.
1) Eat at least 5 servings of fruits and vegetables per day
2) 30% of diet from good fats and less than 10% of diet should be saturated fat
3) 10% of diet from polyunsaturated fats
4) Limit consumption of processed meats
5) 25-35 grams of fiber per day
6) Minimal alcoholic drinks
7) Limited intake of high salt and high sugar food
8) Exercise (like a brisk walk) for 30 minutes at least 5 days/week
I look forward to reading about the study’s outcomes. But in the meantime, I’m going to try to implement these eight principles. I like the simplicity, and they all make sense. It’s about getting basic exercise every day, eating a controlled amount of good fats, and eating lots of green stuff.
I’ve included the abstract of the article I described below, so you can see how simply the researchers explained their proposed behavior change. Keep in mind the researchers’ goal is to improve symptoms associated with ADT use, but reducing weight gain is a good wellness goal for all survivors…actually it is a good life goal for everyone.
A randomized 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 Aug 12; 11(1): 86
Authors: Haseen F, Murray LJ, O'Neill RF, O'Sullivan JM, Cantwell MM
ABSTRACT: BACKGROUND: Treatment with Androgen Deprivation Therapy (ADT) for prostate cancer is associated with changes in body composition including increased fat and decreased lean mass; increased fatigue, and a reduction in quality of life. No study to date has evaluated the effect of dietary and physical activity modification on the side effects related to ADT. The aim of this study is to evaluate the efficacy of a 6-month dietary and physical activity intervention for prostate cancer survivors receiving ADT to minimize the changes in body composition, fatigue and quality of life, typically associated with ADT. METHODS: Men are recruited to this study if they are planned to receive ADT for at least the following 6 months. Men who are randomised to the intervention arm receive a home-based tailored intervention to meet the following guidelines a) [greater than or equal to]5 servings vegetables and fruits/day; b) 30%-35% of total energy from fat, and <10% energy from saturated fat/day; c) 10% of energy from polyunsaturated fat/day; d) limited consumption of processed meats; e) 25-35gm of fibre/day; f) alcoholic drinks [less than or equal to]28units/week; g) limited intake of foods high in salt and/or sugar. They are also encouraged to include at least 30 minutes of brisk walking, 5 or more days per week. The primary outcomes are change in body composition, fatigue and quality of life scores. Secondary outcomes include dietary intake, physical activity and perceived stress. Baseline information collected includes: socio-economic status, treatment duration, perceived social support and health status, family history of cancer, co-morbidities, medication and supplement use, barriers to change, and readiness to change their health behaviour. Data for the primary and secondary outcomes will be collected at baseline, 3 and 6 months from 47 intervention and 47 control patients. DISCUSSION: The results of this study will provide detailed information on diet and physical activity levels in prostate cancer patients treated with ADT and will test the feasibility and efficacy of a diet and physical activity intervention which could provide essential information to develop guidelines for prostate cancer patients to minimise the side effects related to ADT. Trial registration ISRCTN trial number ISCRTN75282423.
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