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Meta-Analysis
. 2022 Sep;25(3):491-506.
doi: 10.1038/s41391-021-00450-0. Epub 2021 Sep 6.

Supervised exercise therapy compared with no exercise therapy to reverse debilitating effects of androgen deprivation therapy in patients with prostate cancer: a systematic review and meta-analysis

Anja Ussing  1   2 , Marie-Louise Kirkegaard Mikkelsen  3 , Brigitta Rasmussen Villumsen  4 , Johnny Wejlgaard  5 , Pernille Envold Bistrup  6 , Kirsten Birkefoss  3 , Thomas Bandholm  7   8   9
Affiliations
Meta-Analysis

Supervised exercise therapy compared with no exercise therapy to reverse debilitating effects of androgen deprivation therapy in patients with prostate cancer: a systematic review and meta-analysis

Anja Ussing et al. Prostate Cancer Prostatic Dis. 2022 Sep.

Abstract

Background: Androgen deprivation therapy (ADT) in patients with prostate cancer can have several debilitating side effects. Supervised exercise is recommended to ameliorate these negative effects.

Objective: To systematically evaluate the effect of supervised exercise therapy compared to no exercise therapy in patients with prostate cancer undergoing ADT, primarily according to the patient critical outcomes, 'disease-specific quality of life' and 'walking performance' measured at end of treatment.

Methods: We searched PubMed/Medline, Embase, Cochrane Library, Cinahl and Pedro, to identify randomised controlled trials (RCTs), which investigated the effect of supervised exercise therapy compared to no exercise therapy in patients with prostate cancer receiving ADT, last search: June 2021. Two independent reviewers extracted data, and assessed risk of bias using Cochrane Risk of Bias Tool and evaluated the certainty of evidence using the GRADE-method.

Results: Eigthteen RCTs (n = 1477) comprised patients with prostate cancer stages T1-T4 were included in the meta-analyses. Compared to no exercise therapy, supervised exercise therapy showed clinically relevant improvements in 'disease-specific quality of life' and 'walking performance'. The standardised mean differences were 0.43 (95% confidence interval (CI): 0.29, 0.58) and -0.41 (95% CI: -0.60, -0.22), respectively. The overall certainty of evidence was moderate due to serious risk of bias.

Conclusions: Evidence of moderate quality shows that supervised exercise therapy probably is superior to no exercise therapy in improving 'disease-specific quality of life' and 'walking performance' in patients with prostate cancer undergoing ADT. The results apply to all patients receiving androgen deprivation therapy regardless of cancer stage. The results support a strong recommendation for supervised exercise therapy for managing side effects in this population.

Protocol registration: NKR-38-Focused-questions-PICOs-for-updating1.ashx (sst.dk).

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Conflict of interest statement

AU and MLK are employed by the Danish Health Authority who initiated and financed the conduction. AU was employed by the Parker Institute at the initiation of the study. All other authors declare no competing interests.

Figures

Fig. 1
Fig. 1. Risk of bias assessment of included trials.
Assessed by the Cochrane risk of bias tool. Green (+): indicates low risk of bias, red (-): indicates high risk of bias, yellow (?): indicates unclear risk of bias.
Fig. 2
Fig. 2. Forest plot of the critical outcome ‘disease-specific quality of life’.
ADT: androgen deprivation therapy, CI: confidence interval, df: degrees of freedom, EORTC-CLQ-C30: The European Organization for Research and Treatment EORTC core quality of life questionnaire, Fact-P: The Functional Assessment of Cancer Therapy - Prostate (range 0-156), Std: standardised.
Fig. 3
Fig. 3. Forest plot of the critical outcome ‘physical performance’ measured by walking performance.
ADT: androgen deprivation therapy, C:I confidence interval, df: degrees of freedom, Std: standardised.
See this image and copyright information in PMC

References

    1. Bray F, Ferlay J, Soerjomataram I, Siegel RL, Torre LA, Jemal A. Global cancer statistics 2018: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin. 2018;68:394–424. - PubMed
    1. Huggins C, Hodges CV. Studies on Prostatic Cancer. I. The Effect of Castration, of Estrogen and of Androgen Injection on Serum Phosphatases in Metastatic Carcinoma of the Prostate. Cancer Res. 1941;1:293. - PubMed
    1. Crawford ED, Heidenreich A, Lawrentschuk N, Tombal B, Pompeo ACL, Mendoza-Valdes A, et al. Androgen-targeted therapy in men with prostate cancer: evolving practice and future considerations. Prostate Cancer Prostatic Dis. 2019;22:24–38. doi: 10.1038/s41391-018-0079-0. - DOI - PMC - PubMed
    1. Mottet N, Cornford P, van den Bergh R, Briers E, De Santis M & Fanti Sea. EAU - EANM - ESTRO - ESUR - SIOG Guidelines on Prostate Cancer (European Association of Urology (EAU), 2020). - PubMed
    1. Pagliarulo V, Bracarda S, Eisenberger MA, Mottet N, Schröder FH, Sternberg CN, et al. Contemporary role of androgen deprivation therapy for prostate cancer. Eur Urol. 2012;61:11–25. doi: 10.1016/j.eururo.2011.08.026. - DOI - PMC - PubMed

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