Efficacy of walking exercise in promoting cognitive-psychosocial functions in men with prostate cancer receiving androgen deprivation therapy A phase III clinical trial of exercise modalities on treatment side-effects in men receiving therapy for prostate cancer A randomized trial of aerobic versus resistance exercise in prostate cancer survivors. Lifestyle changes for improving disease-specific quality of life in sedentary men on long-term androgen-deprivation therapy for advanced prostate cancer: a randomised controlled trial. Cost–effectiveness analysis comparing degarelix with leuprolide in hormonal therapy for patients with locally advanced prostate cancer Comparing eccentric resistance exercise in prostate cancer survivors on and off hormone therapy: a pilot study. Effects of Different Exercise Modalities on Fatigue in Prostate Cancer Patients Undergoing Androgen Deprivation Therapy: A Year-long Randomised Controlled Trial. Prostate cancer treatments and their side effects are associated with increased insomnia. Impact of Radiotherapy When Added to Androgen-Deprivation Therapy for Locally Advanced Prostate Cancer: Long-Term Quality-of-Life Outcomes From the NCIC CTG PR3/MRC PR07 Randomized Trial. Prevalence and predictive factors for the development of de novo psychiatric illness in patients receiving androgen deprivation therapy for prostate cancer. Health-Related Quality of Life in 536 Long-Term Prostate Cancer Survivors after Treatment with Leuprorelin Acetate: A Combined Retrospective and Prospective Analysis Quality of life following localized prostate cancer treated initially with androgen deprivation therapy or no therapy. Effects of a lifestyle intervention on endothelial function in men on long-term androgen deprivation therapy for prostate cancer Quality of Life During Treatment With Chemohormonal Therapy: Analysis of E3805 Chemohormonal Androgen Ablation Randomized Trial in Prostate Cancer. Effects of strength training on body composition, physical functioning, and quality of life in prostate cancer patients during androgen deprivation therapy A randomised controlled trial to evaluate the efficacy of a 6-month dietary and physical activity intervention for patients receiving androgen deprivation therapy for prostate cancer EAU guidelines on prostate cancer. part 1: screening, diagnosis, and local treatment with curative intent-update 2013. Pilot trial of adjuvant paclitaxel plus androgen deprivation for patients with high-risk prostate cancer after radical prostatectomy: results on toxicity, side effects and quality-of-life 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 Exercise effects on adipokines and the IGF axis in men with prostate cancer treated with androgen deprivation: A randomized study. EAU guidelines on prostate cancer. Part 1: screening, diagnosis, and treatment of clinically localised disease. Physical activity for men receiving androgen deprivation therapy for prostate cancer: benefits from a 16-week intervention Age and androgen-deprivation therapy on exercise outcomes in men with prostate cancer Transperineal prostate brachytherapy, using I-125 seed with or without adjuvant androgen deprivation, in patients with intermediate-risk prostate cancer: study protocol for a phase III, multicenter, randomized, controlled trial The impact of hormonal therapy on sexual quality of life in men receiving intensity modulated radiation therapy for prostate cancer. Physical Function in Men With Prostate Cancer on Androgen Deprivation Therapy Bone loss after initiation of androgen deprivation therapy in patients with prostate cancer. Androgen-deprivation therapy in prostate cancer and cardiovascular risk: a science advisory from the American Heart Association, American Cancer Society, and American Urological Association: endorsed by the American Society for Radiation Oncology.
Background Prostate cancer is the most commonly diagnosed non-melanoma cancer among men .  And rogen deprivation therapy ( ADT ) has been the core therapy for men with advanced prostate cancer . It is only in recent years that clinicians began to recognize the cognitive-psychosocial side effects from ADT , which significantly compromise the quality of life of prostate cancer survivors . The objectives of the study are to determine the efficacy of a simple and accessible home-based , walking exercise program in promoting cognitive and psychosocial functions of men with prostate cancer receiving ADT . Methods A 6-month prospect i ve , single-blinded , r and omized controlled trial will be conducted to compare the Exercise Group with the Control Group .  Twenty men with prostate cancer starting ADT will be recruited and r and omly assigned to one of the two groups : the Exercise Group will receive instructions in setting up an individualized 6-month home-based , walking exercise program , while the Control Group will receive st and ard medical advice from the attending physician . The primary outcomes will be psychosocial and cognitive functions . Cognitive functions including memory , attention , working memory , and executive function will be assessed using a battery of neurocognitive tests at baseline and 6 months . Psychosocial functions including depression , anxiety and self-esteem will be assessed at baseline , 3 and 6 months using the Center for Epidemiological Studies Depression Scale , Spielberger State-Trait Anxiety Inventory , and Rosenberg Self-Esteem Scale . Discussion The significance of the cognitive-psychosocial side effects of ADT in men with prostate cancer has only been recently recognized , and the management remains unclear . This study addresses this issue by design ing a simple and accessible home-based , exercise program that may potentially have significant impact on reducing the cognitive and psychosocial side effects of ADT , and ultimately improving the health-related quality of life in men with prostate cancer receiving ADT.Trial registration Background And rogen deprivation therapy ( ADT ) is accompanied by a number of adverse side effects including reduced bone mass and increased risk for fracture , reduced lean mass and muscle strength , mood disturbance and increased fat mass compromising physical functioning , independence , and quality of life . The purpose of this investigation is to examine the effects of long term exercise on reversing musculoskeletal-related side effects , and cardiovascular and diabetes risk factors in men receiving and rogen deprivation for their prostate cancer . Specifically , we aim to investigate the effects of a 12-month exercise program design ed to load the musculoskeletal system and reduce cardiovascular and diabetes disease progression on the following primary endpoints : 1 ) bone mineral density ; 2 ) cardiorespiratory function and maximal oxygen capacity ; 3 ) body composition ( lean mass and fat mass ) ; 4 ) blood pressure and cardiovascular function ; 5 ) lipids and glycemic control ; and 6 ) quality of life and psychological distress . Methods / Design Multi-site r and omized controlled trial of 195 men ( 65 subjects per arm ) undergoing treatment for prostate cancer involving ADT in the cities of Perth and Brisbane in Australia . Participants will be r and omized to ( 1 ) resistance/impact loading exercise , ( 2 ) resistance/cardiovascular exercise groups and ( 3 ) usual care/delayed exercise . Participants will then undergo progressive training for 12 months . Measurements for primary and secondary endpoints will take place at baseline , 6 and 12 months ( end of the intervention ) . Discussion The principal outcome of this project will be the determination of the strength of effect of exercise on the well established musculoskeletal , cardiovascular and insulin metabolism side effects of and rogen deprivation in prostate cancer patients . As this project is much longer term than previous investigations in the area of exercise and cancer , we will gain knowledge as to the continuing effects of exercise in this patient population specifically targeting bone density , cardiovascular function , lean and fat mass , physical function and falls risk as primary study endpoints . In terms of advancement of prostate cancer care , we expect dissemination of the knowledge gained from this project to reduce fracture risk , improve physical and functional ability , quality of life and ultimately survival rate in this population . Clinical Trial RegistryA Phase III clinical trial of exercise modalities on treatment side-effects in men receiving therapy for prostate cancer ; And rogen-deprivation therapy ( ADT ) for prostate cancer ( PCa ) has side effects that significantly impair health-related quality of life ( HRQOL ) . Exercise ameliorates many side effects of ADT , but different modalities , particularly in the home-based setting , have not been well studied . In this study the authors r and omly assigned 66 PCa survivors receiving ADT to 6 mo of home-based aerobic or resistance training .  Psychosocial well-being and physical fitness were measured at baseline , 3 and 6 mo , and then 6 mo postintervention . Intention-to-treat analyses showed that fatigue and HRQOL were not significantly different between groups ; however , in a per- protocol analysis the resistance-exercise training group demonstrated clinical ly significant improvements in HRQOL . Differential within-group effects on physical fitness were also observed at various time points . At all time points , the aerobic-training group engaged in significantly more physical activity than the resistance-training group , a finding that should be further examined given evidence -based guidelines for activity volume in cancer survivors BACKGROUND Prostate cancer is a key driver of cancer-related global disability-adjusted life-years . And rogen-deprivation therapy ( ADT ) for advanced disease is linked to fatigue , reduced physical function , and quality of life ( QoL ) . OBJECTIVE To evaluate the effect of a lifestyle intervention on disease-specific QoL , diastolic blood pressure , and cancer-related fatigue in sedentary men receiving long-term ADT for advanced prostate cancer . DESIGN , SETTING , AND PARTICIPANTS A total of 100 hundred sedentary men with locally advanced or metastatic prostate cancer on long-term ADT were r and omised to an intervention or usual care group . INTERVENTION A 12-wk lifestyle intervention consisting of aerobic and resistance exercise with parallel dietary advice . OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS Disease-specific QoL was measured using the Functional Assessment of Cancer Therapy-Prostate ( FACT-P ) and Functional Assessment of Cancer Therapy-Fatigue ( FACT-F ) question naires at 12 wk postintervention and at 6 mo following withdrawal of support . Analysis of covariance and mixed regression were conducted . RESULTS AND LIMITATIONS Clinical ly relevant improvements in FACT-P were seen at 12 wk in the intervention group compared with controls ( mean difference : 8.9 points ; 95 % confidence interval [ CI ] , 3.7 - 14.2 ; adjusted p=0.001 ) . No difference was apparent at 6 mo ( mean difference : 3.3 points ; 95 % CI , -2.6 to 9.3 ; adjusted p=0.27 ) . No difference in diastolic blood pressure was seen at either follow-up ( all p > 0.05 ) . Clinical ly relevant improvements in FACT-F were seen at 12 wk ( mean difference : 5.3 points ; 95 % CI , 2.7 - 7.9 ; adjusted p<0.001 ) and maintained following withdrawal of supervision ( mean difference : 3.9 points ; 95 % CI , 1.1 - 6.8 ; adjusted p=0.007 ) . Improvements in exercise tolerance and behaviour were maintained at 6 mo ( adjusted p<0.001 and 0.038 ) . CONCLUSIONS A lifestyle intervention result ed in a clinical ly meaningful improvement in disease-specific QoL that was not maintained postintervention . No effect on blood pressure occurred . Durability of response was seen in fatigue and exercise behaviour . Further evaluation of support structures is essential . TRIAL REGISTRATION IS RCT N88605738 Degarelix , approved in the USA in 2008 , is a gonadotropin-releasing hormone antagonist , representing one of the latest additions to and rogen deprivation therapy ( ADT ) . ADT is used as first-line therapy for locally advanced or metastatic prostate cancer with the aim to reduce testosterone to castrate levels . Like other gonadotropin-releasing hormone-antagonists , degarelix treatment results in rapid decrease in luteinizing hormone , follicle-stimulating hormone and testosterone levels without the associated risk of flare . Using one registration trial for degarelix with leuprolide as the active control , a cost – effectiveness analysis with a Markov model and a 20-year time horizon found the incremental cost – effectiveness ratio for degarelix to be US$ 245/ quality -adjusted life years . Degarelix provides a cost-effective treatment for ADT among patients with locally advanced prostate cancer OBJECTIVES To determine the feasibility of an eccentric resistance exercise training protocol in men with prostate cancer and to assess whether men with prostate cancer who are receiving and rogen deprivation therapy ( ADT ) have a blunted effect from the training as compared with prostate cancer survivors not receiving ADT . DESIGN Prospect i ve pilot study . SETTING Academic medical center . PARTICIPANTS Sixteen men with prostate cancer ( Gleason scores 3 + 3 to 4 + 4 ) were initially enrolled . Ten men ( mean age 66 , range 48 - 86 ) completed the study , 5 were currently receiving ADT . Analysis was performed on these 10 men . INTERVENTIONS Subjects were evaluated at baseline . All men underwent a 12-week resistance exercise training protocol using a recumbent , high-force eccentric , leg cycle ergometer 3 times per week at a " somewhat hard " perceived exertion for 12 to 15 minutes . Preexercise and postexercise training changes were examined within and between groups . MAIN OUTCOME MEASURES Quadriceps muscle volume ( magnetic resonance imaging ) , isometric knee extension strength , functional mobility ( Timed Up and Go Test [ TUG ] and 6-minute walk [ 6MW ] ) , health-related quality of life ( FACT-P ) , and fatigue ( FACIT-fatigue scale ) . RESULTS The ADT group demonstrated significant within-group improvements in the 6MW ( P = .01 ) and isometric knee extension strength ( P = .03 ) . This group also demonstrated a clinical ly relevant change in the FACT-P ; however , this did not meet statistical significance . The  non-ADT  group demonstrated significant within-group improvements in the physical subscale of the FACT-P ( P = .03 ) and an increase in muscle volume ( P = .04 ) . Their improvements in the TUG approached significance ( P = .08 ) . No between-group differences existed . CONCLUSIONS Eccentric resistance exercise was well tolerated , and both groups derived some benefits in strength and functional mobility .  Men receiving ADT  did not appear to have a blunted response to the exercise as compared with prostate cancer survivors not receiving ADT BACKGROUND Physical exercise mitigates fatigue during and rogen deprivation therapy ( ADT ) ; however , the effects of different exercise prescriptions are unknown . OBJECTIVES To determine the long-term effects of different exercise modes on fatigue in prostate cancer patients undergoing ADT . DESIGN , SETTING , AND PARTICIPANTS Between 2009 and 2012 , 163 prostate cancer patients aged 43 - 90 y on ADT were r and omised to exercise targeting the musculoskeletal system ( impact loading+resistance training ; ILRT ; n=58 ) , the cardiovascular and muscular systems ( aerobic+resistance training ; ART ; n=54 ) , or to usual care/delayed exercise ( DEL ; n=51 ) for 12 mo across university-affiliated exercise clinics in Australia . INTERVENTION Supervised ILRT for 12 mo , supervised ART for 6 mo followed by a 6-mo home program , and DEL received a printed booklet on exercise information for 6 mo followed by 6-mo stationary cycling exercise . OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS Fatigue was assessed using the European Organisation for Research and Treatment of Cancer Quality of Life Question naire-Core 36 and vitality using the Short Form-36 . Analysis of variance was used to compare outcomes for groups at 6 mo and 12 mo . RESULTS AND LIMITATIONS Fatigue was reduced ( p=0.005 ) in ILRT at 6 mo and 12 mo ( ∼5 points ) , and in ART ( p=0.005 ) and DEL ( p=0.022 ) at 12 mo . Similarly , vitality increased for all groups ( p≤0.001 ) at 12 mo ( ∼4 points ) . Those with the highest levels of fatigue and lowest vitality improved the most with exercise ( ptrend<0.001 ) . A limitation was inclusion of mostly well-functioning individuals . CONCLUSIONS Different exercise modes have comparable effects on reducing fatigue and enhancing vitality during ADT . Patients with the highest levels of fatigue and lowest vitality had the greatest benefits . PATIENT SUMMARY We compared the effects of different exercise modes on  fatigue in men on and rogen deprivation therapy . All exercise programs  reduced fatigue and enhanced vitality . We conclude that undertaking some form of exercise will help reduce fatigue , especially in those who are the most fatigued OBJECTIVE Between 25 % and 40 % of prostate cancer patients report insomnia symptoms . Although a possible role of and rogen deprivation therapy ( ADT ) and radiation therapy ( RTH ) and some of their side effects have been postulated , this issue has rarely been investigated . This study aim ed to ( 1 ) compare the evolution of insomnia symptoms and somatic symptoms , which may affect sleep quality ( i.e. , hot flashes , night sweats , and urinary symptoms ) , in patients receiving combined ADT and RTH with that in patients receiving RTH only and ( 2 ) assess the mediating role of somatic symptoms in the relationship of ADT and RTH with insomnia symptoms . METHODS Sixty men scheduled to receive RTH for prostate cancer , with ( n = 28 ) or without ( n = 32 ) ADT  , were assessed prior to receiving any treatment ( baseline ) and at seven additional times over 16 months ( 1 , 2 , 4 , 6 , 8 , 12 , and 16 months ) using the Insomnia Severity Index and the Physical Symptoms Question naire . RESULTS A significant interaction effect was found indicating an increase in insomnia scores in ADT-RTH patients at 2 , 4 , and 6 months , as compared with baseline , and stable scores in RTH patients . A significant mediating role of hot flashes and night sweats was found in the relationship between ADT and insomnia symptoms . The relationship with RTH was also significantly mediated by these two symptoms albeit more strongly by excessive urinary frequency . CONCLUSIONS And rogen deprivation therapy is associated with an increased risk for insomnia , and side effects of ADT and RTH appear to play a role in the development of insomnia in this population PURPOSE The NCIC CTG PR3/MRC PR07 r and omized phase III trial compared and rogen-deprivation therapy ( ADT ) alone versus ADT with radiotherapy ( RT ) for patients with locally advanced prostate cancer . This article reports the health-related quality -of-life ( HRQOL ) outcomes of this trial . PATIENTS AND METHODS A total of 1,205 patients were r and omly allocated to either ADT alone or ADT with RT .  HRQOL was assessed at baseline and every 6 months thereafter using the European Organisation for Research and Treatment of Cancer Core Question naire and a prostate cancer-specific checklist or the Functional Assessment of Cancer Therapy-Prostate question naire . Mean changes from baseline scores for five function domains and nine symptom domains were analyzed as those most relevant to ADT and RT . The proportions of patients with improved , stable , or worsened HRQOL scores according to instrument-specific minimal important differences were calculated . RESULTS Baseline question naires were completed by 1,028 patients ( 88 % ) . At 6 months , RT had a statistically significant impact on mean score for bowel symptoms ( P = .02 ) , diarrhea ( P < .001 ) , urinary function ( P = .003 ) , and erectile dysfunction ( P = .008 ) ; by 3 years , however , there were no significant between-group differences in any domain . Generalized linear mixed modeling revealed no significant between-arm differences in any of the function scales but showed significant deterioration in both arms over time for Functional Assessment of Cancer Therapy-Prostate total score , treatment outcome index , and physical and functional well-being . CONCLUSION The addition of RT to ADT for patients with locally advanced prostate cancer significantly improved overall survival and had only modest and transient negative impact on relevant domains of HRQOL OBJECTIVE And rogen deprivation therapy ( ADT ) remains a widely utilized modality for treatment of localized and advanced prostate cancer . While ADT-induced alterations in testosterone have demonstrated impacts on quality of life , the effects on mental health remain ill-defined . We investigated the prevalence of de novo psychiatric illness and predictive factors following ADT induction for prostate cancer . MATERIAL S AND METHODS We retrospectively review ed patients receiving ADT for prostate cancer at our institution between 1/1989 - 7/2005 , excluding men receiving only neoadjuvant ADT .  Variables included age , race , body mass index , prostate-specific antigen ( PSA ) , Gleason sum , clinical stage , ADT type ( medical/surgical ) and schedule ( continuous/intermittent ) , and presence of pre-ADT and newly diagnosed psychiatric illness . The cohort was divided into three groups for analysis : pre-ADT psychiatric illness , de novo psychiatric illness , and no psychiatric illness . Data analysis utilized statistical software with p < 0.05 considered significant . RESULTS Three-hundred and ninety-five patients with a mean age of 71.7 years at ADT initiation were analyzed . Thirty-four men ( 8.6 % ) were diagnosed with pre-ADT psychiatric illness .  At mean follow-up of 87.4 months , 101 ( 27.9 % ) men were diagnosed with de novo psychiatric illness , most commonly including : depression ( n = 57 ; 56.4 % ) , dementia ( n = 14 ; 13.9 % ) , and anxiety ( n = 9 ; 8.9 % ) . On multivariate analysis , increasing pre-ADT PSA was predictive of post-ADT anxiety ( p = 0.01 ) . Overall and disease-specific survival outcomes were similar between groups . CONCLUSIONS De novo psychiatric illness was identified in 27.9 % of men . While no predictive factors were identified for de novo psychiatric illness , increasing PSA was associated with de novo anxiety . Prospect i ve investigation using vali date d instruments is requisite to further delineate the relationship between ADT and psychiatric health Introduction : We investigated the health-related quality of life ( HRQoL ) of long-term prostate cancer patients who received leuprorelin acetate in microcapsules ( LAM ) for and rogen-deprivation therapy ( ADT ) . Methods : The observational study was carried out by 30 office-based German urologists in 536 prostate cancer ( PCa ) patients treated for ≥5 years with LAM and in 116 patients of an age-matched control group ( CG ) . Data on HRQoL and health status was collected prospect ively using vali date d question naires QLQ-C30 , QLQ-PR25 and Karnofsky Index . Data on effectiveness ( clinical response , prostate specific antigen [ PSA ] , testosterone ) and safety was collected retrospectively from patients ' health records . We used descriptive statistics to analyze the data . Results : The mean treatment duration was 8.6 years ( range 4.5 - 19.8 years ) . General health status ( QLQ-C30 ) was comparable for both groups . Differences were observed regarding physical - and role functioning . ADT patients rated single items slightly worse than CG . Karnofsky-Index showed comparable high values ( median of 90 % ) . QLQ-PR25 revealed more PCa-related symptoms for ADT patients . Within 6 months , median PSA level declined > 90 % and median testosterone levels declined below castration level from 4.0 to 0.2 ng/mL. Clinical response ( European Organisation for Research and Treatment of Cancer criteria ) was observed in at least 90 % of ADT patients . Conclusions : Long-term ADT with LAM is a well-accepted , tolerated , effective , and low-burden treatment option for patients with advanced , hormone-sensitive PCa BACKGROUND Many men diagnosed with clinical ly localized prostate cancer are initially treated conservatively , receiving neither surgery nor radiotherapy for the first year . Treatment patterns and quality -of-life outcomes have not been previously reported for a population -based sample of such men . METHODS A population -based r and om sample of men ( n = 661 ) from six geographic regions who had been newly diagnosed with clinical ly localized prostate cancer from 1994 through 1995 were followed for up to 1 year . Eligible subjects received neither surgery nor radiotherapy within 1 year of initial diagnosis . We assessed disease-specific and generic quality -of-life outcomes in men receiving and rogen deprivation therapy ( ADT )  compared with men receiving no therapy . All statistical tests were two-sided . RESULTS Two hundred and forty-five study patients received ADT  and the remaining 416 patients received  no therapy . Approximately two thirds of the patients ( n = 159 ) receiving ADT had either baseline Gleason scores greater than six or serum prostate-specific antigen values above 20 ng/mL. Among men who were sexually potent before diagnosis ( ADT = 88 patients ; no therapy = 223 patients ) , 80 % of those on ADT reported being impotent after 1 year compared with 30 % of those receiving no treatment ( P < .001 ) . Patients receiving ADT reported more physical discomfort 1 year after diagnosis than did men who had received no therapy . However , patients receiving ADT , compared with those receiving no therapy , were more likely to be satisfied with their treatment decision ( 56 % pleased versus 45.3 % ; P = .001 ) . Patients on ADT also experienced a statistically significant decline in vitality , but not in physical function , after adjustment for the confounding factors ( P = .05 ) . CONCLUSION ADT is a commonly used primary therapy for clinical ly localized prostate cancer . Therefore , men considering ADT as an initial treatment should be aware that sexual function and some aspects of physical well-being are likely to be affected in the first year following this treatment Background : Treatment of prostate cancer with and rogen deprivation therapy ( ADT ) is associated with metabolic changes that have been linked to an increase in cardiovascular risk . Methods : This r and omised controlled trial investigated the effects of a 12-week lifestyle intervention that included supervised exercise training and dietary advice on markers of cardiovascular risk in 50 men on long-term ADT recruited to an on-going study investigating the effects of such a lifestyle intervention on quality of life . Participants were r and omly allocated to receive the intervention or usual care . Cardiovascular outcomes included endothelial function ( flow-mediated dilatation ( FMD ) of the brachial artery ) , blood pressure , body composition and serum lipids . Additional outcomes included treadmill walk time and exercise and dietary behaviours . Outcomes were assessed before r and omisation ( baseline ) , and 6 , 12 and 24 weeks after r and omisation . Results : At 12 weeks , the difference in mean relative FMD was 2.2 % ( 95 % confidence interval ( CI ) 0.1–4.3 , P=0.04 ) with an effect size of 0.60 ( 95 % CI < 0.01–1.18 ) favouring the intervention group . Improvements in skeletal muscle mass , treadmill walk time and exercise behaviour also occurred in the intervention group over that duration ( P<0.05 ) . At 24 weeks , only the difference in treadmill walk time was maintained . Conclusions : This study demonstrates that lifestyle changes can improve endothelial function in men on long-term ADT for prostate cancer . The implication s for cardiovascular health need further investigation in larger studies over longer duration Purpose Chemohormonal therapy with docetaxel and and rogen deprivation therapy ( ADT+D ) for metastatic hormone-sensitive prostate cancer improves overall survival as compared with and rogen deprivation therapy ( ADT ) alone . We compared the quality of life ( QOL ) between patients with metastatic hormone-sensitive prostate cancer who were treated with ADT+D and those who were treated with ADT alone .  Methods Men were r and omly assigned to ADT+ D ( six cycles ) or to ADT alone .  QOL was assessed by Functional Assessment of Cancer Therapy-Prostate ( FACT-P ) , FACT-Taxane , Functional Assessment of Chronic Illness Therapy-Fatigue , and the Brief Pain Inventory at baseline and at 3 , 6 , 9 , and 12 months . The  Wilcoxon signed rank test  was used to examine changes over time . Mixed-effect models compared the QOL between arms at each time point . Results Seven hundred ninety men were r and omly assigned ( ADT+D [ n = 397 ] and ADT [ n = 393 ] ) and completed FACT-P ( 90 % at baseline , 86 % at 3 months , 83 % at 6 months , 78 % at 9 months , and 77 % at 12 months ) . ADT+D patients reported a statistically significant decline in FACT-P at 3 months ( P < .001 ) but FACT-P did not differ significantly between baseline and 12 months ( P = .38 ) . ADT+D  FACT-P scores were significantly lower at 3 months ( P = .02 ) but significantly higher at 12 months ( P = .04 ) when compared with ADT FACT-P scores . Differences did not exceed the minimal clinical ly important difference at any time point . ADT+D patients reported significantly lower Functional Assessment of Chronic Illness Therapy-Fatigue scores at 3 months than did ADT patients ( P < .001 ) . Over time , both arms reported significantly poorer FACT-Taxane scores ( P < .001 ) when compared with baseline . Brief Pain Inventory scores were similar between arms . Conclusion Although ADT+D was associated with statistically worse QOL at 3 months , QOL was better at 12 months for ADT+D patients than for ADT patients . Both arms reported a similar minimally changed QOL over time , suggesting that ADT+D is not associated with a greater long-term negative impact on QOL Background . And rogen deprivation therapy ( ADT ) increases survival rates in prostate cancer ( PCa ) patients with locally advanced disease , but is associated with side effects that may impair daily function . Strength training may counteract several side effects of ADT , such as changes in body composition and physical functioning , which in turn may affect health-related quality of life ( HRQOL ) . However , additional r and omised controlled trials are needed to exp and this knowledge . Material and methods . Fifty-eight PCa patients on ADT were r and omised to either 16 weeks of high-load strength training ( n = 28 ) or usual care ( n = 30 ) . The primary outcome was change in total lean body mass ( LBM ) assessed by dual x-ray absorptiometry ( DXA ) . Secondary outcomes were changes in regional LBM , fat mass , and areal bone mineral density ( aBMD ) measured by DXA ; physical functioning assessed by 1-repetition maximum ( 1RM ) tests , sit-to-st and test , stair climbing test and Shuttle walk test ; and HRQOL as measured by the European Organization for the Research and Treatment of Cancer Quality of Life Question naire Core 30 . Results and Conclusion . No statistically significant effect of high-load strength training was demonstrated on total LBM ( p = 0.16 ) , but significant effects were found on LBM in the lower and upper extremities ( 0.49 kg , p < 0.01 and 0.15 kg , p < 0.05 , respectively ) . Compared to usual care , high-load strength training showed no effect on fat mass , aBMD or HRQOL , but beneficial effects were observed in all 1RM tests , sit-to-st and test and stair climbing tests . Adherence to the training program was 88 % for lower body exercises and 84 % for upper body exercises . In summary , high-load strength training improved LBM in extremities and physical functioning , but had no effect on fat mass , aBMD , or HRQOL in PCa patients on ADT Purpose Treatment of prostate cancer with and rogen deprivation therapy ( ADT ) is associated with an increased fat mass , decreased lean mass , increased fatigue and a reduction in quality of life ( QoL ) . The aim of this study was to evaluate the efficacy of a 6-month dietary and physical activity intervention for prostate cancer patients receiving ADT , to help minimise these side effects . Methods Patients ( n = 94 ) were recruited to this study if they were planned to receive ADT for prostate cancer for at least 6 months . Men r and omised to the intervention arm received a dietary and exercise intervention , commensurate with UK healthy eating and physical activity recommendations . The primary outcome of interest was body composition ; secondary outcomes included fatigue , QoL , functional capacity , stress and dietary change . Results The intervention group had a significant ( p < 0.001 ) reduction in weight , body mass index and percentage fat mass compared to the control group at 6 months ; the between-group differences were −3.3 kg ( 95 % confidence interval ( 95 % CI ) −4.5 , −2.1 ) , −1.1 kg/m2 ( 95 % CI −1.5 , −0.7 ) and −2.1 % ( 95 % CI −2.8 , −1.4 ) , respectively , after adjustment for baseline values . The intervention result ed in improvements in functional capacity ( p < 0.001 ) and dietary intakes but did not significantly impact fatigue , QoL or stress scores at endpoint . Conclusions A 6-month diet and physical activity intervention can minimise the adverse body composition changes associated with ADT . Implication s for Cancer SurvivorsThis study shows that a pragmatic lifestyle intervention is feasible and can have a positive impact on health behaviours and other key outcomes in men with prostate cancer receiving ADT CONTEXT The most recent summary of the European Association of Urology ( EAU ) guidelines on prostate cancer ( PCa ) was published in 2011 . OBJECTIVE To present a summary of the 2013 version of the EAU guidelines on screening , diagnosis , and local treatment with curative intent of clinical ly organ-confined PCa . EVIDENCE ACQUISITION A literature review of the new data emerging from 2011 to 2013 has been performed by the EAU PCa guideline group . The guidelines have been up date d , and levels of evidence and grade s of recommendation have been added to the text based on a systematic review of the literature , which included a search of online data bases and bibliographic review s. EVIDENCE SYNTHESIS A full version of the guidelines is available at the EAU office or online ( www.uroweb.org ) . Current evidence is insufficient to warrant widespread population -based screening by prostate-specific antigen ( PSA ) for PCa . Systematic prostate biopsies under ultrasound guidance and local anesthesia are the preferred diagnostic method . Active surveillance represents a viable option in men with low-risk PCa and a long life expectancy . A biopsy progression indicates the need for active intervention , whereas the role of PSA doubling time is controversial . In men with locally advanced PCa for whom local therapy is not m and atory , watchful waiting ( WW ) is a treatment alternative to and rogen-deprivation therapy ( ADT ) , with equivalent oncologic efficacy . Active treatment is recommended mostly for patients with localized disease and a long life expectancy , with radical prostatectomy ( RP ) shown to be superior to WW in prospect i ve r and omized trials . Nerve-sparing RP is the approach of choice in organ-confined disease , while neoadjuvant ADT provides no improvement in outcome variables . Radiation therapy should be performed with ≥ 74 Gy in low-risk PCa and 78 Gy in intermediate- or high-risk PCa . For locally advanced disease , adjuvant ADT for 3 yr results in superior rates for disease-specific and overall survival and is the treatment of choice . Follow-up after local therapy is largely based on PSA and a disease-specific history , with imaging indicated only when symptoms occur . CONCLUSIONS Knowledge in the field of PCa is rapidly changing . These EAU guidelines on PCa summarize the most recent findings and put them into clinical practice . PATIENT SUMMARY A summary is presented of the 2013 EAU guidelines on screening , diagnosis , and local treatment with curative intent of clinical ly organ-confined prostate cancer ( PCa ) . Screening continues to be done on an individual basis , in consultation with a physician . Diagnosis is by prostate biopsy . Active surveillance is an option in low-risk PCa and watchful waiting is an alternative to and rogen-deprivation therapy in locally advanced PCa not requiring immediate local treatment . Radical prostatectomy is the only surgical option . Radiation therapy can be external or delivered by way of prostate implants . Treatment follow-up is based on the PSA level Therapeutic strategy remains unclear with no clear consensus for men with high-risk prostate cancer ( PCa ) after radical prostatectomy . We aim ed to evaluate into a prospect i ve r and omized trial the effectiveness and feasibility of adjuvant weekly paclitaxel combined with and rogen deprivation therapy ( ADT ) in these patients . A total of 47 patients with high-risk PCa were r and omized 6 weeks after radical prostatectomy : ADT alone versus combination of ADT and weekly paclitaxel .  Toxicity , quality -of-life and functional results were compared between the two arms . All 23 patients completed eight cycles of paclitaxel .  Toxicity was predominantly of grade 1–2 severity . There were no differences in EORTC QLQ-C30 scores between the two groups and between baseline and last assessment at 24 months after surgery . Urinary continence was complete at 1 year after surgery for all patients and no significant differences were noted at each assessment between the two groups . The interim analysis of this trial confirms the feasibility of weekly paclitaxel in combination with ADT in men at high-risk PCa with curative intent . This adjuvant combined therapy does not alter quality -of-life and continence recovery after surgery plus ADT . A larger cohort is awaited to determine the oncological outcomes of this strategy Background Treatment with And rogen 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 minimise the changes in body composition , fatigue and quality of life , typically associated with ADT . Methods Men are recruited to this study if their treatment plan is to receive ADT for at least 6 months . Men who are r and omised to the intervention arm receive a home-based tailored intervention to meet the following guidelines a ) ≥ 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 - 35 gm of fibre/day ; f ) alcoholic drinks ≤ 28 units/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 IS RCT N trial number BACKGROUND And rogen deprivation therapy ( ADT ) has significant deleterious effects on body composition that may be accompanied by unfavourable changes in adipokine levels . While exercise has been shown to improve a number of side effects associated with ADT for prostate cancer , no studies have assessed the effect of exercise on adiponectin and leptin levels , which have been shown to alter the mitogenic environment . METHODS Twenty-six men with prostate cancer treated with ADT were r and omized to home-based aerobic exercise training or resistance exercise training for 24 weeks . Adiponectin , leptin , insulin-like growth factor 1 ( IGF-1 ) , insulin-like growth factor binding protein 3 ( IGFBP-3 ) were analyzed by ELISA ( enzyme-linked immunosorbent assay ) , in addition to physical activity volume , peak aerobic capacity , and anthropometric measurements , at baseline , 3 months and 6 months . RESULTS Resistance exercise significantly reduced IGF-1 after 3 months ( p = 0.019 ) ; however , this change was not maintained at 6 months . At 6 months , IGFBP-3 was significantly increased compared to baseline for the resistance training group ( p = 0.044 ) . In an exploratory analysis of all exercisers , favourable changes in body composition and aerobic fitness were correlated with favourable levels of leptin , and favourable leptin : adiponectin and IGF-1:IGFBP-3 ratios at 3 and 6 months . CONCLUSIONS Home-based exercise is correlated with positive changes in adipokine levels and the IGF-axis that may be related to healthy changes in physical fitness and body composition . While the improvements of adipokine markers appear to be more apparent with resistance training compared to aerobic exercise , these findings must be considered cautiously and require replication from larger r and omized controlled trials to clarify the role of exercise on adipokines and IGF-axis proteins for men with prostate cancer OBJECTIVE Our aim was to present a summary of the 2010 version of the European Association of Urology ( EAU ) guidelines on the screening , diagnosis , and treatment of clinical ly localised cancer of the prostate ( PCa ) . METHODS The working panel performed a literature review of the new data emerging from 2007 to 2010 . The guidelines were up date d , and level of evidence and grade of recommendation were added to the text based on a systematic review of the literature , which included a search of online data bases and bibliographic review s. RESULTS A full version is available at the EAU office or Web site ( www.uroweb.org ) . Current evidence is insufficient to warrant widespread population -based screening by prostate-specific antigen ( PSA ) for PCa . A systematic prostate biopsy under ultrasound guidance and local anaesthesia is the preferred diagnostic method . Active surveillance represents a viable option in men with low-risk PCa and a long life expectancy .  PSA doubling time in <3 yr or a biopsy progression indicates the need for active intervention . In men with locally advanced PCa in whom local therapy is not m and atory , watchful waiting ( WW ) is a treatment alternative to and rogen-deprivation therapy ( ADT ) with equivalent oncologic efficacy . Active treatment is mostly recommended for patients with localised disease and a long life expectancy with radical prostatectomy ( RP ) shown to be superior to WW in a prospect i ve r and omised trial . Nerve-sparing RP represents the approach of choice in organ-confined disease ; neoadjuvant and rogen deprivation demonstrates no improvement of outcome variables . Radiation therapy should be performed with at least 74 Gy and 78 Gy in low-risk and intermediate/high-risk PCa , respectively . For locally advanced disease , adjuvant ADT for 3 yr results in superior disease-specific and overall survival rates and represents the treatment of choice . Follow-up after local therapy is largely based on PSA , and a disease-specific history with imaging is indicated only when symptoms occur . CONCLUSIONS The knowledge in the field of PCa is rapidly changing . These EAU guidelines on PCa summarise the most recent findings and put them into clinical practice Goals of workProstate cancer patients receiving and rogen deprivation therapy ( ADT )  are vulnerable to a number of potentially debilitating side effects , which can significantly impact quality of life . The role of alternate therapies , such as physical activity ( PA ) , in attenuating these side effects is largely understudied for such a large population . Thus , the purpose of this study was to investigate the effects of PA intervention for men receiving ADT on PA behavior , quality of life , and fitness measures . Patients and methods One hundred participants were r and omized into an intervention ( n = 53 ) or a wait-list control group ( n = 47 ) , with 11 dropping out of the intervention group and 23 dropping out of the wait-list control group prior to post-testing . The intervention consisted of both an individually tailored home-based aerobic and light resistant training program and weekly group sessions .  PA , quality of life , fitness , and physiological outcomes were assessed pre and post the 16-week intervention . Results Significant increases in PA , supported by changes in girth measures and blood pressure , support the beneficial impact of the intervention . Positive trends were also evident for depression and fatigue . However , due to the high dropout rate , these results must be interpreted with caution . Conclusions PA effectively attenuates many of the side effects of ADT and should be recommended to prostate survivors as an alternate therapy . Determining the maintenance of this behavior change will be important for underst and ing how the long-term benefits of increased activity levels may alleviate the late effects of ADT Purpose The purpose of this study is to examine the effects of age ( ≤65 years or > 65 years ) and and rogen-deprivation therapy ( ADT , presence or absence ) as factors that may predict changes in body composition and fitness following a 24-week exercise program in prostate cancer patients . Methods One hundred twenty-one men were r and omly allocated to either : ( 1 ) aerobic exercise ( AE ) , ( 2 ) resistance exercise ( RE ) , or ( 3 ) usual care ( UC ) . Body composition was assessed by DXA . Aerobic fitness was assessed through a maximal treadmill test  . Muscular strength was assessed by leg extension and bench press using the eight-repetition maximum test . Responses were compared between younger ( ≤65 years ) and older ( > 65 years ) patients with or without ADT  . Results There did not appear to be an interaction between age and ADT on body composition or fitness , nor were there any significant changes in body composition for participants ≤65 years . In participants aged > 65 years , lean mass decreased in AE ( p = 0.013 ) and UC ( p = 0.006 ) , but was preserved in RE . In participants receiving ADT , there was a decrease in lean mass in AE ( p = 0.003 ) and UC ( p < 0.001 ) but not in RE . The non-ADT group did not show any changes in body composition but did show improvements in muscular fitness following resistance training ( p < 0.001 ) . Conclusion Changes in body composition and physical fitness following a 24-week exercise program in men with prostate cancer are not influenced by age and /or ADT . Resistance training appears to attenuate the age-related decrease in lean mass and increase in body fat in older patients with prostate cancer and those  receiving ADT Background The optimal protocol for 125I-transperineal prostatic brachytherapy ( TPPB ) in intermediate-risk prostate cancer ( PCa ) patients remains controversial . Data on the efficacy of combining and rogen-deprivation therapy ( ADT ) with 125I-TPPB in this group remain limited and consequently the guidelines of the American Brachytherapy Society ( ABS ) provide no firm recommendations . Methods / Design Seed and Hormone for Intermediate-risk Prostate Cancer ( SHIP ) 0804 is a phase III , multicenter , r and omized , controlled study that will investigate the impact of adjuvant ADT following neoadjuvant ADT and 125I-TPPB . Prior to the end of March , 2011 , a total of 420 patients with intermediate-risk , localized PCa will be enrolled and r and omized to one of two treatment arms . These patients will be recruited from 20 institutions , all of which have broad experience of 125I-TPPB .  Pathological slides will be central ly review ed to confirm patient eligibility . The patients will initially undergo 3-month ADT prior to 125I-TPPB . Those r and omly assigned to adjuvant therapy will subsequently undergo 9 months of adjuvant ADT . All participants will be assessed at baseline and at the following intervals : every 3 months for the first 24 months following 125I-TPPB , every 6 months during the 24- to 60-month post-125I-TPPB interval , annually between 60 and 84 months post-125I-TPPB , and on the 10th anniversary of treatment . The primary endpoint is biochemical progression-free survival ( BPFS ) . Secondary endpoints are overall survival ( OS ) , clinical progression-free survival , disease-specific survival , salvage therapy non-adaptive interval , acceptability ( assessed using the international prostate symptom score [ IPSS ] ) , quality of life ( QOL ) evaluation , and adverse events . In the correlative study ( SHIP36B ) , we also evaluate biopsy results at 36 months following treatment to examine the relationship between the results and the eventual recurrence after completion of radiotherapy . Discussion These two multicenter trials ( SHIP0804 & SHIP36B ) are expected to provide crucial data regarding the efficacy , acceptability and safety of adjuvant ADT . SHIP36B will also provide important information about the prognostic implication s of PSA levels in intermediate-risk PCa patients treated with 125I-TPPB.Trial registration NCT00664456 , NCT00898326 , JUSMH-BRI-GU05 - 01 , PURPOSE Sexual function is an important concern in men receiving intensity modulated radiation therapy ( IMRT ) for prostate cancer . Our aim was to study the impact of IMRT and and rogen deprivation therapy ( ADT ) on sexual function over time and to report the effectiveness of sexual medications or aids . METHODS AND MATERIAL S A total of 179 men , median age 69 , received definitive IMRT for prostate cancer and completed 2 surveys ( Exp and ed Prostate Cancer Index Composite-26 and a sexual medicines/devices survey ) for at least 2 time points . Surveys were prospect ively collected at baseline ( before all therapy ) , and 2 , 6 , 12 , 18 , and 24 months after IMRT . Median dose was 76 Gy to the prostate . ADT was administered to 59 % of patients ( median duration 5 months , initiated 2 months before IMRT ) . Global scores were generated for the Exp and ed Prostate Cancer Index Composite-26 questions . Longitudinal analysis was performed by constructing a generalized estimation equations model , and clinical variables were tested for association with global scores . RESULTS Overall , there was a significant decline in global sexual score through 2 years . Men receiving ADT had a lower sexual score at 2 and 6 months , but this difference disappeared at 24 months . Analysis of individual sexual symptoms showed no significant difference at 24 months except that men on ADT were less likely to be sexually active ( P = .02 ) ; this difference was not observed for men receiving short-term ADT only . Longitudinal analysis revealed that duration of ADT was the only factor associated with global sexual score . Phosphodiesterase inhibitors were attempted by roughly half of all men , with 66 % experiencing benefit , whereas other aids were attempted by roughly 5 % of men . CONCLUSIONS Although ADT adversely affected short-term sexual function , there was no significant difference in global score and most sexual symptoms by 24 months . These data are useful for anticipatory guidance regarding expectations after IMRT Background and Purpose : And rogen deprivation therapy ( ADT ) has become an increasingly st and ard intervention for both early and advanced stages of prostate cancer ; however , decreased physical function and hypogonadism have been reported in men receiving ADT . The objectives of this study were : ( 1 ) to determine whether ADT ( and hypogonadism ) result ed in decreased strength and mobility and ( 2 ) to examine the effect of ADT on an associated test of cognitive and motor function by assessing visuomotor performance . Subjects and Methods : Physical function , walking speed , visuomotor performance , gonadal status , body composition , and Comorbidity Disease Index ( CMDI ) scores were assessed in a cohort of 100 participants that included : ( 1 ) men with prostate cancer who were not on ADT , ( 2 ) men with prostate cancer who were on short-term ADT ( < 6 months ) , ( 3 ) men with prostate cancer who were on long-term ADT ( ≥6 months ) , and ( 4 ) control subjects who did not have prostate cancer . Results : Walking speed varied significantly across the 4 groups , even after adjusting for age , CMDI , and percentage of body fat . Age and CMDI were significantly associated with measurements of physical performance . Adjusted for covariates , men on long-term ADT  walked 0.18 m/s slower than the control subjects . Physical function also varied significantly across the 4 groups . And rogen deprivation therapy did not have a significant effect on visuomotor performance . Discussion and Conclusion : The results suggest that ADT has a significant effect on walking speed and physical performance in men with prostate cancer CONTEXT Although and rogen deprivation therapy ( ADT ) for prostate cancer is associated with bone loss , little is known about when this bone loss occurs . OBJECTIVE We postulated that men on ADT  would experience the greatest bone loss acutely after initiation of ADT . DESIGN AND SETTING We conducted a 12-month prospect i ve study at an academic medical center . PATIENTS OR OTHER PARTICIPANTS We studied 152 men with prostate cancer ( 30 with acute ADT , < 6 months ; 50 with chronic ADT , > or = 6 months ; and 72 with no ADT ) and 43 healthy age-matched controls . MAIN OUTCOME MEASURES We assessed bone mineral density ( BMD ) of the hip , wrist , total body , and spine ; body composition ; and markers of bone turnover . RESULTS After 12 months , men receiving acute ADT had a significant reduction in BMD of 2.5 + /- 0.6 % at the total hip , 2.4 + /- 1.0 % at the trochanter , 2.6 + /- 0.5 % at the total radius , 3.3 + /- 0.5 % at the total body , and 4.0 + /- 1.5 % at the posteroanterior spine ( all P < 0.05 ) . Men with chronic ADT had a 2.0 + /- 0.6 % reduction in BMD at the total radius ( P < 0.05 ) . Healthy controls and men with prostate cancer not receiving ADT had no significant reduction in BMD . Both use and duration of ADT were associated with change in bone mass at the hip ( P < 0.05 ) . Men receiving acute ADT had a 10.4 + /- 1.7 % increase in total body fat and a 3.5 + /- 0.5 % reduction in total body lean mass at 12 months , whereas body composition did not change in men with prostate cancer on chronic ADT or in healthy controls ( P < 0.05 ) . Markers of bone formation and resorption were elevated in men receiving acute ADT after 6 and 12 months compared with the other men with prostate cancer and controls ( P < 0.05 ) . Men in the highest tertile of bone turnover markers at 6 months had the greatest loss of bone density at 12 months . CONCLUSIONS Men with prostate cancer who are initiating ADT  have a 5- to 10-fold increased loss of bone density at multiple skeletal sites compared with either healthy controls or men with prostate cancer who are not on ADT , placing them at increased risk of fracture . Bone loss is maximal in the first year after initiation of ADT , suggesting initiation of early preventive therapy And rogen-deprivation therapy ( ADT ) is a widely used treatment for prostate cancer . Recently , several studies have reported an association between ADT and an increased risk of cardiovascular events , including myocardial infa rct ion and cardiovascular mortality.1 - 5 These reports have led to increased interest and discussion regarding the metabolic effects of ADT and its possible association with increased cardiovascular risk . In addition , likely as a result of these reports , internists , endocrinologists , and cardiologists are now being consulted regarding the evaluation and management of patients in whom ADT is being initiated . Most of these physicians are not aware of the possible effects of ADT on cardiovascular risk factors or the issues regarding ADT and cardiovascular disease . Therefore , this multidisciplinary writing group has been commissioned to review and summarize the metabolic effects of ADT , to evaluate the data regarding a possible relation between ADT and cardiovascular events in patients with prostate cancer , and to generate suggestions regarding the evaluation and management of patients , both with and without known cardiac disease , in whom ADT is being initiated ( Table 1 ) . TABLE 1 Prospect i ve Studies of the Effects of ADT on Cardiac Risk Factors  ADT was first used in prostate cancer for patients with overt metastatic disease,7 and it remains the mainstay of therapy for this group . ADT combined with external-beam radiation therapy is a st and ard of care in the treatment of men with high-risk prostate cancer , on the basis of evidence that shows a survival benefit in multiple r and omized controlled trials.8 - 13 However , ADT is also often used for other prostate cancer states ( eg , for prostate volume reduction in men planning to undergo definitive local therapy with brachytherapy , or in the case of rising prostate-specific antigen after definitive local treatment),14,15 and in these cases , its role in prolonging survival is less certain
Grade B evidence also suggested that exercise may improve prostate cancer patients ' muscle mass , muscular strength , functional performance ( walking and sit to st and speed ) , as well as health-related , social and physical quality of life .
These effects appeared greater for group-rather than home-based-exercise , especially if these programs included resistance training .
CONTEXT Prostate cancer patients , especially those on and rogen deprivation therapy ( ADT ) , experience many symptoms that make it difficult to maintain their independence and quality of life .
Because ADT acts by means of reducing testosterone production , exercise may offset many of the ADT side effects and those of the cancer itself .
OBJECTIVES This systematic review of the literature evaluates whether exercise could reduce symptoms and improve quality of life for prostate cancer patients .