Integrating diet and exercise into care of prostate cancer patients on androgen deprivation therapy

Figures & data

Figure 1 Flow diagram showing manuscript selection process.

Abbreviation: ADT, androgen deprivation therapy.

Table 1 Adverse effects reported with ADT and potential lifestyle, supplemental, and prescription medication solutions

ADT-associated adverse effects		Potential solutions
	Exercise	Diet	Drugs
Anemia	• Primarily normochromic, normocytic anemia with ADT, thus no lifestyle or supplemental options available for treatment^Citation99 • Asymptomatic in 90% of patients, so medication is rarely, if ever, needed^Citation99
Bone loss	Resistance exercise 2–3 times a week in combination with 1,000–1,200 mg of calcium and 800–1,000 IU of vitamin D (from food and/or supplements)^Citation36,Citation51,Citation100		• Prescription medication should be considered based on the duration of ADT and documented severity of bone loss
Fatigue	Resistance exercise^Citation24,Citation38	•Caffeine from beverages (general stimulant)^Citation81 •American ginseng (2,000 mg/day at 3%–5% ginsenosides)^Citation94
Hot flashes	Maintaining a healthy weight may reduce the severity of vasomotor symptoms and moderate aerobic exercise could also be beneficial	No dietary supplement has demonstrated a consistent benefit over placebo^Citation101	• Prescription medication can be effective (eg, megestrol acetate, venlafaxine) for moderate-to-severe QoL – altering hot flashes^Citation101
Lipids and/or prediabetes (elevated cardiovascular risk)	•ADT has controversial cardiovascular risk data^Citation18 •Diet and exercise^Citation80 •Abnormal glucose levels may respond to diet and exercise^Citation70	Omega-3 fatty acids (EPA/DHA; 500 mg/dL or more) FDA-approved for hypertriglyceridemia only (although studies lack clinical endpoints)^Citation95^–^Citation98	•When appropriate, low-dose statin and/or ezetimibe prescription treatment; low-dose aspirin for those who qualify, based on overall cardiovascular risk^Citation80 • When appropriate, prescription metformin has preliminary data with ADT^Citation70
Sarcopenia	Resistance exercise 2–3 times per week in addition to calcium and vitamin D recommended daily intake (as for bone loss)^Citation28,Citation92
		•Preliminary indirect evidence suggests that whey protein isolate (or another protein isolate) at 20–25 g per day could also assist with muscle protein synthesis^Citation93
Weight gain (visceral adipose tissue accumulation)	Diet and aerobic and resistance exercise^Citation24,Citation38	Whey protein isolate may also assist with appetite suppression^Citation93	• Metformin (850 mg twice a day) has preliminary data for weight loss with ADT^Citation70

Notes: Not all the adverse events listed in this table are discussed in this review. We refer the reader to the scientific literature for more detailed discussions of these.

Abbreviations: ADT, androgen deprivation therapy; DHA, docosahexaenoic acid; EPA, eicosapentaenoic acid; FDA, US Food and Drug Administration; IU, international unit; QoL, quality of life.

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