Effectiveness and Safety of Interventions for Sarcopenia in Advanced Prostate Carcinoma: Systematic Review

Sarcopenia has emerged as a potential prognostic factor in patients with advanced prostate cancer (PCa), requiring interventions for its prevention and treatment.

We aimed to systematically identify, critically assess and synthesize the available evidence on the effectiveness and safety of interventions for preventing or treating sarcopenia in advanced PCa patients.

MEDLINE, Embase and Web of Science were searched. Randomized and non-randomized controlled trials or longitudinal observational studies with a control group focusing on PCa patients aged 60 years and older were considered. Study selection, data extraction and risk-of-bias assessment of the included studies were performed in duplicate. When possible, pooled effect estimates were calculated.

Twenty studies (n = 1275) were included. Resistance training (RT) (MD = 3.22 kg; 95% CI 0.69, 5.75) and the use of antimyostatin peptibody (MD = 2.2 kg; SE 0.8%) demonstrated statistically significant prevention of lean body mass loss in men undergoing androgen deprivation therapy (ADT). Exercise improved leg press (MD = 25.17 kg; 95% CI [8.71, 41.62]), leg extension (MD = 9.63 kg; 95% CI [4.83, 14.42]), seated row (MD = 4.38 kg; 95% CI [1.54, 7.22]) and chest press strength (MD = 1.70 kg; 95% CI [-1.48, 4.88]) and enhanced patients' physical functioning in chair sit-to-stand tests (MD = -1.02 kg; 95% CI [-1.70, -0.34]). RT improved health-related quality of life (HRQoL) in both general and specific domains and also reduced somatization (MD = -0.69 kg; 95% CI [-1.32, -0.07]) and psychological distress (MD = -1.63 kg; 95% CI [-3.10, -0.15]).

The findings highlight the potential benefits of RT and selected pharmacological interventions on muscle-related and functional outcomes. However, the significant heterogeneity and lack of comprehensive outcome reporting underscore the need for more standardized and long-term research through larger, well-designed randomized controlled trials with standardized measurement methods to draw conclusive evidence and enhance the reliability and applicability of findings in clinical practice.