Cardiovascular health in men on androgen deprivation therapy for prostate cancer.

Androgen deprivation therapy (ADT) is a cornerstone treatment option for men with metastatic or locally advanced prostate cancer, however, treatment with ADT has been associated with increased incidence of adverse cardiovascular events. Strategies to investigate and monitor cardiovascular risk, as well as to reduce such treatment-related morbidity are urgently required in this population.Study 1 of this thesis investigated the differences in endothelial function between men with advanced prostate cancer treated with ADT and matched controls using a case-control design. Flow-mediated dilatation (FMD) and glyceryl-trinitrate (GTN)-mediated dilatation of the brachial artery were assessed in 20 men (69 +/- 7 years) with prostate cancer treated with ADT for a median of 22 months (range 6-133 months) and compared against 20 controls (69 +/- 5 years) matched for age, history of cardiovascular disease and physical activity levels. FMD was reduced in men on ADT compared to controls (P 0.05). These findings provide novel data to suggest endothelial function is impaired in men with prostate cancer treated with ADT, which is in agreement with evidence of increased cardiovascular risk in this population. Study 2 investigated the effects of a 12-week lifestyle intervention including supervised exercise training and dietary advice on markers of cardiovascular health and general well-being in men treated with ADT for prostate cancer. Fifty men treated with ADT for &ge;6 months were randomly allocated to receive the intervention or usual care. Assessments of vascular function, blood pressure, body composition, exercise tolerance and psychological well-being were undertaken prior to randomisation (baseline) and after completion of the intervention (end-point), with a follow-up assessment completed a further 12 weeks after end-point assessments. Statistically significant differences between groups were observed for changes in skeletal muscle mass, body fat percentage, exercise tolerance, quality of life and fatigue (P <0.05). In addition, clinically meaningful effect sizes were observed for the difference between groups for the change between baseline and end-point in FMD and diastolic blood pressure (d >0.51), with post-hoc analysis demonstrating a statistically significant change in FMD in men in the intervention group (P = 0.038). These findings support evidence that diet and exercise can improve general well-being of patients treated with ADT, and provide novel data on the effects of such an intervention on cardiovascular health.