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Diet, exercise and metformin curb metabolic side effects of androgen suppression

Reuters Health • The Doctor's Channel Daily Newscast

NEW YORK (Reuters Health) – Lifestyle changes and treatment with metformin may offset the development of the metabolic syndrome related to androgen deprivation therapy in men with prostate cancer, a UK team has shown in a small pilot study.

“For men requiring even a short course of androgen suppression, efforts to reduce cardiac risk factors through diet, exercise and the use of lipid-lowering agents may mitigate some of the risks of ADT (androgen deprivation therapy),” conclude the authors of the report in BJU International online September 20 .

Dr. Robert Laing and colleagues with the Royal Surrey County Hospital NHS Foundation Trust, Guildford, point out that ADT improves disease-free survival in men with locally advanced and metastatic prostate cancer but it has been associated with increased of cardiovascular disease and the metabolic syndrome.

To see if the adverse metabolic effects of androgen suppression could be prevented, the team recruited 40 men with prostate cancer starting ADT; 20 of them received metformin, a low glycemic index diet, and an exercise program for 6 months while the other 20 did not.

Over the study period, mean changes in abdominal girth favored the intervention arm (-0.58%) compared to the control arm (+2.15%; p=0.05), the investigators found. Similarly, changes in BMI were -3.15% vs +2.10% (p<0.001) in the two groups respectively, and corresponding changes in systolic blood pressure were -5.96% vs +1.77%.

Other between-group differences did not reach statistical significance, but HDL increased more and the reduction in HbA1c was greater in the intervention arm than the control arm, the data indicate.

“This pilot study has shown a reduction in a number of adverse effects in the intervention arm, with the implementation of a safe, well-tolerated intervention regime,” Dr. Laing and colleagues conclude.

They add, “We anticipate that the impact of this advice will be clarified by ongoing and future interventional studies assessing the individual or combined impact of diet, exercise and insulin sensitizers. Further studies will determine whether overall survival can ultimately be improved by this approach.”

A prospective, randomized pilot study evaluating the effects of metformin and lifestyle intervention on patients with prostate cancer receiving androgen deprivation therapy
BJU Int 2011