1. Prostate cancer management: Selecting the right treatment for the right patient

2. Managing treatment side effects through lifestyle changes: Empowering patients to take control
Francesco Montorsi

3. Short-term side effects of ADT
J Anderson
10-Sep-18
Short-term side effects of ADT
ADT
↓ Libido and sexual interest
Hot flushes
CV events
Fatigue
↓ Muscle strength and volume
Sexual dysfunction
Weight gain
↑ Increased body fat
↓ Lean body mass
Emotional and cognitive changes
Depression
ADT is the mainstay of treatment for men with locally advanced and metastatic PCa
Although effective at controlling disease, either as primary treatment or in combination with RT/RP, ADT can cause significant side effects due to testosterone suppression
ADT-related side effects may:
negatively affect quality of life (QoL) and, if unmanaged, can be distressing and unpleasant
induce serious medical conditions
Ahmadi H & Daneshmand S. BJU Int 2013;111(4):543-48; Cary KC. J Urol 2014;191(4):964-70; Isbarn H. Eur Urol 2009;55(1):62-75; Keating NL. J Natl Cancer Inst 2010;102:39-46
STOP-2 symposium, Malta, October 2010

4. Long-term side effects of ADT that can lead to severe complications
Sarcopenia
Obesity
Lipid alterations
Insulin resistance
↓ Bone mineral density, ↑ bone turnover, osteoporosis, bone fractures
CV toxicity
Isbarn H. Eur Urol 2009;55(1):62-75; Ahmadi H & Daneshmand S. BJU Int 2013;111(4):543-48; Cary KC. J Urol 2014;191(4):964-70

5. Lifestyle changes to manage ADT side effects
J Anderson
10-Sep-18
Lifestyle changes to manage ADT side effects
Increased physical activity
Diet modification
Smoking cessation
Decreased alcohol consumption
Regular exercise: aerobic and resistance training
Healthy diet and weight loss:
Increased intake of calcium (1500 mg/day) and vitamin D (800 IU/day)
Ahmadi H & Daneshmand S. BJU Int 2013;111:543-48; Schulman C. BJU Int 2012;109 (Suppl 6):13-21; Heidenreich A. Eur Urol 2014;65(2):467-79
STOP-2 symposium, Malta, October 2010

6. Effects of exercise on ADT side effects in PCa
Resistance and aerobic exercise programmes can:
↓ fatigue
Improve lean body mass and muscular strength
↓ body weight and BMI
Improve cardiorespiratory fitness
Improve psychosocial functions and cognitive impairment
Improve sexual function in some patients
↓ risk of bone fractures and cardiovascular disease
Ahmadi H & Daneshmand S. BJU Int 2013;111(4):543-48; Bourke L. Eur Urol 2014;65(5):865-72; Cormie P. BJU Int 2014;115(2):256-66; Culos-Reed SN. Support Care Cancer 2010;18(5):591-99; Galvao DA. Med Sci Sports Exerc 2006;38(12): ; Galvao DA. J Clin Oncol 2010;28(2):340-47; Heidenreich A. Eur Urol 2014;65(2):467-79; Keogh JW. J Pain Symptom Manage 2012;43(1):96-110; O’Neil RF. J Cancer Surviv 2015;9(3):431-40; Schulman C. BJU Int 2012;109 (Suppl 6):13-21; Tombal B. Urol Int 2009;83:373-78

7. Counselling and education
J Anderson
10-Sep-18
Counselling and education
Help to manage psychological stress related to PCa diagnosis/treatment and adverse CV events
ADT Survivorship Working Group recommendations:
Educational sessions for couples about the sexual side effects of ADT
Individualised psychological intervention, including sexual therapy techniques
Ahmadi H & Daneshmand S. Patient Relat Outcome Meas 2014:5 63–70; Ahmadi H & Daneshmand S. BJU Int 2013;111(4):543-48; Cohen BE. Am J Hypertens 2015;28: ; Elliott S. J Sex Med 2010;7(9): ; Tombal B. Urol Int 2009;83:373-78
STOP-2 symposium, Malta, October 2010

8. J Anderson
10-Sep-18
FEEL+ Programme1
An educational, patient-oriented and holistic tool to improve health and wellbeing during ADT1
Understand the side effects of ADT and talk about the disease
Pro-actively manage ADT side effects by adopting lifestyle changes
Increase physical activity
Follow a healthy diet
1. Developed in collaboration with Prof. Bertrand Tombal Cliniques Universitaires Saint-Luc, Brussels
©2015-Eddy Kuypers-JAMES®
STOP-2 symposium, Malta, October 2010

9. FEEL+ Programme1: www.myfeelplus.com
J Anderson
10-Sep-18
FEEL+ Programme1:
FEEL+ website includes:
Advice about ADT and the management of ADT side-effects
Get Moving - the JAMES exercise program (Jog/walk, Abdominal, Muscle-building and Suppleness) for optimal physical fitness
Eat well – advice on diet and healthy eating
Your Wellbeing – advice and tips on taking care of mind and body, relationships and getting support
1. Developed in collaboration with Prof. Bertrand Tombal Cliniques Universitaires Saint-Luc, Brussels
©2015-Eddy Kuypers-JAMES®
STOP-2 symposium, Malta, October 2010

10. FEEL+ physical exercise programme1
J Anderson
10-Sep-18
FEEL+ physical exercise programme1
The JAMES exercise programme: Jog/walk, Abdominal, Muscle building Exercises and Suppleness
1. Developed in collaboration with Prof. Bertrand Tombal Cliniques Universitaires Saint-Luc, Brussels
©2015-Eddy Kuypers-JAMES®
STOP-2 symposium, Malta, October 2010

11. FEEL+ healthy diet plan1
J Anderson
10-Sep-18
FEEL+ healthy diet plan1
1. Developed in collaboration with Prof. Bertrand Tombal Cliniques Universitaires Saint-Luc, Brussels
©2015-Eddy Kuypers-JAMES®
STOP-2 symposium, Malta, October 2010

12. Improved cognitive function Improved sexual function
J Anderson
10-Sep-18
Conclusions
Exercise
↑ QoL
↑ Muscle strength
↓ Fatigue
Improved cognitive function
Improved sexual function
↓ Bone fractures
↓ CV toxicity
Diet
Smoking cessation
↓ Alcohol intake
In summary:
Resistance training can increase muscle strength, mitigate fatigue and improve QoL in men with PCa treated with ADT
Physical exercise may also improve cognitive and sexual function
Physical exercise and diet are also important for the management of more serious ADT-related side effects (CV toxicity and bone fractures)
STOP-2 symposium, Malta, October 2010

14. Audience Q&A

15. Summary and conclusions

16. Summary and conclusions
Importance of personalised treatment strategies
For high-burden disease patients, consider ADT treatment with fast onset of action
Neoadjuvant ADT with RT can be used in selected patients
GnRH antagonists provide rapid testosterone suppression and improve IPSS
Consider a holistic approach to patient care

17. Summary and conclusions
High CV risk in prostate cancer patients
GnRH agonists associated with ↑ risk of CV events and new onset diabetes
GnRH antagonists
Less CV toxicity in retrospective analyses
PRONOUNCE trial – prospective RCT GnRH agonist vs antagonist
Importance of:
Multidisciplinary team: urologist, medical and radiation oncologist, palliative team, cardiologist, radiologist and nuclear medicine specialist
Patient education

18. Prostate cancer management: Selecting the right treatment for the right patient