Reversing the effects of androgen deprivation therapy in men with metastatic castration resistant prostate cancer.

Background Bipolar androgen therapy (BAT) is the cyclic administration of high dose testosterone as a novel treatment for metastatic castration resistant prostate cancer (mCRPC). We hypothesized that rapid testosterone cycling would promote improvements in body composition and these would be associated with improvements in lipid profiles, and quality-of-life. Methods Men from two completed trials with CT imaging at baseline and after 3 cycles of BAT were included. Cross sectional areas of psoas muscle, visceral and subcutaneous fat were measured at the L3 vertebral levels. FACIT-Fatigue and Short Form-36 were used to measure quality of life. Results Participants (n=60) lost a mean of 7.8% of subcutaneous fat (SD 8.2%) and 9.8% of visceral fat (SD 18.2%) and gained 12.2% muscle mass (SD 6.7%). Changes in subcutaneous and visceral fat were positively correlated with each other (Spearman's correlation coefficient 0.58; 95% CI 0.35-0.71), independent of effects of age, body mass index, and duration of androgen deprivation therapy. Energy, physical function, and measures of limitations due to physical health were all significantly improved at 3-months. The improvements in body composition were not correlated with decreases in lipid levels or observed improvements in quality of life. Conclusions BAT is associated with significant improvements in body composition, lipid parameters, and quality of life. This has promising implications for the long-term health of men with mCRPC.