Obese Frailty, Physical Performance Deficits, and Falls in Older Men with Biochemical Recurrence of Prostate Cancer on Androgen Deprivation Therapy: A Case-control Study

OBJECTIVES To test the hypothesis that early androgen deprivation therapy (ADT) has no proven survival advantage in older men with biochemical recurrence (BCR) of prostate cancer (PCa), and it may contribute to geriatric frailty. METHODS We conducted a case-control study of men aged 60+ years with BCR on ADT (n = 63) vs PCa survivors without recurrence (n = 71). Frailty prevalence, obese frailty, Short Physical Performance Battery (SPPB) scores, and falls were compared. An exploratory analysis of frailty biomarkers (C-reactive protein, erythrocyte sedimentation rate, hemoglobin, albumin, and total cholesterol) was performed. Summary statistics and univariate and multivariate regression analyses were conducted. RESULTS More patients on ADT were obese (body mass index > 30; 46.2% vs 20.6%; P = .03). There were no statistical differences in SPPB (P = .41) or frailty (P = .20). Using a proposed obese frailty criteria, 8.7% in ADT group were frail and 56.5% were prefrail, compared with 2.9% and 48.8% of controls (P = .02). Falls in the last year were higher in the ADT group (14.3% vs 2.8%; P = .02). In analyses controlling for age, clinical characteristics, and comorbidities, the ADT group trended toward significance for obese frailty (P = .14) and falls (OR = 4.74, P = .11). Comorbidity significantly increased the likelihood of obese frailty (P = .01) and falls (OR 2.02, P = .01). CONCLUSIONS Men with BCR on ADT are frailer using proposed modified obese frailty criteria. They may have lower performance status and more falls. A larger, prospective trial is necessary to establish a causal link between ADT use and progression of frailty and disability. UROLOGY 77: 934-940, 2011. (C) 2011 Elsevier Inc.