Foulkes Stephen J, Daly Robin M, Fraser Steve F
Institute for Physical Activity and NutritionSchool of Exercise and Nutrition Sciences, Deakin University, Geelong, Australia
Institute for Physical Activity and NutritionSchool of Exercise and Nutrition Sciences, Deakin University, Geelong, Australia.
Endocr Relat Cancer. 2017 Mar;24(3):R35-R48. doi: 10.1530/ERC-16-0505. Epub 2017 Jan 6.
Androgen deprivation therapy (ADT) is now considered a mainstay in the treatment of metastatic and locally advanced prostate cancer (PCa). Despite well-established benefits of ADT in relation to overall survival, this treatment has been associated with a number of adverse effects, particularly with regard to key cardiometabolic risk factors including the development of insulin resistance, dyslipidemia and increases in total and regional fat mass. In non-ADT populations, increased levels of visceral adipose tissue (VAT) are thought to be a key mediator of the increased cardiometabolic risk associated with weight gain, but this has received limited attention in men treated with ADT. VAT is best assessed using tools such as computed tomography or magnetic resonance imaging; however, these tools are not readily accessible for the majority of researchers or clinicians. Recent advances allow for a method of estimating VAT using a whole-body dual-energy X-ray absorptiometry (DXA) scan that shows promise as a practical tool for researchers to evaluate changes in body fat distribution during ADT. The aim of this narrative review is to (1) review the available evidence with regard to the relationship between ADT and cardiometabolic risk; (2) discuss the role of body fat distribution on cardiometabolic risk in non-ADT populations, with a particular emphasis on the importance of visceral adiposity; (3) examine the potential influence of ADT on body fat distribution and visceral adiposity and (4) provide an overview of current tools used to measure changes in body fat distribution in men treated with ADT, highlighting the potential utility of a recently developed DXA-derived measure of VAT.
雄激素剥夺疗法（ADT）目前被认为是转移性和局部晚期前列腺癌（PCa）治疗的主要手段。尽管ADT在总体生存方面的益处已得到充分证实，但这种治疗与许多不良反应相关，特别是在关键的心脏代谢危险因素方面，包括胰岛素抵抗的发展、血脂异常以及全身和局部脂肪量的增加。在未接受ADT的人群中，内脏脂肪组织（VAT）水平升高被认为是体重增加相关心脏代谢风险增加的关键介导因素，但在接受ADT治疗的男性中，这一点受到的关注有限。VAT最好使用计算机断层扫描或磁共振成像等工具进行评估；然而，对于大多数研究人员或临床医生来说，这些工具并不容易获得。最近的进展使得可以使用全身双能X线吸收法（DXA）扫描来估计VAT，这显示出有望成为研究人员评估ADT期间身体脂肪分布变化的实用工具。本叙述性综述的目的是：（1）回顾关于ADT与心脏代谢风险之间关系的现有证据；（2）讨论身体脂肪分布在未接受ADT人群的心脏代谢风险中的作用，特别强调内脏肥胖的重要性；（3）研究ADT对身体脂肪分布和内脏肥胖的潜在影响；（4）概述目前用于测量接受ADT治疗男性身体脂肪分布变化的工具，强调最近开发的基于DXA的VAT测量方法的潜在实用性。
