Characteristics of prostate cancer survivors exposed to ADT and enrolled in a fall prevention exercise trial: Comparison of men with confirmed fall history to men with fall risk factors.
Authors: Winters-Stone Kerri M. , Stoyles Sydnee , Amling Christopher L. , Hung Arthur , Dieckmann Nathan , Li Fuzhong , Horak Fay B. , Tibbitts Deanne , Beer Tomasz M. 
Published: February 2022

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Background: Androgen deprivation therapy (ADT) for prostate cancer may result in accelerated aging that increases the risk for falls. Falls are higher in men with a history of ADT use, even if treatment is discontinued, compared to men never on ADT. Less is known, however, about the specific patient characteristics that might be associated with falls. Methods: We analyzed data from prostate cancer survivors with a history of ADT and who had enrolled in an ongoing NIH-funded fall prevention exercise trial (NCT03741335). To be eligible for the trial, men were 1) currently or previously treated with ADT and 2) reported a fall in the previous 6 months or had evidence of fall risk. Fall risk was assessed through slow times on a 5 time sit-to-stand test (5XSTS; sec) or timed up and go walk test (TUG; sec). For this analysis we compared men with a positive fall history to men with no recent falls but evidence of fall risk. We compared age, ADT history (past vs current), body mass index (BMI), self-report comorbidities from the Charlson Comorbidity Index, physical function and disability from the LLFDI, pain from the BPI, anxiety from PROMIS, depressive symptoms from the CES-D, fear of falling and activity restrictions from the SAFFE, and physical activity from CHAMPS, as well as objective measures of strength and mobility using 5XSTS and TUG. Results: A total of 171 cases (mean age 73.1 +/- 7.1 years of age) were available for analysis, with 58 men (34%) reporting a fall in the 6 months prior to enrollment. Of reported falls, 11% were injurious falls, with 4% requiring medical attention. Injuries included fractures (n = 4), head injury (n = 2), joint injury (n = 3), and bruises/scrapes (n = 8). Fallers reported significantly lower levels of physical functioning (p < 0.001), greater levels of disability (p < 0.01), greater fear of falling (p < 0.001), more activity restrictions due to falls worry (p < 0.02) and slower TUG times (p < 0.03), than men who had not recently fallen. There were no significant differences between men with established fall history and men with fall risk only on age, ADT history, comorbidities, BMI, pain, anxiety, depressive symptoms, physical activity, or 5XSTS (p for all > 0.05). Conclusions: Among our preliminary sample of men with a history of ADT use and enrolled in an ongoing fall prevention trial, men with an established fall history functioned less independently, were more worried about falls and apt to restrict their activities accordingly, and had poorer mobility than men who hadn’t recently fallen. From our cross-sectional design we cannot determine whether poorer functioning and mobility and greater fear of falling were antecedents or consequences of a recent fall. Regardless, interventions designed to prevent falls in men exposed to ADT are critical to prevent potential injurious falls and to keep men functioning independently.