Sarcopenia in Prostate Cancer Under Androgen Deprivation Therapy

Background and Objectives: Androgen deprivation therapy (ADT) is a cornerstone of treatment for advanced prostate cancer. By suppressing testosterone, it removes a key anabolic stimulus to skeletal muscle, predisposing patients to sarcopenia. This narrative review summarises current evidence on the mechanisms, diagnosis, prevalence, clinical impact, and management of sarcopenia in men receiving ADT for prostate cancer. Materials and Methods: Relevant literature was identified through a structured search of the PubMed/MEDLINE database, using keywords such as “sarcopenia”, “prostate cancer”, and “androgen deprivation therapy”. The search was limited to English-only studies in humans. Relevant information from the selected articles, including study identification, main outcomes, and key findings, was organised in a structured spreadsheet to facilitate synthesis. Results: Androgens exert anabolic effects on skeletal muscle through genomic and non-genomic pathways, promoting protein synthesis and satellite-cell function while limiting adipogenesis; their withdrawal shifts body composition toward a concurrent loss of muscle and gain of fat mass, a pattern that may culminate in sarcopenic obesity when diagnostic criteria for both components are met. Reported prevalence varies widely, largely reflecting the lack of a uniform definition: whereas the EWGSOP2 consensus prioritises muscle strength, the oncological literature relies predominantly on computed-tomography-derived muscle mass at the third lumbar vertebra. Sarcopenia has been associated with higher non-cancer mortality, although its relationship with survival endpoints remains less certain. Importantly, ADT-induced muscle loss is at least partly modifiable: resistance exercise training shows the strongest evidence for preserving muscle mass and strength, while the role of nutritional interventions alone remains inconclusive. Conclusions: Sarcopenia is a frequent, under-recognised and partly reversible consequence of ADT. Standardised diagnostic criteria and prospective outcome data represent the principal unmet needs. Routine assessments of muscle health and early integration of exercise-based interventions should be considered in the care of men receiving ADT.