The impact of second-generation androgen receptor pathway inhibitors on skeletal muscle morphology and strategies to mitigate their effects in prostate cancer patients.

This is a review of published studies, not a new trial, and the supplied text does not describe a systematic search or appraisal method. Most cited evidence is from men with mCRPC, while the review says it focuses on mCSPC. Muscle health assessments are inconsistent, and many studies measured only muscle cross-sectional area or skeletal muscle index without strength or physical function. Doublet therapy combines ADT with enzalutamide, abiraterone, apalutamide, or darolutamide, and some studies also include prednisolone, so the effect of any single component cannot be separated. Exercise evidence comes from small, short-term studies with different interventions and populations, and no studies have investigated exercise effects on muscle health in mCSPC. The authors state that age, baseline fitness, and comorbidities were outside the scope of the review.

Financial support was received for the research or publication. The project is funded in part by the Prostate Cancer Fight Foundation/Ride for Dad.

Do not read this review as proof that ADT plus enzalutamide, abiraterone, apalutamide, or darolutamide causes more muscle loss than ADT alone in mCSPC or that exercise prevents it. Most evidence is from mCRPC, muscle assessments are inconsistent, and no studies have tested exercise effects on muscle health in mCSPC.