Citation: Lin, Y.-C.; Shao, I.-H.; Juan, Y.-H.; Yeh, K.-Y.; Hou, C.-P.; Chen, C.-L.; Yu, K.-J.; Chen, L.-S.; Lin, C.-L.; Chuang, H.-H. The Impact of Exercise on Improving Body Composition and PSA in High-Risk Prostate Cancer Patients on Androgen-Deprivation Therapy. Nutrients 2022, 14, 5088. https:// doi.org/10.3390/nu14235088 Academic Editors: Aurora Bueno-Cavanillas and Naomi Cano-Ibáñez Received: 26 October 2022 Accepted: 25 November 2022 Published: 30 November 2022 Publisher’s Note: MDPI stays neutral with regard to jurisdictional claims in published maps and institutional affil- iations. Copyright: © 2022 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https:// creativecommons.org/licenses/by/ 4.0/). nutrients Article The Impact of Exercise on Improving Body Composition and PSA in High-Risk Prostate Cancer Patients on Androgen-Deprivation Therapy Yu-Ching Lin 1,2 , I-Hung Shao 2,3,4 , Yu-Hsiang Juan 2,5 , Kun-Yun Yeh 2,6 , Chen-Pang Hou 3,4,7 , Chien-Lun Chen 2,3 , Kai-Jie Yu 3,4 , Liang-Sien Chen 8 , Chin-Li Lin 9 and Hai-Hua Chuang 2,8,10,11, * 1 Department of Medical Imaging and Intervention, Chang Gung Memorial Hospital at Keelung, Keelung 204, Taiwan 2 College of Medicine, Chang Gung University, Taoyuan 333, Taiwan 3 Division of Urology, Department of Surgery, Chang Gung Memorial Hospital at Linkou, Taoyuan 333, Taiwan 4 Graduate Institute of Clinical Medical Sciences, College of Medicine, Chang Gung University, Taoyuan 333, Taiwan 5 Department of Medical Imaging and Intervention, Chang Gung Memorial Hospital at Taoyuan, Taoyuan 333, Taiwan 6 Division of Hemato-Oncology, Department of Internal Medicine, Chang Gung Memorial Hospital, Keelung 204, Taiwan 7 Department of Healthcare Management, Yuanpei University of Medical Technology, Hsinchu 300, Taiwan 8 Department of Family Medicine, Chang-Gung Memorial Hospital, Linkou Branch, Taoyuan 333, Taiwan 9 Department of Athletics Training and Health, College of Exercise and Health Sciences, National Taiwan Sport University, Taoyuan333, Taiwan 10 School of Medicine, National Tsing Hua University, Hsinchu 300, Taiwan 11 Department of Industrial Engineering and Management, National Taipei University of Technology, Taipei 106, Taiwan * Correspondence: chhaihua@cgmh.org.tw; Tel.: +886-975366509; Fax: +886-3-328-5060 Abstract: This prospective study investigated how exercise impacted chronological changes in anthropometrics, body composition, prostate-specific antigen (PSA) level and prognostic nutrition index (PNI) in high-risk prostate cancer (PCa) patients on androgen deprivation therapy (ADT). The patients were divided into either the usual care or exercise group. All patients received measurements a week before ADT initiation, six- and twelve months after treatment. The exercise group received both aerobic and resistance training. The analysis was conducted using appropriate statistical methods. There were 45 males enrolled (age 67.4 ± 8 years and BMI 25.5 ± 3.6 kg/m 2 ). Profound changes were observed at six months follow-up. The exercise group showed a significant increase in the trunk and leg lean mass, and a lesser loss of total and arm lean mass. A significant decrease in PSA was also observed among the exercise group. PNI and PSA were significantly associated with regional lean mass. Exercise can prevent loss or even increase lean mass in high-risk PCa, especially in the early stage of ADT treatment. Moreover, a strong bond between lean mass and PNI and PSA further underscores the importance of early and continuous exercise interventions. Keywords: androgen deprivation therapy; body composition; exercise; high-risk prostate cancer; prostate-specific antigen 1. Introduction Prostate cancer (PCa) is the second most common cancer in men and accounts for 3.8% of all cancer deaths [1,2]. Fortunately, androgen deprivation therapy (ADT), alone or as an adjuvant therapy, is able to control the growth of PCa by reducing the production of testosterone and has been the backbone treatment for advanced PCa [3–5]. However, ADT influences body composition negatively [6,7]. ADT can increase fat mass and de- crease lean mass, leading to osteoporosis, sarcopenia, obesity, metabolic syndrome and Nutrients 2022, 14, 5088. https://doi.org/10.3390/nu14235088 https://www.mdpi.com/journal/nutrients