Creatine Supplementation and Resistance Training to Preserve Muscle Mass and Attenuate Cancer Progression

Inclusion Criteria:

• Subject age ≥ 18 years old.

• Metastatic castration-sensitive prostate cancer patients who have not met criteriafor disease progression (per Prostate Cancer Working Group guidelines) on currentsystemic therapy

• Currently treated with surgical castration or medical castration withGonadotropin-releasing hormone (GnRH) agonists/antagonists, and/or an androgenreceptor pathway inhibitor (ARPI)) aka novel hormone therapy (e.g., abiraterone,enzalutamide, apalutamide, darolutamide). Must have started the current regimen atleast 12 weeks prior to enrollment.

• Eastern Cooperative Oncology Group (ECOG) Performance Status ≤ 2

• Not currently adhering to national physical activity guidelines for resistancetraining, as defined as participating in structured resistance training (e.g., timeset aside in your day to workout) ≥ two days per week.

• Regular access to an electronic device with internet service and ability for videocalls (e.g., computer, smart phone, iPad, tablet, etc).

• Access to an active MyChart account or the willingness to create an account for thepurposes of the trial.

• Willingness to engage in a home-based resistance exercise program two days per week.

• Willingness to take creatine monohydrate supplementation or placebo for the durationof the 52 week trial and to avoid taking additional creatine-containingsupplementation or other nutritional supplementation during the study period.

• Willingness to complete and submit weekly supplementation logs to study personnelthroughout the duration of the 52-week study via email, text, in person, or verballyverified over the phone.

• Willingness to complete three in-person assessment sessions (baseline, 24-, and 52-weeks).

• Able to provide informed consent and willing to sign an approved consent form thatconforms to federal and institutional guidelines.

Exclusion Criteria:

• Treatment with cytotoxic chemotherapy within 12 weeks prior to enrollment.

• Estimated Glomerular Filtration Rate (eGFR) < 30 ml/min/1.73m2.

• ECOG Performance Status ≥ 3