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Prostate Cancer
Maintaining Bone Health and Integrity During
Androgen-deprivation Therapy for Prostate Cancer
a report by
Thomas J Polascik, MD, FACS
Associate Professor, Duke Prostate Center and Division of Urological Surgery, Duke University Medical Center
Since the early 1990s, earlier diagnosis and improved treatment options high-density lipoprotein cholesterol, or elevated blood pressure. Low
have caused a steady decline in the prostate cancer mortality rate.
1,2
testosterone levels are predictive of the development of metabolic
Consequently, many of the 186,000 men in the US who will be syndrome in men.
3,8
Results of a recent cross-sectional study showed that
diagnosed with prostate cancer in 2008 may live for many years with the 55% of prostate cancer patients receiving ADT for at least one year
disease and any long-term treatment-related adverse effects (AEs).
2
Androgen-deprivation therapy (ADT) has become an accepted standard
of care for prostate cancer treatment and its use is recommended in
Androgen-deprivation therapy has
various stages of the disease.
3
However, ADT is not without AEs, some of
which may have long-term consequences. Of particular concern is the become an accepted standard of care
increased risk for fracture associated with ADT, especially in patients
for prostate cancer treatment and its
treated for many years.
4–6
Clinicians who treat prostate cancer patients
should be aware of the potential AEs associated with ADT and of use is recommended in various stages
strategies for preventing and/or treating them. This article reviews the
of the disease.
prevalence and consequences of bone loss and fractures in men with
prostate cancer and without bone metastases receiving ADT, and
discusses prevention and treatment strategies.
developed metabolic syndrome compared with 22% of age-matched
Adverse Effects Associated with eugonadal men not receiving ADT.
8
The presence of metabolic syndrome
Androgen-deprivation Therapy in prostate cancer patients increases the risk for insulin resistance,
diabetes mellitus, CVD, and death.
3
Changes in body composition such
Non-skeletal Adverse Effects as an increased proportion of body fat and/or weight gain are often
ADT-treated patients commonly experience a range of AEs, including observed in men receiving ADT, and also contribute to the risk for CVD.
9
sexual dysfunction, hot flashes, anemia, metabolic syndrome, body
composition changes, fatigue, and cognitive and mood changes.
7–10
Compared with healthy controls, Chen and colleagues
9
found that men
Although the focus of this article is skeletal-related AEs, a brief discussion receiving ADT for one to five years were 5.5 times more likely to become
about the increased risk for cardiovascular disease (CVD) in patients obese (body mass index [BMI] ≥30kg/m
2
). Prostate cancer patients are
receiving ADT is warranted to increase awareness of this potential more likely to die from CVD than from prostate cancer itself, so clinicians
long-term AE.
8
ADT-associated AEs that can increase the risk for CVD should be aware of the increased CVD risk in all prostate cancer patients,
include metabolic syndrome and body composition changes.
3,8,9
especially those receiving ADT, and should monitor patients for early
Metabolic syndrome is diagnosed when three or more of the following signs of CVD.
11
Furthermore, before administering ADT to men with
are present: abdominal obesity, hypertriglyceridemia, low levels of early-stage disease who are likely to receive long-term therapy (>1 year),
clinicians must consider the risk for ADT-associated CVD, especially for
men already at increased risk for CVD-related mortality.
3
Thomas J Polascik, MD, FACS, is an Associate Professor who
practices surgical urological oncology in the Division of
Urology and Department of Surgery at Duke University Skeletal Adverse Effects
Medical Center. His research interests include the
Bone loss is the most studied ADT-associated AE. Results of multiple
development of focal therapy (subtotal in situ glandular
ablation) as a treatment option for low-risk prostate cancer
studies have shown that bone mineral density (BMD) of the femoral neck,
and developing molecular imaging techniques to identify lumbar spine, and total hip decreases by up to 4.6% annually in prostate
prostate cancer foci within the gland. Before joining Duke
cancer patients without bone metastases who receive ADT, a rate that is
University Medical Center, he completed a fellowship in
urological oncology at Johns Hopkins Hospital. He completed his residency training in general
four to eight times higher than the normal bone loss rate (0.5–1% per
surgery and urology at the same institution. Dr Polascik received his medical degree from the year) observed in otherwise healthy aging men.
1,10,12–21
As bone loss
University of Chicago, Pritzker School of Medicine.
increases the probability of fracture, prostate cancer patients who receive
E: polas001@mc.duke.edu ADT are at an increased risk for fracture and related morbidity and
mortality.
4–6,22
Indeed, men with prostate cancer and no bone metastases
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