Objective: To analyse changes in lipid profiles observed in patients receiving androgen deprivation therapy (ADT) and to evaluate differences between medical castration and maximal androgen blockade (MAB). Material and Methods: Serum levels of total cholesterol (TC), high-density lipoproteins (HDL), low-density lipoproteins (LDL) and triglycerides (TG) were prospectively evaluated in 33 patients with locally advanced or metastatic prostate cancer treated with ADT. The median age was 73.4 years. Serum lipids were measured at baseline and thereafter at 6 and 12 months. The modality of ADT was medical, with 3 months depot LHRH agonist, in 11 patients and MAB, by addition of 50 mg/day of bicalutamide, in 22 patients. Results: TC increased from 210 to 227 mg/dl (p < 0.05), while LDL increased from 132 to 148 mg/dl (p < 0.05) at 6 months. There were no significant changes in HDL or TG levels. There were no significant differences in any of the analysed parameters after 12 months of ADT. The comparison between the group of patients treated with LHRH agonists alone and the group treated with MAB demonstrated no significant differences in any of the analysed parameters at 6 and 12 months (p > 0.05). Conclusions: Changes observed in TC and LDL after 6 months of ADT were transitory. No significant differences were observed according to the modality of ADT.
neck and total hip by dual-energy X-ray absorptiometry. All patients had severe osteopenia or osteoporosis at baseline. The risk of femoral neck fracture was calculated at baseline and 12 months (Z-score 2.7).
RESULTSPatients treated with alendronate had a significant increase in BMD at the lumbar spine and femoral neck after 1 year of follow-up, with mean ( SD ) values of 1.06 (0.26) vs 1.01 (0.21) g/cm 2 at baseline ( P < 0.001), and 0.75 (0.07) vs 0.73 (0.07) g/ cm 2 ( P = 0.03), respectively, while the control group had a significant loss of BMD at the total hip of 0.79 (0.14) vs 0.81 (0.13) g/cm 2 ( P = 0.03). BMD was significantly improved at the three locations in patients treated with alendronate compared with the control group, with differences at the lumbar spine, femoral neck and total hip of 0.05 (0.07) vs 0.01 (0.10) ( P = 0.001), 0.01 (0.04) vs − 0.002 (0.03) ( P = 0.04) and 0.01 (0.04) vs − 0.01 (0.02) g/cm 2 , respectively ( P = 0.001). Patients treated with alendronate had a significant decrease in the fracture risk at the femoral neck, by − 0.54 (1.29) ( P = 0.04) after 1 year of follow-up.
CONCLUSIONSTreatment with once-weekly 70 mg alendronate significantly improved the BMD at the lumbar spine and femoral neck in patients with prostate cancer with severe osteopenia or osteoporosis and on ADT, and significantly decreased the risk of femoral neck fracture.
KEYWORDSprostate cancer, androgen-deprivation therapy, bisphosphonates, osteoporosis Study Type -Therapy (case control) Level of Evidence 3b
OBJECTIVETo evaluate changes in bone mass and fracture risk in patients with prostate cancer on androgen-deprivation therapy (ADT) and with a basal T-score of >− 2.0, who were treated with an oral bisphosphonate, as such patients treated with ADT are at increased risk of bone loss and bone fracture.
PATIENTS AND METHODSWe selected 61 patients with prostate cancer treated with ADT; 31 were treated with oral alendronate 70 mg once-weekly and a control group of 30 were not. At baseline and 12 months we measured bone mineral density (BMD) of the lumbar spine, femoral
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