Risk factors for bone loss with prostate cancer in Korean men not receiving androgen deprivation therapy

Abstract

Purpose: Preexisting bone loss in men with prostate cancer is an important issue due to the accelerated bone loss during androgen deprivation therapy (ADT). In addition, a high prostate-specific antigen (PSA) level has been reported to be related to bone metabolism. This study assessed the factors associated with osteoporosis in Korean men with non-metastatic prostate cancer before undergoing ADT. Materials and Methods:The study enrolled patients admitted for a prostate biopsy because of a high PSA or palpable nodule on a digital rectal examination. We divided the patients (n = 172) according to the results of the biopsy: group I, non-metastatic prostate cancer (n = 42) and group II, benign prostatic hypertrophy (BPH; n = 130). The lumbar bone mineral density (BMD) was evaluated using quantitative computed tomography. The demographic, health status, lifestyle, body mass index (BMI), serum testosterone concentration, and disease variables in prostate cancer (Gleason score, clinical stage, and PSA) were analyzed prospectively to determine their effect on the BMD. Results: The estimated mean T-score was higher in group I than in group II (-1.96 ± 3.35 vs. -2.66 ± 3.20), but without statistic significance (p = 0.235). The significant factors correlated with BMD in group I were a high serum PSA (β = -0.346, p = 0.010) and low BMI (β = 0.345, p = 0.014) in the multiple linear regression model. Also old age (r = -0.481, p = 0.001), a high serum PSA (r = -0.571, p < 0.001), low BMI (r = 0.598, p < 0.001), and a high Gleason's score (r = -0.319, p = 0.040) were the factors related to BMD in the correlation. The significant factors correlated with BMD in group II were old age (β = -0.324, p = 0.001) and BMI (β = 0.143, p = 0.014) in the multiple linear regression model. Conclusions: The risk factors for osteoporosis in men with prostate cancer include a low BMI, and elevated serum PSA. Monitoring BMD from the outset of ADT is a logical first step in the clinical strategy to avoid or minimize potential bonerelated complications in these patients.

Incidence of low bone mineral density in patients with advanced prostate cancer before hormonal manipulation

“…As the prevalence of prostate cancer and osteoporosis increases with age, many patients may already have osteoporosis when diagnosed with prostate cancer. 12 Prostate cancer patients are now living longer, and many patients receive several lines of therapy, which can have a cumulative impact on bone health over a period of years. 13 BMD is an important determinant of fracture risk prospective studies show that the risk of fracture increases progressively with decreasing BMD.…”

Comparison of bone mineral loss by combined androgen block agonist versus GnRH in patients with prostate cancer: A 12 month-prospective observational study

“…However, this study showed that the proportion of patients with osteopenia or osteoporosis was insignificantly increased slightly at 12M post-ADT initiation between groups (p > 0.05, Table 3) and osteoporosis was 9.4% of hormone-naïve Korean prostate cancer patients with an average age of 65.1, which is more common than the 3.4% of healthy controls in Korea (p = 0.001) and corresponding Japanese prostate cancer patients of an average age of 68.18. As shown in literature reviews (Table 5), most prospective ADT studies were composed of patients from Western countries using GnRH agonists or orchiectomy, and only a few prospective studies from patients with CAB and only a few non-prospective, cross-sectional Asian studies have published their ADT-related results of bone mineral loss27282930. This study has clinical relevance because it is the first prospectively designed study of longitudinal BMD changes by different types of ADT including CAB and GnRH agonists in Asian patients.…”

Radiation therapy and androgen deprivation in the management of high risk prostate cancer

“…Androgen deprivation has been associated with numerous side-effects including sexual dysfunction, gynecomastia, bone mineral loss, anemia, fatigue, muscular pain, hot-flashes, metabolic complications and potentially increased cardiovascular events (65)(66)(67)(68). The latter is a controversial issue receiving increasing attention in the decision-making process.…”