Bisphosphonate therapy in patients under androgen deprivation therapy for prostate cancer: a systematic review and meta-analysis

Neto, Ary Serpa; Tobias-Machado, Marcos; Esteves, M. A.; Senra, M. D.; Wroclawski, Marcelo Langer; Fonseca, Fernando Luiz Affonso; Reis, Rodolfo Borges dos; Pompeo, Antônio Carlos Lima; Giglio, Auro del

doi:10.1038/pcan.2011.4

Cited by 72 publications

(31 citation statements)

References 39 publications

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“…Furthermore, there are concerns surrounding the overall safety of antiresorptive therapy with adverse effects such as flu-like symptoms, hypercalcaemia and hepatic failure reported in men treated with ADT. 73 Finally, as antiresorptive therapy has no effect on other key fracture risk factors, such as muscle strength, muscle mass, balance and gait, all of which are associated with an increased risk of falls and fracture, independent of BMD, alternative or adjunct interventions should be made available to patients currently undergoing ADT (Table 4). …”

Section: Methodsmentioning

confidence: 99%

Lifestyle guidelines for managing adverse effects on bone health and body composition in men treated with androgen deprivation therapy for prostate cancer: an update

Owen

Daly

Livingston

et al. 2017

Prostate Cancer Prostatic Dis

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Background:Men treated with androgen deprivation therapy (ADT) for prostate cancer are prone to multiple treatment-induced adverse effects, particularly with regard to a deterioration in bone health and altered body composition including decreased lean tissue mass and increased fat mass. These alterations may partially explain the marked increased risk in osteoporosis, falls, fracture and cardiometabolic risk that has been observed in this population.Methods:A review was conducted that assessed standard clinical guidelines for the management of ADT-induced adverse effects on bone health and body composition in men with prostate cancer.Results:Currently, standard clinical guidelines exist for the management of various bone and metabolic ADT-induced adverse effects in men with prostate cancer. However, an evaluation of the effectiveness of these guidelines into routine practice revealed that men continued to experience increased central adiposity, and, unless pharmacotherapy was instituted, accelerated bone loss and worsening glycaemia occurred.Conclusions:This review discusses the current guidelines and some of the limitations, and proposes new recommendations based on emerging evidence regarding the efficacy of lifestyle interventions, particularly with regard to exercise and nutritional factors, to manage ADT-related adverse effects on bone health and body composition in men with prostate cancer.

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Section: Methodsmentioning

confidence: 99%

Lifestyle guidelines for managing adverse effects on bone health and body composition in men treated with androgen deprivation therapy for prostate cancer: an update

Owen

Daly

Livingston

et al. 2017

Prostate Cancer Prostatic Dis

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“…64,72 Administration of denosumab and zole-dronic acid decrease the rates of skeletal-related events (pathological fractures, bone pain, need for radiation or surgery for bone metastasis or spinal cord compression) and is recommended in the case of skeletal metastasis. 73,74 In patients with non-metastatic castration-resistant prostate cancer (CRPC) and with PSA doubling times of less than 6 months, treatment with denosumab delayed the occurrence of bone metastasis by 7.2 months (HR 0.77; P = 0.006). 75 …”

Section: Radiotherapymentioning

confidence: 99%

Challenges of managing elderly men with prostate cancer

et al. 2014

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The incidence of prostate cancer increases with age. Current evidence suggests that prostate cancer is under treated in patients aged ≥70 years, despite evidence of efficacy and acceptable toxicity. Radical cystectomy and definitive radiotherapy are often denied owing to fears of post-operative complications and radiotherapy-associated gastrointestinal and genitourinary toxicity. However, modern radical prostatectomy techniques provide excellent clinical outcomes with low perioperative morbidity. Moreover, volume-restricted intensity-modulated radiation therapy is a significant improvement over previous 2D conformal radiotherapy with similar efficacy and lower toxicity. Androgen-deprivation therapy is also under-prescribed among the elderly, owing to concerns of increases in cardiac deaths and osteoporosis acceleration. However, prospective trials have not identified any increase in cardiovascular mortality among elderly men receiving androgen-deprivation therapy compared to age-matched controls. Most patients on androgen deprivation eventually progress to a castration-resistant state. At this stage, the disease still responds to newer agents that target the androgen pathway and to chemotherapy. Among the elderly, chemotherapy is under-prescribed even though it has been demonstrated to be palliative and improve survival. We describe the trends in prostate cancer management in the elderly and the importance of assessing comorbidity status, tumour characteristics, and health status, including a complete geriatric evaluation, before making treatment recommendations.

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“…(51, 52) Consistent with these individual studies, a recent systematic review and meta-analysis of bisphosphonate therapy in men undergoing ADT for prostate cancer, which included 15 studies and 2634 subjects, concluded that bisphosphonate therapy significantly reduced both fracture risk [relative risk (RR) 0.80; P < 0.01] and osteoporosis (RR 0.39; P < 0.001), with zoledronic acid having the greatest effect among the bisphosphonates. (53)…”

Section: Prostate Cancermentioning

confidence: 99%

Osteoporosis and Cancer

Drake

2013

Curr Osteoporos Rep

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Cancer is a major risk factor for bone loss and fractures. This is due both to direct effects of cancer cells on the skeleton and to deleterious effects of cancer-specific therapies on bone cells. Marked improvements in survival for many cancers mean that strategies to limit bone loss and reduce fracture risk must be incorporated into the care plans for nearly all patients with cancer. The vast majority of effort thus far has focused on bone loss in patients with breast and prostate cancers, with comparatively few studies in other malignancies. Anti-resorptive therapies have proven nearly universally effective for limiting bone loss in cancer patients, although few studies have been powered sufficiently to include fractures as primary endpoints, and patients are frequently neither identified nor treated according to published guidelines. Non-pharmacologic approaches to limit falls, particularly in elderly patients, are also likely important adjunctive measures for most cancer patients.

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Bisphosphonate therapy in patients under androgen deprivation therapy for prostate cancer: a systematic review and meta-analysis

Cited by 72 publications

References 39 publications

Lifestyle guidelines for managing adverse effects on bone health and body composition in men treated with androgen deprivation therapy for prostate cancer: an update

Lifestyle guidelines for managing adverse effects on bone health and body composition in men treated with androgen deprivation therapy for prostate cancer: an update

Challenges of managing elderly men with prostate cancer

Osteoporosis and Cancer

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