Bone Mineral Density in Men Treated With Synthetic Gonadotropin-Releasing Hormone Agonists for Prostatic Carcinoma

Joung

et al. 2017

Sci Rep

The multi-centre, prospective, observational study was designed to examine the efficacy of continuous combined androgen block (CAB) vs. GnRH agonist monotherapy in terms of bone mineral density (BMD) change during 12 months post-androgen deprivation therapy (ADT) in Asian prostate cancer patients. Multiple regression analysis and estimated the 10-year probability of major fractures among the patients with Fracture Risk Assessment Tool were conducted to investigate the underlying factors affecting BMD. Paired t-test to evaluate the change of BMD from baseline to 12 month, and two sample t-test to examine the difference of BMD changes were used between two groups. BMD significantly decreased in both the CAB and GnRH groups, with no group wise differences. The proportion of osteopenia or osteoporosis was slightly increased after the 12-month post-ADT. Ten-year probability of hip fracture and major osteoporotic fracture was approximately 3% and 5%, respectively. In conclusion, a significant decrease of BMD by 12-month ADT was observed without any differences between the two groups, whereas ADT-related BMD loss did not induce detrimental effects on bone health in terms of increased bone fracture risk. This was the first prospective study on BMD changes as a predictor of fracture during ADT in an Asian population.

Section: Discussionsupporting

confidence: 91%

Section: Discussionmentioning

confidence: 99%

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

Joung

et al. 2017

Sci Rep

“…Once used primarily to treat metastatic prostate cancer, ADT is now used as adjuvant therapy for locally advanced or high-risk localized prostate cancer and as treatment of biochemical failure after primary therapy (1–3). Because most men with prostate cancer receive the diagnosis at an older age and because androgen deficiency is associated with low bone mineral density (BMD), men with prostate cancer who receive treatment with ADT are at particularly increased risk for osteoporosis and related fractures (4–9). …”

mentioning

confidence: 99%

Cost-Effectiveness of Fracture Prevention in Men Who Receive Androgen Deprivation Therapy for Localized Prostate Cancer

Ito

Elkin²,

Girotra³

et al. 2010

Ann Intern Med

Background Androgen deprivation therapy (ADT) increases the risk for fractures in patients with prostate cancer. Objective To assess the cost-effectiveness of measuring bone mineral density (BMD) before initiating ADT followed by alendronate therapy in men with localized prostate cancer. Design Markov state-transition model simulating the progression of prostate cancer and the incidence of hip fracture. Data Sources Published literature. Target Population A hypothetical cohort of men aged 70 years with locally advanced or high-risk localized prostate cancer starting a 2-year course of ADT after radiation therapy. Time Horizon Lifetime. Perspective Societal. Intervention No BMD test or alendronate therapy, a BMD test followed by selective alendronate therapy for patients with osteoporosis, or universal alendronate therapy without a BMD test. Outcome Measures Incremental cost-effectiveness ratio (ICER), measured by cost per quality-adjusted life-year (QALY) gained. Results of Base-Case Analysis The ICERs for the strategy of a BMD test and selective alendronate therapy for patients with osteoporosis and universal alendronate therapy without a BMD test were $66 800 per QALY gained and $178 700 per QALY gained, respectively. Results of Sensitivity Analyses The ICER for universal alendronate therapy without a BMD test decreased to $100 000 per QALY gained, assuming older age, a history of fractures, lower mean BMD before ADT, or a lower cost of alendronate. Limitations No evidence shows that alendronate reduces actual fracture rates in patients with prostate cancer who receive ADT. The model predicted fracture rates by using data on the surrogate BMD end point. Conclusion In patients starting adjuvant ADT for locally advanced or high-risk localized prostate cancer, a BMD test followed by selective alendronate for those with osteoporosis is a cost-effective use of resources. Routine use of alendronate without a BMD test is justifiable in patients at higher risk for hip fractures. Primary Funding Source None.

“…By improving bone health, older patients with prostate cancer may have less need for opiate medications, orthopedic procedures, and less risk of fractures, with the occurrence of any of these potentially causing a dramatic shift in a patient's ability to live independently and contribute to their risk of morbidity and mortality. Beyond its beneficial anti-cancer effects, ADT worsens bone health as it contributes to osteoporosis, compounding the morbidity of this disease in terms of bone health [48]. Providers should monitor vitamin D levels and encourage calcium and vitamin D supplementation as indicated to maintain good bone health in patients on ADT or with bone metastasis.…”

Section: Bone Therapymentioning

confidence: 99%

Geriatric considerations in the treatment of advanced prostate cancer

Kessler¹,

Flaig²

2014

F1000Prime Rep

Prostate cancer is the most common non-cutaneous cancer in US men and mainly affects elderly patients, with most new diagnoses occurring in those over 65. As the geriatric population in the US continues to grow, the incidence of this disease is likewise expected to rise. Many older patients are diagnosed with advanced disease or are treated only when their disease becomes symptomatic or metastatic. The treatment options for advanced prostate cancer have increased dramatically in the last decade. It is important to understand the nuances of caring for an elderly cancer patient in order to optimally treat prostate cancer, such as the importance of using a geriatric assessment to uncover overlooked or under-reported vulnerabilities. In addition, many of the newly approved agents for the treatment of advanced prostate cancer have a unique mechanism of action and toxicities that warrant consideration when choosing therapies for older patients. This review focuses on the importance of a geriatric assessment as well as the considerations of treating elderly patients with the newer agents approved for prostate cancer.