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Posted by on Aug 22, 2014 in Prostate cancer | 2 comments

In a nutshell

The authors evaluated 1-year differences in outcome between 4 different treatments for bone mass loss associated with androgen deprivation therapy.

Some background

Androgen deprivation therapy (ADT) is the cornerstone of treatment for metastatic prostate cancer (cancer that has spread beyond the prostate), high-risk early-stage cancer and for those with recurrent (returning) disease following surgery or radiation therapy for early stage disease.  ADT is intended to reduce the production of androgens (male sex hormones such as testosterone), or inhibit their effect on cancer cell growth. ADT is associated with decreased bone mineral density (the amount of mineral matter per square centimeter of bone), and bone loss associated with ADT is more rapid and severe than that associated with normal age-related bone loss.

Bisphosphonates (for example alendronate;Fosamax) and denosumab (Prolia) are drug therapies used to treat cancer treatment-induced bone loss. This study evaluated bone mass changes after 1 year associated with 4 different modes of treatment for bone mass loss.

Methods & findings

The authors studied the records of 97 patients who were receiving ADT (for example leuprorelin;Eligard or bicalutamide;Casodex) for nonmetastatic prostate cancer. Patients were divided into 4 groups. Group 1 consisted of 28 patients treated with denosumab. Group 2 consisted of 24 patients treated with alendronate. Group 3 consisted of 24 patients who did not undergo any treatment for bone loss. Group 4 consisted of 21 patients who were previously treated with alendronate who were switched to denosumab. Patients were followed for 1 year.

Patients in group 1 and 2 showed a significant bone mass increase at the lumbar spine (the lower back); an increase of 2.4% in group 1 and 5% in group 2. Group 3 saw a decrease in bone mass of 1.4% and group 4 saw an increase in bone mass of 2.9%, but these results were not deemed to be significant.

At the femoral neck (part of the thigh bone), group 1 and 2 again showed significant bone mass increase; an increase of 3.7% for group 1 and 3.6% for group 2. Group 3 saw a decrease in bone mass of 0.3% while group 4 saw an increase in bone mass of 2.1%, but these results were not deemed to be significant.

At the hip, a significant bone mass increase was observed in group 1 patients of 29%, while a significant bone mass decrease was observed in group 3 of 1.9%.

The bottom line

The authors concluded that treatment with alendronate or denosumab is beneficial for bone mass loss associated with ADT. 

The fine print

The number pf patients evaluated was small, and so further studies with more patients are warranted to confirm results. 

Published By :

Rheumatology International

Date :

Mar 11, 2014

Original Title :

Bone mass behavior after 1 year of different treatment strategies in prostate cancer patients subjected to androgen deprivation therapy.

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