Short‐term impact of androgen deprivation therapy on bone strength in castration‐sensitive prostate cancer

Abstract

Objectives To prospectively evaluate changes in bone quality and bone mineral density after androgen deprivation therapy in castration‐sensitive prostate cancer. Methods A total of 32 patients with castration‐sensitive prostate cancer who were scheduled for androgen deprivation therapy for >12 months were included. The bone mineral density of the femoral neck and lumbar spine was evaluated before, and 6 and 12 months after androgen deprivation therapy. Bone metabolic (serum undercarboxylated osteocalcin, tartrate‐resistant acid phosphatase 5b and procollagen type I propeptides) and bone quality markers (plasma pentosidine and homocysteine) were measured before, and 3, 6 and 12 months after androgen deprivation therapy. Results The median patient age was 71 years. A total of 17 patients were treated primarily with androgen deprivation therapy, and 15 were treated with androgen deprivation therapy in combination with definitive radiotherapy. Bone quality markers did not change substantially after androgen deprivation therapy. Bone mineral density decreased significantly after 12 months of androgen deprivation therapy. Serum undercarboxylated osteocalcin and tartrate‐resistant acid phosphatase 5b levels increased significantly 3 months after androgen deprivation therapy, but procollagen type I propeptides levels stayed unchanged. Conclusions Bone quality markers do not change substantially after androgen deprivation therapy, whereas bone mineral density decreases significantly. Bone turnover markers might play an important role in monitoring bone health during androgen deprivation therapy.

Early effects of androgen deprivation on bone and mineral homeostasis in adult men: a prospective cohort study

“…P1NP was not affected in our study. Discrepancies have been observed, with both unaltered (6) and increased (38) P1NP levels being reported following ADT. Timing could play a role, as others have described a decrease in serum P1NP after 4 weeks of ADT in healthy men, which normalized again by 12 weeks (37).…”

“…It is well known that male hypogonadism is associated with bone loss. Accordingly, in prostate cancer patients androgen deprivation therapy (ADT) induces bone loss, thereby increasing the risk for osteoporosis and fractures (2)(3)(4)(5)(6)(7)(8)(9). However, in case of metastatic prostate cancer the impact of ADT per se on bone homeostasis could be obscured.…”

“…In contrast to prostate cancer patients, this patient group is generally younger, has less comorbidities, and is expected to need long-term treatment with ADT (11,12). However, research on adverse health effects of ADT is limited in these patients and only a few studies included data on bone health (3)(4)(5)(6)8). Moreover, while the long-term effects of androgen deprivation on bone have been extensively investigated, mainly in prostate cancer patients, studies on the short-term impact of changes in sex steroids on bone and mineral homeostasis are limited.…”

Silica‐Based Nanoparticles as Drug Delivery Vehicles for Prostate Cancer Treatment

“…Hence, other modes of treatment are sought after cancer advances further. It has also been shown that ADT can cause a significant decrease in bone mineral density and is one of the major side effects of ADT [37] …”

The relationship of diffuse idiopathic skeletal hyperostosis, visceral fat accumulation, and other age-related diseases with the prevalent vertebral fractures in elderly men with castration-naïve prostate cancer

“…Although the incidence of prostate cancer in Asian countries, including Japan, is lower than in North America and Europe, it is expected that it will rapidly increase in the future as the population ages [1][2][3]. Most prostate cancer treatments, mainly androgen deprivation therapy (ADT), lead to cancer treatment-induced bone loss (CTIBL) and increase the risk of fracture [4][5][6][7][8], which is greatly related to the patient's quality of life (QOL). Identifying the characteristics of patients at risk of fracture before the initiation of cancer treatment is becoming more important for maintaining QOL during and after cancer treatment in elderly patients.…”