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. 2020 May-Jun;46(3):363-373.
doi: 10.1590/S1677-5538.IBJU.2019.0023.

Special emphasis on bone health management in prostate cancer patients: a prospective longitudinal study

Ashish Sharma  1 , Rahul Janak Sinha  1 , Gaurav Garg  1 , Samarth Agarwal  1 , Asif Akhtar Statistician  1 , Vishwajeet Singh  1
Affiliations

Special emphasis on bone health management in prostate cancer patients: a prospective longitudinal study

Ashish Sharma et al. Int Braz J Urol. 2020 May-Jun.

Abstract

Introduction: Use of androgen deprivation therapy (ADT) in carcinoma prostate (CaP) has deleterious effect on bone mineral density (BMD) leading to increase incidence of osteoporosis and skeletal-related events. We evaluated bone health status and impact of bone-directed therapy (BDT) and ADT on BMD in these patients from Jan 2015-Dec 2018.

Materials and method: Baseline bone health was assessed using Tc-99 MDP Bone scan/DEXA scan for patients on ADT. Monthly zoledronic acid (ZA) was given to high-risk candidates (T-score ≤2.5 or previous hip/vertebral fracture) or Skel et al. metastatic patients who were receiving ADT. Baseline and follow-up (at 12-months) BMD using DEXA scan at various sites (spine, femur total, femur neck and radius) and subjective improvement in bony pain using Numeric Pain Rating Score after administration of ZA were compared.

Results: A total of 96-patients of locally advanced and metastatic prostate cancer receiving ADT with or without BDT were included in the study cohort. Mean age of presentation was 68.4±15.61 years. Median serum PSA was 32.2±13.1ng/mL. There was significant improvement in mean BMD (T-score) in 64-patients post ZA therapy at 12-months (at femoral total, femoral neck and spine; 0.95, 0.79 and 0.68, respectively) (p < 0.05) while there was significant deterioration in mean BMD at 12-months (at spine, femoral neck and femoral total; -0.77, -0.55 and -0.66, respectively) in 32 patients who did not receive ZA and were on ADT (p < 0.05). Pain scores significantly decreased in patients after 12-months of ZA use (-2.92±2.16, p < 0.01).

Conclusion: Bone-directed therapy (Zoledronic acid) leads to both subjective and objective improvement in bone health of prostate cancer patients on ADT.

Keywords: Longitudinal Studies; Population Health Management; Prostatic Neoplasms.

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Conflict of interest statement

None declared.

Figures

Figure 1
Figure 1. Flow Chart of the study.
Figure 2
Figure 2. Baseline and post-therapy (Zoledronic acid therapy) BMD (T-Score) showing improvement at all site except radius.
Figure 3
Figure 3. Baseline and Follow-up BMD (T-Score) in patients on ADT without Zoledronic acid therapy showing worsening at all site except radius.
Figure 4
Figure 4. Comparison of T-Scores in patients who received therapy and did not received therapy showing favourable results for therapy group.
Figure 5
Figure 5. Comparison of pain scores pre and post Zoledronic acid therapy in patients on ADT showing a significant improvement in pain scores.
See this image and copyright information in PMC

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