Eric D Johnson1, Katerina Butler1, Sumati Gupta1. 1. and are Oncologists, and is a Clinical Oncology Pharmacist; all at George E. Wahlen Department of Veterans Affairs Medical Center in Salt Lake City, Utah. Eric Johnson is a Clinical Fellow and Sumati Gupta is an Assistant Professor, both at Huntsman Cancer Institute at the University of Utah in Salt Lake City.
Abstract
BACKGROUND: The veteran population has an increasingly high number of patients who have either survived, are currently living with, or are being treated for prostate cancer. Survivorship concerns related to the treatment of this disease is a relevant topic in the Veterans Health Administration, given the longevity of life with localized disease treatment and the fairly durable therapies for metastatic disease. Long-term androgen deprivation therapy (ADT) forms the backbone of treatment for advanced and metastatic castration-sensitive prostate cancer. OBSERVATIONS: The potential bone-health complications resulting from treatment with ADT should be recognized as many patients live for prolonged periods with stable or controlled disease. It is well established that prolonged ADT can lead to significant bone loss and increased fracture risk, which increases all-cause mortality and disability. Bone-remodeling agents, such as bisphosphonates and receptor-activated nuclear factor κ-B ligand inhibitors, are recommended to reduce the risk of fragility fractures in patients at high risk due to diminished bone density while on hormone deprivation therapy for hormone-naive prostate cancer. These agents are also indicated at a higher dose to prevent complications from bone metastases in castration-resistant prostate cancer with bone metastases. CONCLUSIONS: This article reviews recent studies on bone health in men with prostate cancer and presents an evidence-based algorithm for bone-health monitoring during treatment and recommended interventions.
BACKGROUND: The veteran population has an increasingly high number of patients who have either survived, are currently living with, or are being treated for prostate cancer. Survivorship concerns related to the treatment of this disease is a relevant topic in the Veterans Health Administration, given the longevity of life with localized disease treatment and the fairly durable therapies for metastatic disease. Long-term androgen deprivation therapy (ADT) forms the backbone of treatment for advanced and metastatic castration-sensitive prostate cancer. OBSERVATIONS: The potential bone-health complications resulting from treatment with ADT should be recognized as many patients live for prolonged periods with stable or controlled disease. It is well established that prolonged ADT can lead to significant bone loss and increased fracture risk, which increases all-cause mortality and disability. Bone-remodeling agents, such as bisphosphonates and receptor-activated nuclear factor κ-B ligand inhibitors, are recommended to reduce the risk of fragility fractures in patients at high risk due to diminished bone density while on hormone deprivation therapy for hormone-naive prostate cancer. These agents are also indicated at a higher dose to prevent complications from bone metastases in castration-resistant prostate cancer with bone metastases. CONCLUSIONS: This article reviews recent studies on bone health in men with prostate cancer and presents an evidence-based algorithm for bone-health monitoring during treatment and recommended interventions.
Authors: Matthew Smith; Chris Parker; Fred Saad; Kurt Miller; Bertrand Tombal; Quan Sing Ng; Martin Boegemann; Vsevolod Matveev; Josep Maria Piulats; Luis Eduardo Zucca; Oleg Karyakin; Go Kimura; Nobuaki Matsubara; William Carlos Nahas; Franco Nolè; Eli Rosenbaum; Axel Heidenreich; Yoshiyuki Kakehi; Amily Zhang; Heiko Krissel; Michael Teufel; Junwu Shen; Volker Wagner; Celestia Higano Journal: Lancet Oncol Date: 2019-02-06 Impact factor: 41.316
Authors: David P Dearnaley; Malcolm D Mason; Mahesh K B Parmar; Karen Sanders; Matthew R Sydes Journal: Lancet Oncol Date: 2009-08-10 Impact factor: 41.316