Long-term dynamics of bone mineral density during intermittent androgen deprivation for men with nonmetastatic, hormone-sensitive prostate cancer Full Text
Journal of Clinical Oncology,
Yu EY et al. – Patients experienced the greatest average change in BMD during early treatment periods of IAD with a smaller average change thereafter. Fractures were rare.Methods
- Men with prostate cancer who lacked radiographically detectable metastases were treated in a prospective trial of IAD.
- After 9 months of treatment with leuprolide and flutamide, androgen deprivation therapy (ADT) was stopped until prostate-specific antigen reached a threshold (1 ng/mL for radical prostatectomy; 4 ng/mL for radiation or primary ADT) for a new cycle.
- Dual-energy x-ray absorptiometry (DXA) scans were performed before starting ADT and subsequently with each change in therapy.
- At least two consecutive DXA scans were required for this analysis.
- Computed tomography, bone scintigraphy, and lumbar spine x-rays were performed at the beginning and end of each treatment period.
- Fifty-six of 100 patients met criteria for this analysis. The median age at study entry was 64.5 years (range, 49.8 to 80.9 years).
- The average percentage change in BMD during the first on-treatment period was -3.4% (P < .001) for the spine and -1.2% (P = .001) for the left hip.
- During the first off-treatment period (median, 37.4 weeks; range, 13.4 weeks to 8.7+ years), BMD recovery at the spine was significant, with an average percentage change of +1.4% (P = .002).
- Subsequent periods had heterogeneous changes of BMD without significant average changes.
- After a median of 5.5 years (range, 1.1 to 13.8+) years on trial, one patient (1.8%) had a compression fracture associated with trauma.