Bone complications among prostate cancer survivors: long-term follow-up from the prostate cancer outcomes study
Amee MorgansK-H FanTatsuki KoyamaPeter C. AlbertsenMark M. GoodmanAnn S. HamiltonRichard M. HoffmanJ. L. StanfordAntoinette M. StroupDavid F. Penson
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• Androgen deprivation therapy is associated with metabolic derangements due to profound hypogonadism that can increase the risk of CV disease in prostate cancer survivors. • Therapeutic advances have resulted in prolonged patient exposure to androgen deprivation therapy, thereby increasing CV complications for many prostate cancer survivors. • A systematic approach to monitoring and addressing reversible CV risk factors and purposeful engagement in multidisciplinary care between oncologists, urologists, and cardiologists is critical to optimizing CV outcomes in men with prostate cancer.
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Osteoporosis is a common complication of androgen deprivation therapy (ADT). In this large Swedish cohort study consisting of a total of nearly 180,000 older men, we found that those with prostate cancer and ADT have a significantly increased risk of future osteoporotic fractures. Androgen deprivation therapy (ADT) in patients with prostate cancer is associated to increased risk of fractures. In this study, we investigated the relationship between ADT in patients with prostate cancer and the risk of incident fractures and non-skeletal fall injuries both compared to those without ADT and compared to patients without prostate cancer. We included 179,744 men (79.1 ± 7.9 years (mean ± SD)) from the Swedish registry to which national directories were linked in order to study associations regarding fractures, fall injuries, morbidity, mortality and medications. We identified 159,662 men without prostate cancer, 6954 with prostate cancer and current ADT and 13,128 men with prostate cancer without ADT. During a follow-up of approximately 270,300 patient-years, we identified 10,916 incident fractures including 4860 hip fractures. In multivariable Cox regression analyses and compared to men without prostate cancer, those with prostate cancer and ADT had increased risk of any fracture (HR 95% CI 1.40 (1.28–1.53)), hip fracture (1.38 (1.20–1.58)) and MOF (1.44 (1.28–1.61)) but not of non-skeletal fall injury (1.01 (0.90–1.13)). Patients with prostate cancer without ADT did not have increased risk of any fracture (0.97 (0.90–1.05)), hip fracture (0.95 (0.84–1.07)), MOF (1.01 (0.92–1.12)) and had decreased risk of non-skeletal fall injury (0.84 (0.77–0.92)). Patients with prostate cancer and ADT is a fragile patient group with substantially increased risk of osteoporotic fractures both compared to patients without prostate cancer and compared to those with prostate cancer without ADT. We believe that this must be taken in consideration in all patients with prostate cancer already at the initiation of ADT.
Hip Fracture
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Cancer Therapy
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To determine best practices for managing hot flashes associated with androgen deprivation therapy (ADT) in men with prostate cancer.The CINAHL®, Embase®, PsycINFO®, PubMed®, and Scopus® databases were used to identify randomized controlled trials (RCTs) and quasiexperimental studies published between January 1994 and June 2018.Using the Cochrane Handbook for Systematic Reviews of Interventions, the authors reviewed 15 studies examining the effects of pharmacologic or complementary and alternative medicine interventions on ADT-associated hot flashes in men with prostate cancer.Pharmacologic interventions (e.g., cyproterone, medroxyprogesterone, megestrol acetate) showed some promise for reducing hot flashes but were associated with side effects and risks. Acupuncture demonstrated potential benefit in reducing hot flashes without side effects.Evidence is insufficient to support interventions for ADT-associated hot flashes in men with prostate cancer. Future RCTs should be sufficiently powered, include a control group, and use standardized outcome measures.
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Hormone Therapy
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Prostate cancer is one of the most common malignancies in men. Charles Huggins and Clarence V. Hodges reported the androgen dependence of prostate cancer in 1941. That led to the utilization of androgen deprivation therapy as an important therapeutic modality to treat prostate cancer. Androgen deprivation therapy has additional systemic effects that include sexual dysfunction, psychological changes and more important are the metabolic changes. Metabolic changes in particular include insulin resistance, increase fat mass and low-density lipoprotein cholesterol, and induce type 2 diabetes. In this review we will focus on the cardiovascular risk associated with androgen deprivation therapy that includes the mechanisms involved.
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No AccessJournal of UrologyEditorial1 Jun 2015Uncovering the Metabolic Complications of Androgen Deprivation Therapy in Patients with Prostate Cancer—Where Do We Take it Next? Jehonathan H. Pinthus Jehonathan H. PinthusJehonathan H. Pinthus More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2015.03.070AboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail "Uncovering the Metabolic Complications of Androgen Deprivation Therapy in Patients with Prostate Cancer—Where Do We Take it Next?." The Journal of Urology, 193(6), pp. 1882–1883 References 1 : Risk of diabetes among patients receiving primary androgen deprivation therapy for clinically localized prostate cancer. J Urol2015; 193: 1956. Link, Google Scholar 2 : The metabolic syndrome and its components in patients with prostate cancer on androgen deprivation therapy. J Urol2015; 193: 1963. Link, Google Scholar 3 : Association between androgen-deprivation therapy and incidence of diabetes among males with prostate cancer. Urology2007; 70: 1104. Google Scholar 4 : Diabetes and cardiovascular disease during androgen deprivation therapy for prostate cancer. J Clin Oncol2006; 24: 4448. Google Scholar 5 : Metabolic syndrome in men with prostate cancer undergoing long-term androgen-deprivation therapy. J Clin Oncol2006; 24: 3979. Google Scholar 6 : Standards of medical care in diabetes–2014. Diabetes Care2014; 37: S14. Google Scholar 7 : The effects of induced hypogonadism on arterial stiffness, body composition, and metabolic parameters in males with prostate cancer. J Clin Endocrinol Metab2001; 86: 4261. Crossref, Medline, Google Scholar 8 : The effect of androgen deprivation therapy on body composition in men with prostate cancer: systematic review and meta-analysis. J Cancer Surviv2010; 4: 128. Google Scholar 9 : Quantitation of muscle glycogen synthesis in normal subjects and subjects with non-insulin-dependent diabetes by 13C nuclear magnetic resonance spectroscopy. N Engl J Med1990; 322: 223. Google Scholar 10 : Exercise-induced reversal of insulin resistance in obese elderly is associated with reduced visceral fat. J Appl Physiol (1985)2006; 100: 1584. Google Scholar 11 : Reduction in the incidence of type 2 diabetes with lifestyle intervention or metformin. N Engl J Med2002; 346: 393. Google Scholar 12 : GnRH antagonist associates with less adiposity and reduced characteristics of metabolic syndrome and atherosclerosis compared with orchiectomy and GnRH agonist in a preclinical mouse model. Urol Oncol2014; 32: 1126. Google Scholar © 2015 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 193Issue 6June 2015Page: 1882-1883 Advertisement Copyright & Permissions© 2015 by American Urological Association Education and Research, Inc.MetricsAuthor Information Jehonathan H. Pinthus More articles by this author Expand All Advertisement PDF downloadLoading ...
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