In what is believed to be the first study to describe the impact on men with a ‘high’ risk of bone fracture who are receiving long-term androgen deprivation therapy (ADT) for prostate cancer, research from The Cancer Institute of New Jersey shows this population to have a higher occurrence of fracture following completion of treatment.
Men with prostate cancer that hasn’t spread to other parts of the body who have underlying health conditions often receive ADT, because they are considered inappropriate candidates for more aggressive treatments such as surgery or radiation. Some patients receive ADT in addition to these treatments to boost the effect of the initial therapy. With ADT, the hope is to shrink or delay growth of the cancer. Previous studies have shown an association between the receipt of ADT for prostate cancer and an increased risk of bone fracture and other skeletal complications. Investigators at The Cancer Institute of New Jersey further explored the impact of this treatment on men already deemed to be at a high risk for fracture prior to receiving therapy. The findings were published in the January 2013 edition of BJU International (doi:10.1111/j.1464-410X.2012.11758.x).
Using the population-based Surveillance, Epidemiology, and End Results (SEER)-Medicare linked database, researchers reviewed demographics and tumor characteristics of some 76,000 men aged 66 and older, who were diagnosed between 1992 and 2007 as having prostate cancer that had not spread. Some of these men who had received ADT also had previously received surgery or radiation therapy to treat their prostate cancer. Investigators created a risk assessment scale for baseline skeletal complications - including fracture. Health conditions such as diabetes, alcohol and cigarette use, paralysis, and liver disease were considered in this scale if they were present in the patient within one year of them first being diagnosed with prostate cancer.
“Our findings suggest that treating men having a high baseline risk of fracture with long-term androgen deprivation therapy may have serious adverse consequences.”
—Grace Lu-Yao, PhD, MPH
Investigators found that during a 12-year follow up, more than 58 percent of men determined to be at a ‘high’ risk of fracture before receiving treatment and 38 percent considered at ‘low’ risk developed at least one fracture after receiving ADT. The likelihood of death was found to be 40 percent higher within two years after experiencing a fracture.
“Our findings suggest that treating men having a high baseline risk of fracture with long-term androgen deprivation therapy may have serious adverse consequences,” said senior author Grace Lu-Yao, PhD, MPH, cancer epidemiologist at The Cancer Institute of New Jersey and professor of medicine at Robert Wood Johnson Medical School and of epidemiology at UMDNJ-School of Public Health. “We anticipate the results of this study will prompt further examination of a patient’s baseline-risk of fracture and skeletal complications prior to administering this course of therapy.”
Along with Lu-Yao, the author team consists of Yu-Hsuan Shao, PhD, The Cancer Institute of New Jersey and UMDNJ-School of Public Health; Dirk F. Moore, PhD, Weichung Shih, PhD, Yong Lin, PhD, and Thomas L. Jang, MD, MPH, all The Cancer Institute of New Jersey and Robert Wood Johnson Medical School.
The study was supported by grants from the National Cancer Institute (R01 CA 116399) and (Cancer Center Support Grant - P30 CA072720-13); and the Robert Wood Johnson Foundation (60624).