Abstract
ObjectiveAndrogen deprivation therapy (ADT) increases fracture risk in men with carcinoma of the prostate, but little is known about the fracture risk for different types of ADT. We studied the fracture risk amongst Chinese patients with carcinoma of the prostate prescribed different ADT regimens.Subjects and methodsThis was a single-centered observational study that involved 741 patients with carcinoma of the prostate from January 2001 to December 2011.ResultsAfter a median follow-up of 5 years, 71.7% of the study cohort received ADT and the incidence rate of fracture was 8.1%. Multivariable Cox regression analysis revealed that use of ADT was significantly associated with risk of incident fracture (Hazard Ratio [HR] 3.60; 95% Confidence Interval [95% CI] 1.41–9.23; p = 0.008), together with aged >75 years and type 2 diabetes. Compared with no ADT, all three types of ADT were independently associated with the risk of incident fracture: anti-androgen monotherapy (HR 4.47; 95% CI 1.47–13.7; p = 0.009), bilateral orchiectomy ± anti-androgens (HR 4.01; 95% CI 1.46–11.1; p = 0.007) and luteinizing hormone-releasing hormone agonists ± anti-androgens (HR 3.16; 95% CI 1.18–8.43; p = 0.022). However, there was no significant difference in the relative risks among the three types of ADT.ConclusionsFracture risk increases among all types of ADT. Clinicians should take into account the risk-benefit ratio when prescribing ADT, especially in elderly patients with type 2 diabetes.
Highlights
Carcinoma of the prostate, a classic hormone-dependent malignancy, is the second most frequent cancer diagnosed and is the sixth most common cause of death in men worldwide.[1,2] In Hong Kong, carcinoma of the prostate ranks as the third leading cancer in men, accounting for 6.5% of all cancers in those aged 45–64 years and 17% in those aged 65–74 years.[3]
Multivariable Cox regression analysis revealed that use of androgen deprivation therapy (ADT) was significantly associated with risk of incident fracture (Hazard Ratio [hazard ratio (HR)] 3.60; 95% Confidence Interval [95% confidence interval (CI)] 1.41–9.23; p = 0.008), together with aged >75 years and type 2 diabetes
Compared with no ADT, all three types of ADT were independently associated with the risk of incident fracture: anti-androgen monotherapy (HR 4.47; 95% CI 1.47–13.7; p = 0.009), bilateral orchiectomy ± anti-androgens (HR 4.01; 95% CI 1.46–11.1; p = 0.007) and luteinizing hormone-releasing hormone agonists ± anti-androgens (HR 3.16; 95% CI 1.18–8.43; p = 0.022)
Summary
A classic hormone-dependent malignancy, is the second most frequent cancer diagnosed and is the sixth most common cause of death in men worldwide.[1,2] In Hong Kong, carcinoma of the prostate ranks as the third leading cancer in men, accounting for 6.5% of all cancers in those aged 45–64 years and 17% in those aged 65–74 years.[3] Over the last decade, the incidence of prostate carcinoma has been steadily increasing by 4.6% per annum, probably related to the aging population as well as a more westernized lifestyle in Hong Kong.[4] Because it is androgen dependent, androgen deprivation therapy (ADT) is the mainstay systemic treatment in patients with metastatic carcinoma of the prostate.[5] It has been widely used amongst those with less advanced disease.[6,7] To date, androgen deprivation can be achieved in several ways: surgically by performing bilateral orchiectomy, or pharmacologically with gonadotrophin-releasing hormone (GnRH) agonists such as luteinizing hormonereleasing hormone agonists (LHRHa), GnRH antagonists, and non-steroidal anti-androgen drugs such as bicalutamide and flutamide. The aim of this study was to evaluate the fracture risk for different forms of ADT [16] using data from a retrospective cohort of Chinese patients with carcinoma of the prostate
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