Incidence of Skeletal-Related Events in Patients With Advanced and Metastatic Prostate Cancer Treated With Hormone Therapy in a Low- and Middle-Income Country

Abstract

Abstract 16 Background: Skeletal-related events (SREs) are fractures, radiotherapy to bone, or spinal cord compression that occurs concurrently with or after the first bone metastasis in men with prostate cancer (PC) and may result from hormone therapy (HT). In this work, we report the incidence of SREs in patients with PC who are treated with HT and highlight the burden of advanced and metastatic PC in a practice in a low- and middle-income country. Methods: Retrospective data was of newly diagnosed patients with PC with SREs who were treated with androgen deprivation therapy at the University of Abuja Teaching Hospital, Abuja, Nigeria, between January 2012 and December 2015. Results: Of 219 cases reviewed, 142 patients (64.8%) had American Joint Committee on Cancer stage IV PC and so commenced treatment with HT, with > 50% of these patients being older than 65 years (mean [standard deviation], 68.3 [± 9.5] years). Serum prostate-specific antigen range was 1.4 to 2,461.58 ng/mL (mean [standard deviation], 113.7 [± 288.9] ng/mL). Twenty-nine patients (20.5%) had one or more SREs: spinal cord compression (19.1%), pathological fractures (1.4%), and radiotherapy to the affected bone (1.4%) being the most common. Fifty additional patients (35.2%) had bone pain with localization to the lumbosacral spine in > 50% of them, whereas two patients with pathologic fractures had internal fixation and bone radiotherapy, respectively. HT was orchiectomy, luteinizing hormone-releasing hormone agonists (LHRH), antiandrogens, and complete androgen blockade (orchiectomy plus antiandrogens) in 14 (9.8%), 3 (2.1%), 44 (30.9%), and 81 (57%) patients, respectively. Conclusion: That 65% of our patients had advanced or metastatic PC at first diagnosis lends credence to late presentation with increased morbidity and mortality of PC in our environment where penetration of radiotherapy services and access to LHRH is significantly low, as evidenced by patients who had complete androgen blockade that was treated with orchiectomy plus antiandrogens. AUTHORS' DISCLOSURES OF POTENTIAL CONFLICTS OF INTEREST No COIs from either author.