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Álvarez Ossorio JL, Rodrigo Aliaga M, Rodríguez Antolin A, Unda Urzaiz M, Calleja MÁ, de la Cruz Ruiz M, Blas Quilez J, Hernández Millán IR, Sánchez Zalabardo D, Cozar Olmo JM. Hormone sensitive protocol for metastatic prostate cancer, an update. Actas Urol Esp 2023; 47:244-249. [PMID: 36270435 DOI: 10.1016/j.acuroe.2022.10.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2022] [Revised: 09/21/2022] [Accepted: 09/21/2022] [Indexed: 05/05/2023]
Abstract
To review and update last protocols in hormone sensitive metastatic prostate cancer for improving clinical management in routine. Evidence analysis available about recent updates protocols in hormone sensitive metastatic prostate cancer according to expert panel of clinicians about this field. A nominal consensus group for unify and improve the recommendations to the management of sensitive metastatic prostate cancer patients is currently needed. This document unifies and improve the management of patients with hormone sensitive metastatic prostate cancer, with a methodology that combines data quantitative and qualitative and based on the participation of a broad scientific committee appointed by the Spanish Association of Urology.
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Affiliation(s)
- J L Álvarez Ossorio
- Servicio de Urología, Hospital Universitario Puerta del Mar, Cádiz, Spain; Asociación Española de Urología (AEU) y Fundación para la Investigación en Urología (FIU).
| | - M Rodrigo Aliaga
- Servicio de Urología, Hospital General Universitario de Castellón, Castellón, Spain
| | | | - M Unda Urzaiz
- Servicio de Urología, Clínica IMQ Zorrotzaurre, Bilbao, Vizcaya, Spain
| | - M Á Calleja
- Servicio de Farmacia Hospitalaria, Hospital Universitario Virgen del Rocío, Sevilla, Spain
| | - M de la Cruz Ruiz
- Servicio de Urología, Hospital Son Espases, Palma de Mallorca, Baleares, Spain
| | - J Blas Quilez
- Hospital Universitario Virgen de la Salud, Complejo Hospitalario de Toledo, Toledo, Spain
| | | | | | - J M Cozar Olmo
- Servicio de Urología, Hospital Universitario Virgen de las Nieves, Granada, Spain; IDI-URO (Instituto de Investigación en Urología)
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Una actualización en el protocolo en cáncer de próstata metastásico hormonosensible. Actas Urol Esp 2022. [DOI: 10.1016/j.acuro.2022.09.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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Brown JE, Handforth C, Compston JE, Cross W, Parr N, Selby P, Wood S, Drudge-Coates L, Walsh JS, Mitchell C, Collinson FJ, Coleman RE, James N, Francis R, Reid DM, McCloskey E. Guidance for the assessment and management of prostate cancer treatment-induced bone loss. A consensus position statement from an expert group. J Bone Oncol 2020; 25:100311. [PMID: 32995252 PMCID: PMC7516275 DOI: 10.1016/j.jbo.2020.100311] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2020] [Accepted: 07/27/2020] [Indexed: 02/08/2023] Open
Abstract
CONTEXT AND OBJECTIVE Incidence of prostate cancer (PC) is increasing, but androgen deprivation therapy (ADT) and other therapies are substantially improving survival. In this context, careful consideration of skeletal health is required to reduce the risk of treatment-related fragility fractures and their associated morbidity and mortality. This risk is currently not well-managed. ADT causes significant loss of bone mineral density (BMD). In the metastatic setting, systemic treatments (e.g. chemotherapy, abiraterone, enzalutamide) are used alongside ADT and may require concomitant glucocorticoids. Both ADT and glucocorticoids pose significant challenges to skeletal health in a population of patients already likely to have ongoing age-related bone loss and/or comorbid conditions. Current PC guidelines lack specific recommendations for optimising bone health. This guidance presents evidence for assessment and management of bone health in this population, with specific recommendations for clinical practitioners in day-to-day PC management. METHODS Structured meetings of key opinion leaders were integrated with a systematic literature review. Input and endorsement was sought from patients, nursing representatives and specialist societies. SUMMARY OF GUIDANCE All men starting or continuing long-term ADT should receive lifestyle advice regarding bone health. Calcium/vitamin D supplementation should be offered if required. Fracture risk should be calculated (using the FRAX® tool), with BMD assessment included where feasible. BMD should always be assessed where fracture risk calculated using FRAX® alone is close to the intervention threshold. Intervention should be provided if indicated by local or national guidelines e.g. UK National Osteoporosis Guideline Group (NOGG) thresholds. Men requiring bone protection therapy should be further assessed (e.g. renal function), with referral to specialist centres if available and offered appropriate treatment to reduce fracture risk. Those near to, but below an intervention threshold, and patients going on to additional systemic therapies (particularly those requiring glucocorticoids), should have FRAX® (including BMD) repeated after 12-18 months. PATIENT SUMMARY Modern treatments for prostate cancer have led to significant improvements in survival and quality of life. However, some of these treatments may lead to weakening of patient's bones with risk of fracture and it is therefore important to monitor patients' bone health and provide bone protection where needed. This paper provides specific guidance to clinical teams, based on the most recent research evidence, to ensure optimal bone health in their patients.
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Affiliation(s)
- Janet E. Brown
- Academic Unit of Clinical Oncology, Department of Oncology and Metabolism, University of Sheffield, United Kingdom
| | - Catherine Handforth
- Academic Unit of Clinical Oncology, Department of Oncology and Metabolism, University of Sheffield, United Kingdom
| | | | - William Cross
- Department of Urology, Leeds Teaching Hospitals NHS Trust, United Kingdom
| | - Nigel Parr
- Department of Urology, Wirral University Hospitals NHS Foundation Trust, United Kingdom
| | - Peter Selby
- Faculty of Medicine and Health, University of Manchester, United Kingdom
| | - Steven Wood
- Academic Unit of Clinical Oncology, Department of Oncology and Metabolism, University of Sheffield, United Kingdom
| | | | - Jennifer S. Walsh
- Academic Unit of Bone Metabolism, University of Sheffield, United Kingdom
| | - Caroline Mitchell
- Academic Unit of Primary Medical Care, University of Sheffield, United Kingdom
| | - Fiona J. Collinson
- Leeds Institute of Clinical Trials Research, University of Leeds, United Kingdom
| | - Robert E. Coleman
- Academic Unit of Clinical Oncology, Department of Oncology and Metabolism, University of Sheffield, United Kingdom
| | - Nicholas James
- Institute of Cancer and Genomic Sciences, University of Birmingham, United Kingdom
| | - Roger Francis
- Institute of Cellular Medicine, University of Newcastle, United Kingdom
| | - David M. Reid
- Institute of Medical Sciences, University of Aberdeen, United Kingdom
| | - Eugene McCloskey
- Academic Unit of Bone Metabolism, University of Sheffield, United Kingdom
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Kim TJ, Koo KC. Pathophysiology of Bone Loss in Patients with Prostate Cancer Receiving Androgen-Deprivation Therapy and Lifestyle Modifications for the Management of Bone Health: A Comprehensive Review. Cancers (Basel) 2020; 12:cancers12061529. [PMID: 32532121 PMCID: PMC7352908 DOI: 10.3390/cancers12061529] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Revised: 06/01/2020] [Accepted: 06/08/2020] [Indexed: 12/24/2022] Open
Abstract
Androgen-deprivation therapy (ADT) is a systemic therapy administered for the management of advanced prostate cancer (PCa). Although ADT may improve survival, long-term use reduces bone mass density (BMD), posing an increased risk of fracture. Considering the long natural history of PCa, it is essential to preserve bone health and quality-of-life in patients on long-term ADT. As an alternative to pharmacological interventions targeted at preserving BMD, current evidence recommends lifestyle modifications, including individualized exercise and nutritional interventions. Exercise interventions include resistance training, aerobic exercise, and weight-bearing impact exercise, and have shown efficacy in preserving BMD. At the same time, it is important to take into account that PCa is a progressive and debilitating disease in which a substantial proportion of patients on long-term ADT are older individuals who harbor axial bone metastases. Smoking cessation and limited alcohol consumption are commonly recommended lifestyle measures in patients receiving ADT. Contemporary guidelines regarding lifestyle modifications vary by country, organization, and expert opinion. This comprehensive review will provide an evidence-based, updated summary of lifestyle interventions that could be implemented to preserve bone health and maintain quality-of-life throughout the disease course of PCa.
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Affiliation(s)
- Tae Jin Kim
- Department of Urology, CHA Bundang Medical Center, CHA University College of Medicine, Seongnam 13496, Korea
| | - Kyo Chul Koo
- Department of Urology, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul 06229, Korea
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Sharma A, Sinha RJ, Garg G, Agarwal S, Akhtar A, Singh V. Special emphasis on bone health management in prostate cancer patients: a prospective longitudinal study. Int Braz J Urol 2020; 46:363-373. [PMID: 32167698 PMCID: PMC7088500 DOI: 10.1590/s1677-5538.ibju.2019.0023] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2019] [Accepted: 09/15/2019] [Indexed: 11/22/2022] Open
Abstract
Introduction: Use of androgen deprivation therapy (ADT) in carcinoma prostate (CaP) has deleterious effect on bone mineral density (BMD) leading to increase incidence of osteoporosis and skeletal-related events. We evaluated bone health status and impact of bone-directed therapy (BDT) and ADT on BMD in these patients from Jan 2015-Dec 2018. Materials and Method: Baseline bone health was assessed using Tc-99 MDP Bone scan/ DEXA scan for patients on ADT. Monthly zoledronic acid (ZA) was given to high-risk candidates (T-score ≤2.5 or previous hip/vertebral fracture) or Skel et al. metastatic patients who were receiving ADT. Baseline and follow-up (at 12-months) BMD using DEXA scan at various sites (spine, femur total, femur neck and radius) and subjective improvement in bony pain using Numeric Pain Rating Score after administration of ZA were compared. Results: A total of 96-patients of locally advanced and metastatic prostate cancer receiving ADT with or without BDT were included in the study cohort. Mean age of presentation was 68.4±15.61 years. Median serum PSA was 32.2±13.1ng/mL. There was significant improvement in mean BMD (T-score) in 64-patients post ZA therapy at 12-months (at femoral total, femoral neck and spine; 0.95, 0.79 and 0.68, respectively) (p <0.05) while there was significant deterioration in mean BMD at 12-months (at spine, femoral neck and femoral total; −0.77, −0.55 and −0.66, respectively) in 32 patients who did not receive ZA and were on ADT (p <0.05). Pain scores significantly decreased in patients after 12-months of ZA use (−2.92±2.16, p <0.01). Conclusion: Bone-directed therapy (Zoledronic acid) leads to both subjective and objective improvement in bone health of prostate cancer patients on ADT.
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Abstract
PURPOSE OF REVIEW The improvement in prostate cancer survival over time, even in those with advanced disease, has led to an increasing recognition of the impact of prostate cancer and its treatment on bone health. Cancer treatment-induced bone loss (CTIBL) is a well-recognized entity but greater awareness of the risks associated with CTIBL and its treatment is required. RECENT FINDINGS The principal culprit in causing CTIBL is hormonal ablation induced by prostate cancer treatment, including several new agents which have been developed in recent years which significantly improve survival, but may cause CTIBL. This review discusses the impact of prostate cancer and its treatment on bone health, including published evidence on the underlying pathophysiology, assessment of bone health, and strategies for prevention and treatment. It is important to recognize the potential cumulative impact of systemic prostate cancer treatments on bone health.
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Affiliation(s)
| | - Abdulazeez Salawu
- Department of Oncology and Metabolism, University of Sheffield, Sheffield, UK
| | - Janet E Brown
- Department of Oncology and Metabolism, University of Sheffield, Sheffield, UK.
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Systemic Treatment of Prostate Cancer in Elderly Patients: Current Role and Safety Considerations of Androgen-Targeting Strategies. Drugs Aging 2019; 36:701-717. [DOI: 10.1007/s40266-019-00677-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
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Abstract
Considerable advances in oncology over recent decades have led to improved survival, while raising concerns about long-term consequences of anticancer treatments. In patients with breast or prostate malignancies, bone health is a major issue due to the high risk of bone metastases and the frequent prolonged use of hormone therapies that alter physiological bone turnover, leading to increased fracture risk. Thus, the onset of cancer treatment-induced bone loss (CTIBL) should be considered by clinicians and recent guidelines should be routinely applied to these patients. In particular, baseline and periodic follow-up evaluations of bone health parameters enable the identification of patients at high risk of osteoporosis and fractures, which can be prevented by the use of bone-targeting agents (BTAs), calcium and vitamin D supplementation and modifications of lifestyle. This review will focus upon the pathophysiology of breast and prostate cancer treatment-induced bone loss and the most recent evidence about effective preventive and therapeutic strategies.
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Affiliation(s)
- Catherine Handforth
- Department of Oncology and Metabolism, Academic Unit of Clinical Oncology, Weston Park Hospital, University of Sheffield, Sheffield, UK
| | - Stella D’Oronzo
- Department of Oncology and Metabolism, Academic Unit of Clinical Oncology, Weston Park Hospital, University of Sheffield, Sheffield, UK
| | - Robert Coleman
- Department of Oncology and Metabolism, Academic Unit of Clinical Oncology, Weston Park Hospital, University of Sheffield, Sheffield, UK
| | - Janet Brown
- Department of Oncology and Metabolism, Academic Unit of Clinical Oncology, Weston Park Hospital, University of Sheffield, Sheffield, UK
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García-Fontana B, Morales-Santana S, Varsavsky M, García-Martín A, García-Salcedo JA, Reyes-García R, Muñoz-Torres M. Sclerostin serum levels in prostate cancer patients and their relationship with sex steroids. Osteoporos Int 2014; 25:645-51. [PMID: 23903956 DOI: 10.1007/s00198-013-2462-y] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2013] [Accepted: 07/11/2013] [Indexed: 10/26/2022]
Abstract
UNLABELLED The role of sclerostin on bone metabolism and its relation to sex steroids in patients with prostate cancer (PC) is not well known. We found that sclerostin levels are significantly increased in PC patients, particularly in those with androgen deprivation therapy (ADT), and there is an inverse relationship between sclerostin levels and testosterone. INTRODUCTION Recent studies have evaluated sclerostin levels in bone diseases as osteoporosis. However, there are few data in PC patients, particularly in patients with hypogonadism related to ADT. The aim of the present study was to compare serum sclerostin levels in ADT/non-ADT-treated PC patients and healthy controls and to evaluate their relationship with sex steroids and bone metabolism. METHODS We performed a cross-sectional study involving 81 subjects: 25 ADT-treated PC patients, 34 PC patients without ADT treatment, and 22 healthy controls. We measured serum sclerostin levels, bone turnover markers, bone mineral density (BMD) in all individuals, and sex steroids levels in PC patients. RESULTS Serum sclerostin levels were significantly higher in PC patients compared to those in control subjects. ADT-treated patients had significantly higher sclerostin levels than PC patients without ADT treatment: ADT 64.52 ± 27.21 pmol/L, non-ADT 48.24 ± 15.93 pmol/L, healthy controls 38.48 ± 9.19 pmol/L, p < 0.05. In PC patients, we found a negative relationship between serum sclerostin levels and androgens after age adjustment (total testosterone: r = -0.309, p = 0.029; bioavailable testosterone: r = -0.280, p = 0.049; free testosterone: r = -0.299, p = 0.035). We did not observe any relationship between sclerostin levels and bone turnover markers or BMD in any group. CONCLUSIONS Circulating sclerostin levels are significantly increased in patients with PC and particularly in those receiving ADT. The inverse relationship between serum sclerostin and testosterone in these patients suggests that androgens are key regulators of bone metabolism in this population.
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Affiliation(s)
- B García-Fontana
- Bone Metabolic Unit, Endocrinology Division (RETICEF), Hospital Universitario San Cecilio, Avda. Doctor Olóriz 16, 18012, Granada, Spain
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Ng T, Cheung YT, Ng QS, Ho HK, Chan A. Vascular endothelial growth factor inhibitors and cognitive impairment: evidence and controversies. Expert Opin Drug Saf 2013; 13:83-92. [PMID: 23931162 DOI: 10.1517/14740338.2013.828034] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
INTRODUCTION Chemotherapy-induced cognitive impairment, or 'chemobrain,' has been well established in the literature. However, neurocognitive toxic effect induced by targeted therapies such as anti-angiogenic agents is poorly investigated. Recently, emerging evidence suggests vascular endothelial growth factor (VEGF) to have a possible role in brain cognition giving rise to concerns whether VEGF inhibitors (VEGFIs) may induce neurotoxic effect on cancer patients' cognitive function. AREAS COVERED The aim of this review was to evaluate the plausible mechanisms underlying VEGF and cognition, and to highlight the evidence and controversies surrounding the cognitive issues associated with the use of VEGFIs. EXPERT OPINION This review paper has brought attention to the potential cognitive issues associated with the use of VEGFIs and has added a new, unexplored dimension to the problem of cancer treatment-related cognitive changes. However, the lack of evidence warrants the need for more well-designed studies to quantify the prevalence and severity of VEGFI-induced cognitive impairment in the cancer population, and to establish the role of VEGF in human cognitive function.
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Affiliation(s)
- Terence Ng
- National University of Singapore , Singapore , Singapore
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Wang F, Chen W, Chen H, Mo L, Jin H, Yu Z, Li C, Liu Q, Duan F, Weng Z. Comparison between zoledronic acid and clodronate in the treatment of prostate cancer patients with bone metastases. Med Oncol 2013; 30:657. [DOI: 10.1007/s12032-013-0657-x] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2013] [Accepted: 06/28/2013] [Indexed: 10/26/2022]
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Pradhan MR, Mandhani A, Chipde SS, Srivastava A, Singh M, Kapoor R. Bone densitometric assessment and management of fracture risk in Indian men of prostate cancer on androgen deprivation therapy: Does practice pattern match the guidelines? Indian J Urol 2013; 28:399-404. [PMID: 23450674 PMCID: PMC3579118 DOI: 10.4103/0970-1591.105750] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
Objective: Estimation of baseline bone mineral density (BMD) at the time of instituting androgen deprivation therapy (ADT) for metastatic prostate cancer is recommended by several specialty groups and expert panels. The present study was carried out to analyze the practice pattern of Indian urologists with regard to bone densitometric assessment and management of fracture risk in men of prostate cancer on ADT, and their degree of adherence to currently available guidelines Materials and Methods: Telephonic interviews of 108 qualified urologists, randomly selected from the member database of Urological Society of India was carried out with a predefined questionnaire. The responses were analyzed and compared with the available evidences and recommendations. Results: Only 19.4% urologists routinely perform a baseline BMD before starting ADT. Although majority of them prescribe calcium and vitamin D supplementation, only few tell regarding fracture risk and life-style modification to their patients. While 59.6% of the respondents use Zoledronic acid (ZA) in their patients on ADT, half of them prescribe it without knowing the BMD status, which may lead to overuse of ZA. Conclusion: Majority of the urologists in India do not follow the guidelines for BMD measurement in prostate cancer. A baseline BMD may help in reducing the unnecessary use of ZA.
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Affiliation(s)
- Manas R Pradhan
- Department of Urology and Renal Transplantation, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Raebareli Road, Lucknow, Uttar Pradesh, India
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Winters-Stone KM, Lyons KS, Nail LM, Beer TM. The Exercising Together project: design and recruitment for a randomized, controlled trial to determine the benefits of partnered strength training for couples coping with prostate cancer. Contemp Clin Trials 2011; 33:342-50. [PMID: 22101224 DOI: 10.1016/j.cct.2011.10.015] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2011] [Revised: 09/29/2011] [Accepted: 10/31/2011] [Indexed: 10/15/2022]
Abstract
Prostate cancer can threaten quality of life for the patient and his spouse and the quality of his marital relationship. The purpose of our study is to evaluate the effects of "Exercising Together" - a partnered strength training program for married couples coping with prostate cancer - on the physical and emotional health of prostate cancer survivors (PCS) and their spouses and on marital quality. We are conducting a 6-month randomized controlled trial with two groups: 1) Exercising Together - a progressive, supervised strength training program and 2) a usual care control condition. The primary aims of this exploratory study are to: 1) Determine the effect of partnered strength training on physical and emotional health (muscle strength, physical function, body composition and self-report physical and mental health) in PCS, 2) Determine the effect of partnered strength training on physical and emotional health in spouses and 3) Explore the effect of partnered strength training on marital quality (incongruence, communication, relationship quality, intimacy) of the PCS and spouse. Target accrual has been met in this study with 64 couples enrolled and randomized to exercise (n=32) or usual care (n=32) groups. This study is the first to examine the feasibility of this exercise format in both the chronically ill patient and spouse and explore benefits at the individual and couple level.
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Affiliation(s)
- Kerri M Winters-Stone
- School of Nursing, Oregon Health and Science University, Portland, OR 97239, United States.
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Lee CE, Leslie WD, Czaykowski P, Gingerich J, Geirnaert M, Lau YKJ. A comprehensive bone-health management approach for men with prostate cancer receiving androgen deprivation therapy. ACTA ACUST UNITED AC 2011; 18:e163-72. [PMID: 21874106 DOI: 10.3747/co.v18i4.746] [Citation(s) in RCA: 57] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
For advanced and metastatic prostate cancer, androgen deprivation therapy (adt) is the mainstay of treatment. Awareness of the potential bone-health complications consequent to adt use is increasing. Many studies have shown that prolonged adt leads to significant bone loss and increased fracture risk that negatively affect quality of life. Clinical practice guidelines for preserving bone health in men with prostate cancer on adt vary across Canada. This paper reviews recent studies on bone health in men with prostate cancer receiving adt and the current evidence regarding bone-health monitoring and management in reference to Canadian provincial guidelines. Based on this narrative review, we provide general bone-health management recommendations for men with prostate cancer receiving adt.
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Affiliation(s)
- C E Lee
- Department of Physical Therapy, School of Medical Rehabilitation, University of Manitoba, Winnipeg, MB
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Serpa Neto A, Tobias-Machado M, Esteves MAP, Senra MD, Wroclawski ML, Fonseca FLA, dos Reis RB, Pompeo ACL, Del Giglio A. A systematic review and meta-analysis of bone metabolism in prostate adenocarcinoma. BMC Urol 2010; 10:9. [PMID: 20482867 PMCID: PMC2882358 DOI: 10.1186/1471-2490-10-9] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2009] [Accepted: 05/19/2010] [Indexed: 11/20/2022] Open
Affiliation(s)
- Ary Serpa Neto
- Urologic Oncology Division, Dept. of Urology, ABC Medical School, Santo André, Brazil
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Droz JP, Balducci L, Bolla M, Emberton M, Fitzpatrick JM, Joniau S, Kattan MW, Monfardini S, Moul JW, Naeim A, van Poppel H, Saad F, Sternberg CN. Background for the proposal of SIOG guidelines for the management of prostate cancer in senior adults. Crit Rev Oncol Hematol 2010; 73:68-91. [PMID: 19836968 DOI: 10.1016/j.critrevonc.2009.09.005] [Citation(s) in RCA: 78] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2009] [Revised: 09/23/2009] [Accepted: 09/23/2009] [Indexed: 12/27/2022] Open
Affiliation(s)
- Jean-Pierre Droz
- Department of Medical Oncology, Centre Léon-Bérard, 69008 Lyon, France.
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THOMAS-JOHN MARIA, CODD MARYB, MANNE SIALAJA, WATTS NELSONB, MONGEY ANNEBARBARA. Risk Factors for the Development of Osteoporosis and Osteoporotic Fractures Among Older Men. J Rheumatol 2009; 36:1947-52. [DOI: 10.3899/jrheum.080527] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Objective.Osteoporotic fractures are associated with significant morbidity and mortality particularly among older men. However, there is little information regarding risk factors among this population. The aims of our study were to determine risk factors for osteoporosis and fragility fractures and the predictive value of bone mineral density (BMD) measurements for development of fragility fractures in a cohort of elderly Caucasian and African American men.Methods.We evaluated 257 men aged 70 years or older for risk factors for osteoporosis and fragility fractures using a detailed questionnaire and BMD assessment. Exclusion criteria included conditions known to cause osteoporosis such as hypogonadism and chronic steroid use, current treatment with bisphosphonates, bilateral hip arthroplasties, and inability to ambulate independently.Results.Age, weight, weight loss, androgen deprivation treatment, duration of use of dairy products, exercise, and fracture within 10 years prior to study entry were associated with osteoporosis (p ≤ 0.05). Fragility fractures were associated with duration of use of dairy products, androgen deprivation treatment, osteoporosis, and history of fracture within 10 years prior to BMD assessment (p ≤ 0.05). There were some differences in risk factors between the Caucasian and African American populations, suggesting that risk factors may vary between ethnic groups.Conclusion.Although men with osteoporosis had a higher rate of fractures, the majority of fractures occurred in men with T-scores > −2.5 standard deviations below the mean, suggesting that factors other than BMD are also important in determining risk.
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Jung SI, Kim SO, Kang TW, Kwon DD, Park JY, Cheon J, Lee HM, Hong SJ, Choi HY, Ryu SB. A Multicenter Prospective Study of the Risk Factors Affecting Bone Mineral Density in Korean Patients with Prostate Cancer. Korean J Urol 2009. [DOI: 10.4111/kju.2009.50.4.327] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Affiliation(s)
- Seung Il Jung
- Department of Urology, College of Medicine, Chonnam National University, Gwangju, Korea
| | - Sun-Ouck Kim
- Department of Urology, College of Medicine, Chonnam National University, Gwangju, Korea
| | - Taek Won Kang
- Department of Urology, College of Medicine, Chonnam National University, Gwangju, Korea
| | - Dong Deuk Kwon
- Department of Urology, College of Medicine, Chonnam National University, Gwangju, Korea
| | - Jong Yeon Park
- Department of Urology, College of Medicine, University of Ulsan, Seoul, Korea
| | - Jun Cheon
- Department of Urology, College of Medicine, Korea University, Seoul, Korea
| | - Hyun Moo Lee
- Department of Urology, College of Medicine, Sungkyunkwan University, Seoul, Korea
| | - Sung Joon Hong
- Department of Urology, Yonsei University College of Medicine, Seoul, Korea
| | - Han Yong Choi
- Department of Urology, College of Medicine, Sungkyunkwan University, Seoul, Korea
| | - Soo Bang Ryu
- Department of Urology, College of Medicine, Chonnam National University, Gwangju, Korea
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Agarwal MM, Rana SV, Mandal AK, Malhotra S, Khandelwal N, Kumar S, Acharya NC, Singh SK. Lactose intolerance in prostate cancer patients: incidence and associated factors. Scand J Gastroenterol 2008; 43:270-6. [PMID: 18938658 DOI: 10.1080/00365520701676831] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
OBJECTIVE Osteoporosis is common in prostate cancer (CaP) patients both before and after institution of androgen deprivation therapy and is associated with significant morbidity. Lactose intolerance (LI) can affect bone mass but has not been studied in this group of patients. The objective of this study was to compare the incidence of LI in CaP patients with that in the general population and to identify factors affecting lactose intolerance in CaP patients. MATERIAL AND METHODS Fifty-five men with CaP planned for bilateral orchidectomy were enrolled in the study and their baseline characteristics including age, weight, height, body mass index (BMI), prostate-specific antigen, serum calcium profile, lactose tolerance status, physical activity, alcohol intake and smoking, bone mineral density and calcium intake were registered. The data on lactose tolerance in these patients were compared with those of 81 age-matched controls (data taken from the available database). RESULTS The incidence of LI in CaP patients was significantly less than that in the control group (36.2% and 58.3%, respectively, p = 0.027). A significantly greater number of CaP patients in the lactose-tolerant group had a calcium intake of >1500 mg/day (p = 0.03) and that of milk >500 ml/day (p = 0.05) than those in the intolerant group. Age >70 years, BMI <25 kg/m2, height >163 cm, lower physical activity and co-abuse of alcohol and smoking significantly correlated with the presence of LI (p < or = 0.05). Patients with serum calcium <9 mg/dl had higher fasting breath H2 levels and a higher proportion had a BMI >25 kg/m2 and weight >65 kg. CONCLUSIONS The incidence of LI in CaP patients is less than that in the general population despite a higher incidence of osteoporosis, indicating a complex etiology of CaP-related osteoporosis. Certain physical characteristics and personal habits are important in determining lactose-tolerant status.
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Affiliation(s)
- Mayank Mohan Agarwal
- Department of Urology, Postgraduate Institute of Medical Education and Research, Chandigarh, India.
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Israeli RS, Ryan CW, Jung LL. Managing Bone Loss in Men With Locally Advanced Prostate Cancer Receiving Androgen Deprivation Therapy. J Urol 2008; 179:414-23. [DOI: 10.1016/j.juro.2007.09.028] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2007] [Indexed: 11/16/2022]
Affiliation(s)
- Ron S. Israeli
- Staten Island Urological Research, Staten Island, New York
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Androgen-deprivation-therapy-induced fractures in men with nonmetastatic prostate cancer: what do we really know? ACTA ACUST UNITED AC 2008; 5:24-34. [DOI: 10.1038/ncpuro0995] [Citation(s) in RCA: 107] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2007] [Accepted: 10/05/2007] [Indexed: 11/09/2022]
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Bone health in prostate cancer patients receiving androgen-deprivation therapy: the role of bisphosphonates. Prostate Cancer Prostatic Dis 2007; 11:13-9. [PMID: 17923854 DOI: 10.1038/sj.pcan.4501019] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Androgen-deprivation therapy, a mainstay in the treatment of locally advanced and metastatic prostate cancer, is associated with significant bone loss and related complications, such as fracture. Bisphosphonates, osteoclast inhibitors, are effective in preventing skeletal-related events in patients with metastatic prostate cancer and also in preventing bone loss in patients with locally advanced disease. Understanding the management of bone health, including identifying patients at risk, the most appropriate therapy, and monitoring and managing side effects, is critical. This review provides the most recent bone health risk factor and bisphosphonate data available for prostate cancer patients.
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Ryan CW, Huo D, Stallings JW, Davis RL, Beer TM, McWhorter LT. Lifestyle factors and duration of androgen deprivation affect bone mineral density of patients with prostate cancer during first year of therapy. Urology 2007; 70:122-6. [PMID: 17656221 DOI: 10.1016/j.urology.2007.03.026] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2006] [Revised: 02/08/2007] [Accepted: 03/07/2007] [Indexed: 11/29/2022]
Abstract
OBJECTIVES Androgen deprivation therapy (ADT) is associated with loss of bone mineral density (BMD) and increased fracture risk. We sought to examine the impact of ADT and lifestyle variables on BMD in 120 patients with prostate cancer without bone metastases entering a randomized clinical trial. METHODS A total of 120 patients with prostate cancer and without bone metastases who had been treated with ADT for less than 12 months were enrolled in a clinical trial of zoledronic acid versus placebo. BMD measurements of the femoral neck, total hip, and lumbar spine were obtained before starting the study treatment by dual energy x-ray absorptiometry. The subjects answered a questionnaire regarding possible osteoporosis risk factors, including dairy product use, caffeinated beverage use, smoking history, alcohol intake, calcium/vitamin D supplementation, thyroid medication, and exercise. RESULTS The median duration of ADT was 3 months (range 0 to 12). Osteopenia or osteoporosis (T score of less than -1) was detected in two thirds of the subjects at one or more measured sites. The mean baseline BMD Z scores were femoral neck -0.091 +/- 0.959, total hip 0.122 +/- 1.005, and lumbar spine 0.657 +/- 1.789. On multiple linear regression analysis, the duration of ADT was negatively associated with the Z score at all three sites and the body mass index, calcium/vitamin D supplementation, and alcohol use were positively associated with the Z score. CONCLUSIONS BMD loss is a function of the duration of ADT during the first year of therapy. The body mass index, calcium/vitamin D supplementation, and alcohol use were associated with greater BMD, even after controlling for ADT exposure.
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Affiliation(s)
- Christopher W Ryan
- Cancer Institute, Oregon Health and Science University, Portland, Oregon 97239, USA.
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Planas J, Morote J, Orsola A, Salvador C, Trilla E, Cecchini L, Raventós CX. The relationship between daily calcium intake and bone mineral density in men with prostate cancer. BJU Int 2007; 99:812-5; discussion 815-6. [PMID: 17378843 DOI: 10.1111/j.1464-410x.2006.06695.x] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To analyse the relationship between daily calcium intake (DCI) and bone mineral density (BMD) in patients with prostate cancer, and to assess if DCI is a risk factor for osteoporosis in this group of patients. PATIENTS AND METHODS DCI was assessed by a standard questionnaire answered by men with prostate cancer who had had bone densitometry. BMD was measured by dual-energy X-ray absorptiometry in the lumbar spine and different hip sites, in a cross-sectional study including 372 men with prostate cancer free of bone metastases, 71.5% (266) under androgen-deprivation therapy (ADT) and 28.5% (106) after radical prostatectomy (RP). Osteoporosis was defined according to the International Society for Clinical Densitometry official position (2005). RESULTS A DCI of <1000 mg, the National Institute of Health recommendation, was detected in 93% of the men, (93.5% under ADT and 91.5% after RP). Osteoporosis was identified in 49.2% (183) of the patients, 54.9% (146) under ADT and 34.9% (37) after RP. The mean DCI was 609.7 mg in men with osteoporosis and 682.8 mg in those without (P < 0.001); in men under ADT the mean DCI remained significantly lower in those with osteoporosis (615.5 vs 700.4 mg, P < 0.001). A multivariate analysis showed that DCI was an independent risk factor for osteoporosis, together with patient age, ADT and its duration. CONCLUSIONS DCI seems to be related to BMD; a low DCI was an independent risk factor for osteoporosis in men with prostate cancer. In the study population overall the DCI was inadequate. Urologists should recommend a DCI of >1000 mg in patients with prostate cancer, especially in those under ADT.
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Affiliation(s)
- Jacques Planas
- Department of Urology. Vall d'Hebron Hospital, Autónoma University School of Medicine, Barcelona, Spain
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Doyle-Lindrud S. Implications of Androgen-Deprivation Therapy in Patients With Prostate Cancer: A Case Study. Clin J Oncol Nurs 2007; 10:565-6. [PMID: 17063610 DOI: 10.1188/06.cjon.565-566] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
S.R., a 65-year-old male with a history of prostate cancer, went to a cancer center in 2003. He had developed symptoms of bladder outlet obstruction in 1999 and was seen by a urologist. His baseline prostate-specific antigen (PSA) was 44 ng/ml. On physical examination, his prostate was enlarged, and a biopsy in January 2000 revealed adenocarcinoma with a Gleason score of 8. A metastatic workup, including a bone scan and a computed tomography scan of the abdomen and pelvis (CT A/P), was negative for evidence of metastatic disease. S.R. received conformal external beam radiation, and the luteinizing hormone-releasing hormone agonist leuprolide acetate was initiated. Following treatment, his PSA nadired to 0.2 ng/ml, and he did well until 2002, when his PSA started to rise. A reevaluation CT A/P revealed enlarged retroperitoneal and pelvic lymph nodes, and a bone scan was positive for metastatic disease. He underwent a bilateral orchiectomy in November 2002.
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Affiliation(s)
- Susan Doyle-Lindrud
- Gallo Prostate Cancer Center, The Cancer Institute of New Jersey, New Brunswick, USA.
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Holzbeierlein JM. Managing Complications of Androgen Deprivation Therapy for Prostate Cancer. Urol Clin North Am 2006; 33:181-90, vi. [PMID: 16631456 DOI: 10.1016/j.ucl.2005.12.008] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
With the increase in the number of prostate cancer cases seen in the United States, the use of androgen deprivation therapy (ADT) as a form of treatment has continued to rise. With the increasing use of ADT, it is important for the urologist to recognize the potential side effects from the use of ADT and ways in which to minimize or eliminate the risks from these side effects. This article describes the potential complications of ADT and the recommendations for treatment or prevention of these complications. In addition,we examine the role of nontraditional forms of ADT and the potential benefits they offer.
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