Background: Skeletal complications frequently complicate the natural history of prostate cancer with metastatic bone disease. Androgen deprivation therapy (ADT), the mainstay of therapy for advanced prostate cancer, induces osteoporosis and may cause adverse skeletal related events (SRE) irrespective of disease progression in bone. SRE, however, are relatively uncommon until the tumor is responsive to ADT but they are more frequent when the tumor becomes hormone refractory. The relative contribution of ADT in predisposing SRE in hormone refractory stage is totally unknown. Methods: From July 1990 to September 2003, 205 prostate cancer patients with hormone refractory disease were treated and followed in our institution. Eighty-three of them (41.0%) underwent SRE defined as vertebra collapses (20.0%), bone fractures (12.7%), spinal cord compression (8.0%). SRE occurred before hormone refractoriness in eight patients (3.9%). Results: Hormone refractory patients destined to undergo SRE had at baseline conditions greater bone pain (P = 0.002), higher values of serum bone alkaline phosphatase (P < 0.01), and urinary N-telopeptide (P = 0.02) than their counterparts. There was no difference in serum calcium levels and serum PSA between the two groups. The distribution of SRE did not differ in patients with blastic bone lesions (40.5%) as opposed to those with lytic/mixed bone lesions (53.7%). Stratifying patients according to disease extent in bone, the distribution of SRE was 31.7% in patients with < 3 bone lesions, 40.5% in patients with 3–6 bone lesions and 53.6% in patients with >6bone lesions (P = 0.01). Median duration of ADT (range) was 22.9 months (1.1–138.0) in hormone refractory patients destined to undergo SRE and 25.9 months (1.0–211.0) in hormone refractory patients who did not develop SRE (P = n.s.). Conclusions: The occurrence of SRE in hormone refractory prostate cancer with metastatic bone disease is significantly influenced by tumor load in bone and levels of bone turnover markers, but not by the duration of androgen deprivation therapy
THE ONSET OF SKELETAL COMPLICATIONS IN HORMONEREFRACTORY PROSTATE CANCER PATIENTS IS NOT INFLUENCEDBY THE DURATION OF ANDROGEN DEPRIVATION THERAPY
BERRUTI, Alfredo;TAMPELLINI, MARCO;SCARPA, Roberto Mario;DOGLIOTTI, Luigi
2004-01-01
Abstract
Background: Skeletal complications frequently complicate the natural history of prostate cancer with metastatic bone disease. Androgen deprivation therapy (ADT), the mainstay of therapy for advanced prostate cancer, induces osteoporosis and may cause adverse skeletal related events (SRE) irrespective of disease progression in bone. SRE, however, are relatively uncommon until the tumor is responsive to ADT but they are more frequent when the tumor becomes hormone refractory. The relative contribution of ADT in predisposing SRE in hormone refractory stage is totally unknown. Methods: From July 1990 to September 2003, 205 prostate cancer patients with hormone refractory disease were treated and followed in our institution. Eighty-three of them (41.0%) underwent SRE defined as vertebra collapses (20.0%), bone fractures (12.7%), spinal cord compression (8.0%). SRE occurred before hormone refractoriness in eight patients (3.9%). Results: Hormone refractory patients destined to undergo SRE had at baseline conditions greater bone pain (P = 0.002), higher values of serum bone alkaline phosphatase (P < 0.01), and urinary N-telopeptide (P = 0.02) than their counterparts. There was no difference in serum calcium levels and serum PSA between the two groups. The distribution of SRE did not differ in patients with blastic bone lesions (40.5%) as opposed to those with lytic/mixed bone lesions (53.7%). Stratifying patients according to disease extent in bone, the distribution of SRE was 31.7% in patients with < 3 bone lesions, 40.5% in patients with 3–6 bone lesions and 53.6% in patients with >6bone lesions (P = 0.01). Median duration of ADT (range) was 22.9 months (1.1–138.0) in hormone refractory patients destined to undergo SRE and 25.9 months (1.0–211.0) in hormone refractory patients who did not develop SRE (P = n.s.). Conclusions: The occurrence of SRE in hormone refractory prostate cancer with metastatic bone disease is significantly influenced by tumor load in bone and levels of bone turnover markers, but not by the duration of androgen deprivation therapy
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