Abstract:【Objective】 To investigate the influencing factors of decreased bone mineral density (BMD) in elderly patients with prostate cancer during androgen blockade therapy. 【Methods】 The clinical data of 105 elderly prostate cancer patients admitted to our hospital from April 2016 to May 2018 were retrospectively analyzed. All patients were treated with androgen blockade combined with radiotherapy. The incidence of bone mineral density reduction during androgen blockade treatment in elderly prostate cancer patients was statistically analyzed. According to whether the bone mineral density decreased during treatment,the patients were divided into reduced bone mineral density group and non reduced bone mineral density group. The clinical data of the two groups of patients were statistically analyzed. Logistic regression analysis was used to explore the influencing factors of bone mineral density reduction in elderly prostate cancer patients during androgen blockade therapy. Kaplan-Meier method was used to draw survival curves,and log rank test was used to analyze the difference in the biochemical failure curve between the reduced bone mineral density group and the non reduced bone mineral density group.【Results】 Among 105 elderly patients with prostate cancer,22 patients (20.95%) had decreased bone density during androgen blockade therapy (BMD reduction group); The remaining 83 patients did not have a decrease in bone density (non reduced bone density group),accounting for 79.05%. The GS score,body mass index (BMI),serum prostate specific antigen (PSA),high tumor necrosis factor-α(TNF-α) and interleukin-1 (IL-1) levels in the decreased bone density group were higher than those in the non decreased bone density group (P<0.05),while the serum testosterone (T),osteoprotegerin (OPG) levels were lower than those in the non decreased bone density group (P<0.05); Logistic multivariate analysis showed that BMI,PSA,T,and OPG were all influential factors for bone mineral density reduction in elderly prostate cancer patients during androgen blockade therapy (P<0.05). During a 2-year follow-up,1 case was lost in the low bone density group and 2 cases in the non low bone density group. The median follow-up time was 12 months (1-24 months). The 2-year biochemical failure free rate in the reduced bone density group was 80.95%,while the 2-year biochemical failure free rate in the non reduced bone density group was 82.72%. There was no statistically significant difference in the biochemical failure curve between the two groups(χ2=0.003,P=0.955). 【Conclusion】 BMI,PSA,T,and OPG are all factors that affect the decrease of bone mineral density in elderly prostate cancer patients during androgen therapy,and the decrease of bone mineral density during treatment is not associated with long-term biochemical failure in elderly prostate cancer patients.
李志清, 胡明. 老年前列腺癌患者雄性激素阻断治疗期间骨密度降低的影响因素分析[J]. 医学临床研究, 2023, 40(3): 385-388.
LI Zhi-qing, HU Ming. Analysis of the Influencing Factors of Bone Mineral Density Decrease during Androgen Blockade Therapy in Elderly Patients with Prostate Cancer. JOURNAL OF CLINICAL RESEARCH, 2023, 40(3): 385-388.
[1] CARLSSON S V,VICKERS A J. Screening for prostate cancer[J].Med Clin North Am,2020,104(6):1051-1062. [2] EMMETT L,YIN C,CRUMBAKER M,et al. Rapid modulation of PSMA expression by androgen deprivation:Serial(68) Ga-PSMA-11 PET in men with hormone-sensitive and castrate-resistant prostate cancer commencing androgen blockade[J].J Nucl Med,2019,60(7):950-954. [3] BLOCK G A,ROSENBAUM D P,YAN A,et al. Efficacy and safety of tenapanor in patients with hyperphosphatemia receiving maintenance hemodialysis:A randomized phase 3 trial[J].J Am Soc Nephrol,2019,30(4):641-652. [4] KERSCHAN-SCHINDL K. Romosozumab:A novel bone anabolic treatment option for osteoporosis?[J].Wien Med Wochenschr,2020,170(5-6):124-131. [5] 邱志磊,牛海涛,孙光. 2005年欧洲泌尿外科会议前列腺癌诊断治疗指南[J].国际泌尿系统杂志,2006,26(5):583-586. [6] DELOUGHERY E P,DOW M L. Decreased bone mineral density and reproductive axis dysfunction:More than oestrogen[J].Neth J Med,2020,78(2):50-54. [7] VAN DEN BROECK T,VAN DEN BERGH R,ARFI N,et al.Prognostic value of biochemical recurrence following treatment with curative intent for prostate cancer:A systematic review[J].Eur Urol,2019,75(6):967-987. [8] VITZTHUM L K,STRAKA C,SARKAR R R,et al. Combined androgen blockade in localized prostate cancer treated with definitive radiation therapy[J].J Natl Compr Canc Netw,2019,17(12):1497-1504. [9] AGARWAL M,CANAN T,GLOVER G,et al. Cardiovascular effects of androgen deprivation therapy in prostate cancer[J].Curr Oncol Rep,2019,21(10):91. [10] 刘宇,刘敏,沈冲,等. 江苏省句容市农村地区60岁以上老年人骨质疏松流行情况及影响因素研究[J].实用老年医学,2020,34(6):580-584. [11] MIYAZAWA Y,SEKINE Y,ARAI S,et al. Prognostic factors in hormone-sensitive prostate cancer patients treated with combined androgen blockade:A consecutive 15-year study at a single Japanese institute[J].In Vivo,2021,35(1):373-384. [12] BIVER E. Bone effects of bisphosphonates and denosumab treatments in breast or prostate cancer[J].Rev Med Suisse,2019,15(647):824-830. [13] KIMURA T,KOIKE Y,AIKAWA K,et al. Short-term impact of androgen deprivation therapy on bone strength in castration-sensitive prostate cancer[J].Int J Urol,2019,26(10):980-984. [14] HUSSAIN A.Bone health effects of androgen-deprivation therapy and androgen receptor inhibitors in patients with nonmetastatic castration-resistant prostate cancer[J].Prostate Cancer Prostatic Dis,2021,24(2):290-300. [15] 段万里,胥博愈,任伟,等. 前列腺特异性抗原联合炎性细胞计数、年龄对前列腺癌的诊断价值[J].现代泌尿外科杂志,2021,26(6):505-509.