Prostate cancer is the second most common cancer among men in the United States. One in nine men will be diagnosed with the disease at some point in their life. It is also one of the most treatable if caught early enough. One treatment for more advanced prostate cancer, androgen suppression therapy, may lead to weaker bone health later in life, but not enough men are undergoing tests to measure their bone density measurement (BMD), said the authors of a new study from McGill University in Montreal, Canada.
Androgen suppression therapy, also called hormone therapy, is not first-line therapy when a man is diagnosed with an early-stage cancer. It is used to treat prostate cancer that is more advanced, such as:
- When the cancer has spread and won’t respond to surgery or radiation
- Alongside radiation as a first-line treatment if there is a higher risk of the cancer returning
- Before radiation in order to shrink the tumor
- If the cancer has returned following surgery or radiation therapy
Androgen, a male hormone, provides fuel to the cancer cells to help them grow. By suppressing androgen in the body, the cancer cells have a harder time spreading throughout the body.
But, androgen suppression therapy can cause weakening of the bones, resulting in osteoporosis and fractures.
The researchers found that although more patients with prostate cancer who took hormone therapy did have BMD testing, the number was still quite low overall. The numbers were lowest among men who:
- Were older
- Had other illnesses
- Lived in rural areas
- Had metastatic disease (cancer had spread)
“Although we expected BMD testing rates to be fairly low given the prior literature, we were somewhat surprised that they didn’t go up more in recent years,” senior author Alice Dragomir, MSc, PhD, said in a press release. “Bone density testing helps doctors evaluate fracture risk and identify which patients would benefit from additional monitoring and interventions like lifestyle changes and/or medications. Perhaps the low rate of testing will change in the coming years thanks to renewed attention on bone health issues in the clinical oncology community. It may be interesting to re-examine BMD testing rates in a few years.”
The researchers looked through a government database and identified over 22,000 men who had received treatment for prostate cancer. Of those, only 3,910 men had a BMD test at some point during the 15-year study period.
“While we have known for many years that the androgen deprivation therapies used to treat prostate cancer carry an increased risk of osteoporosis, this study identifies specific populations that might not undergo recommended screening prior to hormone-based therapies,” Joshua M. Lang, MD MS, said in the same press release. Dr. Lang is an associate professor of medicine at Carbone Cancer Center, University of Wisconsin and was not involved in the study. “These populations are especially vulnerable, including our older patients located in rural areas of the country.”
Dr. Lang pointed out that given that there are treatments that can slow the progress of osteoporosis, this screening is important. “The NCCN Guidelines for Prostate Cancer specifically recommend screening for these patients and this report demonstrates that more work is needed to advocate for and implement screening of vulnerable patient populations.”
The dangers of osteoporosis
Osteoporosis is often thought of as a disease that affects women, because they are at risk after menopause, but men can and do develop the condition as well.
Often called “thinning of the bones,” osteoporosis occurs when the bones lose their density or they don’t regenerate bone cells fast enough. These bones become weaker over time and are prone to fractures, even from the slightest fall, if the condition has progressed enough.
Fractures can cause many other serious conditions. They can restrict your mobility and ability to work or do daily tasks, but they also can lead to pneumonia and other complications.
If you are receiving hormone therapy to treat prostate cancer and your doctor has not mentioned tests to check your bone health, bring it up at your next appointment or your next telehealth check-up.