Quantitated CT reveals association between prostate cancer treatment and bone decay

Australian investigators using virtual CT-based bone biopsies found that androgen deprivation therapy, a commonly used solution to prostate cancer, causes structural decay of cortical and trabecular bone in men.

Androgen deprivation therapy (ADT) works by blocking the production or action of male sex hormones upon which prostate cancer relies for growth, but it does so at the cost of bone integrity, according to lead authors of the study Emma Hamilton, MBBS, and Mathis Grossmann, MD, PhD, of the University of Melbourne.

“We used a new technology that allows us to assess bone micro-architecture, and we found ADT is associated with structural decay of cortical (hard outer shell) and trabecular (spongy inner mesh) bone,” Hamilton and Grossman stated in a press release from the Endocrine Society.

The study, which will be published in the Journal of Clinical Endocrinology & Metabolism this December, is one of the first to examine changes in bone structure during ADT.

The investigators enrolled 26 men with prostate cancer who began ADT in a 12-month prospective observational study. At several time points during the study, they measured the men’s sex steroid levels, bone turnover markers and bone mineral density and took virtual bone biopsies using 3D high-resolution peripheral quantitative CT (HR-pQCT) to assess the bone micro-architecture of the men.

“Sex steroid deficiency induced by ADT for prostate cancer results in micro-architectural decay,” Grossman stated in the release. “Bone fragility in these men may be more closely linked to testosterone than estradiol deficiency.”

HR-pQCT studies may have other uses, according to Hamilton and Grossmann.

“This technology may be a useful test in predicting fractures in patients, but further research is needed in identifying individuals at greatest fracture risk as well as optimal therapeutic strategies,” they stated in the release.

Reference:
www.endo-society.org

As in all research, positives and negatives are found that usually lead to insight into areas of darkness. Firstly, the virtual bone biopsies are a major breakthrough in technology — not just in this area, but for all treatments involving bone metabolism. It will probably replace bone density studies in the future.

Secondly, many life-sparing therapies forget the side effects created by them. Osteoporosis, which is considered a disease of women, is actually very common in men — especially men undergoing treatment with hormone therapy. Bone metabolism is affected by so many aspects of the physiologic nature of the body.

Thirdly, most men (in general) have lower than normal testosterone levels that are not addressed. Testosterone is needed for healthy bone and soft tissue metabolism. So this breakthrough may lead to more specific awareness of deficiencies in the male population of testosterone and thus, become an indicator for supplements in bone metabolism issues.

— Elton Strauss, MD
Orthopedics Today Editorial Board Member
Mount Sinai Medical School
New York

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