Saad Fred, Olsson Carl, Schulman Claude C
Department of Surgery/Urology, Centre Hospitalier de l'Université de Montréal, Hôpital Notre-Dame, 1560 Rue Sherbrooke East, Montréal, Quebec, Canada H2L 4M1.
Eur Urol. 2004 Dec;46(6):731-39; discussion 739-40. doi: 10.1016/j.eururo.2004.08.016.
With current treatments, men usually survive many years after being diagnosed with prostate cancer. However, without supportive care, the systemic effects of prostate cancer and therapies such as androgen deprivation therapy (ADT) can undermine skeletal integrity, resulting in skeletal complications that may erode quality of life (QOL). Prostate cancer patients are at risk for fractures from cancer treatment-induced bone loss. In addition, they are also at risk for pathologic fractures, severe bone pain, and other sequelae from bone metastases, which almost invariably occur during the progression of prostate cancer. This review investigates the incidence and pathophysiology of bone loss and skeletal morbidity in prostate cancer patients and reviews available treatment options for maintaining skeletal health throughout the continuum of care for these patients.
Studies were identified through MEDLINE searches, review of bibliographies of relevant articles, and review of abstracts from national meetings.
Several supportive care options are available to prevent generalized and localized bone loss, including calcium and vitamin D supplements and bisphosphonates. Oral calcium and vitamin D supplementation alone, however, appears to be insufficient to prevent bone loss during ADT. Zoledronic acid administered every 3 months during ADT or every 3 to 4 weeks for patients with bone metastases can reverse bone loss and reduce skeletal morbidity, respectively, in patients with prostate cancer.
Skeletal complications contribute to the erosion of QOL in prostate cancer patients. Palliative care can provide important benefits to these patients. Some agents, such as zoledronic acid, may provide skeletal health benefits throughout the course of prostate cancer progression. Further investigations of the QOL impact of these benefits are warranted.
采用当前的治疗方法，男性在被诊断出患有前列腺癌后通常能存活多年。然而，若没有支持性护理，前列腺癌的全身影响以及雄激素剥夺疗法（ADT）等治疗手段会损害骨骼完整性，导致骨骼并发症，进而可能影响生活质量（QOL）。前列腺癌患者因癌症治疗导致的骨质流失而有骨折风险。此外，他们还面临病理性骨折、严重骨痛以及骨转移引发的其他后遗症的风险，这些几乎总会在前列腺癌进展过程中出现。本综述调查了前列腺癌患者骨质流失和骨骼疾病的发病率及病理生理学，并回顾了在这些患者的整个护理过程中维持骨骼健康的可用治疗方案。
通过医学文献数据库（MEDLINE）检索、查阅相关文章的参考文献以及回顾全国会议的摘要来确定研究。
有几种支持性护理方案可用于预防全身性和局部性骨质流失，包括补充钙和维生素D以及使用双膦酸盐。然而，单独口服钙和维生素D补充剂似乎不足以预防ADT期间的骨质流失。在ADT期间每3个月给予唑来膦酸，或对于有骨转移的患者每3至4周给予一次，可分别逆转前列腺癌患者的骨质流失并降低骨骼疾病的发生率。
骨骼并发症会影响前列腺癌患者的生活质量。姑息治疗可为这些患者带来重要益处。一些药物，如唑来膦酸，可能在前列腺癌进展过程中对骨骼健康有益。有必要进一步研究这些益处对生活质量的影响。
