Department of Urology, Hospital Vall d'Hebrón, Universitat Autònoma de Barcelona, Barcelona 08035, Spain.
Asian J Androl. 2012 Sep;14(5):670-5. doi: 10.1038/aja.2012.70. Epub 2012 Aug 20.
Therapy based on androgenic deprivation is one of the standard treatments that many prostate cancer patients receive. Moreover, its use is increasing owing to a clear expansion of the indications for this therapy in patients with localized prostate cancer. Despite classically being considered to be well tolerated, androgenic deprivation has adverse effects. Of these, the loss of mineral bone mass is particularly notable and can lead to osteoporosis, as well as an increased risk of bone fracture. Some fractures, such as hip fractures, may have serious consequences. Useful procedures such as bone densitometry can aid in the diagnosis of these conditions. Once diagnosed, decreases in mineral bone mass can be managed by dietary recommendations, general changes in lifestyle or medication. We review the most important randomized controlled trials evaluating different drugs (bisphosphonates, denosumab and toremifene) in the prevention of bone loss and in the reduction in fracture risk in prostate cancer patients treated with androgen-deprivation therapy. Following the applicable recommendations, urologists must carefully monitor the bone health of prostate cancer patients subjected to androgenic deprivation to obtain an early diagnosis and apply the appropriate general and/or therapeutic measures if necessary.
基于去雄激素治疗是许多前列腺癌患者接受的标准治疗方法之一。此外，由于去雄激素治疗在局限性前列腺癌患者中的适应证明显扩大，其应用也在增加。尽管去雄激素治疗通常被认为耐受性良好，但它仍有不良反应。其中，矿物质骨量的丢失尤为显著，可导致骨质疏松症以及骨折风险增加。某些骨折，如髋部骨折，可能会产生严重后果。骨密度测定等有用的程序有助于诊断这些疾病。一旦诊断出矿物质骨量减少，可以通过饮食建议、生活方式的一般改变或药物治疗来进行管理。我们回顾了评估不同药物（双磷酸盐、地舒单抗和托瑞米芬）在预防去雄激素治疗的前列腺癌患者骨丢失和降低骨折风险方面的最重要的随机对照试验。根据适用的建议，泌尿科医生必须仔细监测接受去雄激素治疗的前列腺癌患者的骨骼健康，以便及早诊断，并在必要时应用适当的一般和/或治疗措施。
