雄激素剥夺治疗和雄激素受体抑制剂对非转移性去势抵抗性前列腺癌患者的骨骼健康影响。
Bone health effects of androgen-deprivation therapy and androgen receptor inhibitors in patients with nonmetastatic castration-resistant prostate cancer.
机构信息
University of Maryland Greenebaum Cancer Center and Baltimore VA Medical System, Baltimore, MD, USA.
University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA.
出版信息
Prostate Cancer Prostatic Dis. 2021 Jun;24(2):290-300. doi: 10.1038/s41391-020-00296-y. Epub 2020 Oct 7.
BACKGROUND
Osteoporosis is a skeletal disorder characterized by compromised bone strength, resulting in increased fracture risk. Patients with prostate cancer may have multiple risk factors contributing to bone fragility: advanced age, hypogonadism, and long-term use of androgen-deprivation therapy. Despite absence of metastatic disease, patients with nonmetastatic castrate-resistant prostate cancer receiving newer androgen receptor inhibitors can experience decreased bone mineral density. A systematic approach to bone health care has been hampered by a simplistic view that does not account for heterogeneity among prostate cancer patients or treatments they receive. This review aims to raise awareness in oncology and urology communities regarding the complexity of bone health, and to provide a framework for management strategies for patients with nonmetastatic castrate-resistant prostate cancer receiving androgen receptor inhibitor treatment.
METHODS
We searched peer-reviewed literature on the PubMed database using key words "androgen-deprivation therapy," "androgen receptor inhibitors," "bone," "bone complications," and "nonmetastatic prostate cancer" from 2000 to present.
RESULTS
We discuss how androgen inhibition affects bone health in patients with nonmetastatic castrate-resistant prostate cancer. We present data from phase 3 trials on the three approved androgen receptor inhibitors with regard to effects on bone. Finally, we present management strategies for maintenance of bone health.
CONCLUSIONS
In patients with nonmetastatic castrate-resistant prostate cancer, aging, and antiandrogen therapy contribute to bone fragility. Newer androgen receptor inhibitors were associated with falls or fractures in a small subset of patients. Management guidelines include regular assessment of bone density, nutritional guidance, and use of antiresorptive bone health agents when warranted.
背景
骨质疏松症是一种骨骼疾病，其特征是骨强度受损，导致骨折风险增加。患有前列腺癌的患者可能存在多种导致骨骼脆弱的风险因素：年龄较大、性腺功能减退和长期使用雄激素剥夺疗法。尽管没有转移性疾病，但接受新型雄激素受体抑制剂治疗的非转移性去势抵抗性前列腺癌患者可能会经历骨密度降低。由于缺乏考虑到前列腺癌患者或他们接受的治疗存在异质性的简单观点，因此对骨骼健康护理的系统方法受到了阻碍。本综述旨在提高肿瘤学和泌尿科社区对骨骼健康复杂性的认识，并为接受雄激素受体抑制剂治疗的非转移性去势抵抗性前列腺癌患者提供管理策略框架。
方法
我们使用“雄激素剥夺疗法”、“雄激素受体抑制剂”、“骨骼”、“骨骼并发症”和“非转移性前列腺癌”等关键词，在 PubMed 数据库中搜索同行评议文献，检索时间从 2000 年至今。
结果
我们讨论了雄激素抑制如何影响非转移性去势抵抗性前列腺癌患者的骨骼健康。我们介绍了关于三种批准的雄激素受体抑制剂对骨骼影响的 3 期试验数据。最后，我们提出了维持骨骼健康的管理策略。
结论
在非转移性去势抵抗性前列腺癌患者中，衰老和抗雄激素治疗导致骨骼脆弱。新型雄激素受体抑制剂与一小部分患者的跌倒或骨折有关。管理指南包括定期评估骨密度、营养指导以及在需要时使用抗吸收骨骼健康药物。
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