Yalçiner Merih, Erdat Efe Cem, Yazgan Sati Coşkun, Ergenoğlu Said Buğra, Gülpinar Başak, Yekedüz Emre, Ürün Yüksel
Department of Medical Oncology, Ankara University School of Medicine, Ankara, Türkiye.
Department of Radiology, Ankara University School of Medicine, Ankara, Türkiye.
Cancer Diagn Progn. 2025 Jun 30;5(4):499-505. doi: 10.21873/cdp.10464. eCollection 2025 Jul-Aug.
BACKGROUND/AIM: Prostate cancer is linked to an elevated risk of osteoporotic fractures, which can lead to significant morbidity and even mortality. The optimal screening methods and frequency, particularly for patients with non-metastatic disease receiving androgen deprivation therapy (ADT), remain contentious. This study aimed to assess the utility of incidental cross-sectional imaging in the diagnosis of osteoporosis.
We screened patients diagnosed with prostate cancer and followed-up at our tertiary cancer center between July 1, 2006, and December 31, 2023. For eligible patients, three cross-sectional images (computed tomography, alone or with positron-emission tomography) acquired at different times were evaluated to determine the mean attenuation of the L5 vertebral body.
A total of 66 patients were included, with 31 patients (47%) receiving adjuvant ADT. The median follow-up period was 45.2 months. Skeletal events were recorded in 15 patients (26.2%). The mean attenuation of the L5 vertebral body, expressed in Hounsfield units (HU), was measured across three consecutive imaging sessions. The median change in the overall cohort was -4.5, it was -5.7 in patients who received adjuvant ADT, -3.9 in patients with bone metastasis, -2.8 in patients who had skeletal events, and -1.65 in patients who received bone-modifying agents. No significant difference was observed between patient subgroups. Logistic and Bayesian regression analyses showed no relationship between skeletal events and changes in bone density (Bayesian Factor 01: 2.494-2.892, low causality).
While computed tomography imaging can detect bone loss in this patient population, it does not appear to be of sufficient utility to predict skeletal events. This highlights the need for exploring new imaging techniques and their integration with nomograms, which are crucial research areas for improving the management of osteoporosis in patients with prostate cancer.
背景/目的：前列腺癌与骨质疏松性骨折风险升高有关，这可能导致严重的发病率甚至死亡率。最佳的筛查方法和频率，尤其是对于接受雄激素剥夺治疗（ADT）的非转移性疾病患者，仍存在争议。本研究旨在评估偶然的横断面成像在骨质疏松症诊断中的效用。
我们对2006年7月1日至2023年12月31日期间在我们的三级癌症中心被诊断为前列腺癌并接受随访的患者进行了筛查。对于符合条件的患者，评估在不同时间获取的三张横断面图像（计算机断层扫描，单独或与正电子发射断层扫描联合），以确定L5椎体的平均衰减。
共纳入66例患者，其中31例（47%）接受辅助ADT。中位随访期为45.2个月。15例患者（26.2%）记录了骨骼事件。在连续三次成像检查中测量了以亨氏单位（HU）表示的L5椎体的平均衰减。整个队列的中位变化为-4.5，接受辅助ADT的患者为-5.7，有骨转移的患者为-3.9，发生骨骼事件的患者为-2.8，接受骨改良剂治疗的患者为-1.65。患者亚组之间未观察到显著差异。逻辑回归和贝叶斯回归分析显示骨骼事件与骨密度变化之间无关联（贝叶斯因子01：2.494 - 2.892，低因果关系）。
虽然计算机断层扫描成像可以检测该患者群体中的骨质流失，但它似乎不足以预测骨骼事件。这突出了探索新的成像技术及其与列线图整合的必要性，这是改善前列腺癌患者骨质疏松症管理的关键研究领域。
