Endocrine Abstracts

Prostate cancer is projected to be the commonest cancer by 2030, with 1 in 8 men receiving a diagnosis in their lifetime. Although there are more than 400,000 cases in Europe diagnosed each year, many new prostate cancer treatments have been introduced and patients now live with their disease for many years. Consideration of the long-term consequences of treatment is of therefore of increasing importance. More than one third of patients with prostate cancer receive androgen deprivation therapy (ADT), an endocrine-based treatment. Whilst highly successful in reducing testosterone levels and improving prostate cancer survival, ADT is associated with negative impacts on bone health, leading to bone loss and increased fracture risk. In addition, ADT causes sarcopaenia which increases the risk of falls, further compounding the risk of fractures. Many patients continue receiving ADT throughout their prostate cancer journey. However, these patients are often not routinely referred to bone specialists for optimisation of their bone health, despite the fact that bone loss and the resulting increased risks of osteoporotic fragility fractures (often requiring hospitalisation) represent substantial problems for patients and healthcare systems. The bone loss induced by ADT is linked to its effects in disturbing normal bone turnover, leading to increased bone resorption and reduction in bone density. The gold standard for measuring bone density is dual energy x-ray absorptiometry (DEXA) scan. However, our recent work using a sophisticated form of CT scanning (QCT) has revealed that ADT not only reduces bone density, but also impairs the mechanical properties of bone. Bone density loss can be prevented or repaired using bone targeted agents such as bisphosphonates or the fully humanised antibody, denosumab. In this presentation, recent detailed guidance for managing the skeletal health of patients receiving ADT will be discussed in the light of current treatment pathways for prostate cancer patients.