The effect of combined androgen blockade on bone turnover and bone mineral density in men with prostate cancer.
Our study and previous reports suggest that castration results in increased bone turnover and lowered BMD and that these changes might be attenuated by anti-androgens, such as BL and EMP.


BACKGROUND
Recent studies have shown that castration for PC decreases bone mineral density (BMD), while estrogen therapy or bicalutamide (BL) monotherapy maintains BMD. However, the effect of combined androgen blockade (CAB) on bone turnover is not well studied.


METHODS
A total of 204 men were evaluated in the study (control group: n = 56, castration group: n = 102, 'CAB with BL' group: n = 22, 'CAB with estramustine phosphate (EMP)' group: n = 24). We measured steroid hormone levels, BMD (measured at one-third distal radius), bone turnover markers (levels of urinary N-telopeptide cross links of type 1 collagen (u-NTx) and deoxypyridinoline (u-DPD), serum concentrations of osteocalcin (OC)) in order to assess differences between groups.


RESULTS
The BMD % Z score of the castration group was significantly lower than that of the control group or the 'CAB with EMP' group (90.6% vs. 95.5%, 98.6%; p < 0.042, p < 0.044, respectively). Levels of u-NTx, u-DPD, OC of the castration group were the highest followed by the control group, then the 'CAB with BL' group and the 'CAB with EMP' group.


CONCLUSIONS
Our study and previous reports suggests that castration results in increased bone turnover and lowered BMD and that these changes might be attenuated by anti-androgens, such as BL and EMP.
Yamada
Y
Y
Department of Urology, The Fraternity Memorial Hospital, 2-1-11, Yokoami, Sumida-ku, Tokyo 130-8587, Japan.
Takahashi
S
S
Fujimura
T
T
Nishimatsu
H
H
Ishikawa
A
A
Kume
H
H
Tomita
K
K
Takeuchi
T
T
Kitamura
T
T
D015502:Absorptiometry, Photon; D000368:Aged; D000369:Aged, 80 and over; D000596:Amino Acids / Q000652:urine; D000726:Androgen Antagonists / Q000494:pharmacology* / Q000627:therapeutic use; D000813:Anilides / Q000494:pharmacology / Q000627:therapeutic use; D015415:Biomarkers / Q000097:blood / Q000652:urine; D015519:Bone Density / Q000187:drug effects*; D024042:Collagen Type I / Q000652:urine; D003131:Combined Modality Therapy; D004961:Estramustine / Q000494:pharmacology / Q000627:therapeutic use; D006801:Humans; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D009570:Nitriles / Q000494:pharmacology / Q000627:therapeutic use; D009919:Orchiectomy; D015675:Osteocalcin / Q000097:blood; D010455:Peptides / Q000652:urine; D011471:Prostatic Neoplasms / Q000188:drug therapy / Q000473:pathology / Q000503:physiopathology* / Q000601:surgery; D012189:Retrospective Studies; D014105:Tosyl Compounds / Q000494:pharmacology / Q000627:therapeutic use
D000596:Amino Acids; D000726:Androgen Antagonists; D000813:Anilides; D015415:Biomarkers; D024042:Collagen Type I; D009570:Nitriles; D010455:Peptides; D014105:Tosyl Compounds; C052929:collagen type I trimeric cross-linked peptide; D015675:Osteocalcin; D004961:Estramustine; C036020:deoxypyridinoline; C053541:bicalutamide