Changes in bone health and skeletal-related events following implementation of a multidisciplinary consensus statement guiding surveillance and treatment of men undergoing androgen deprivation therapy for prostate cancer.
OBJECTIVE
Androgen deprivation therapy (ADT) is a cornerstone for inhibiting progression of prostate cancer (CAP) and improving survival. After previously establishing that men with CAP treated with ADT at our institution had significant skeletal morbidity, we evaluate the effectiveness of a multidisciplinary consensus statement (MCS) to improve outcomes.


METHODS
We reviewed the records of men treated with ADT in our clinic. Only 38% of men had BMD studies, and 81% of those men had bone loss. Twenty-four percent of men had skeletal-related events (SREs). A minority of men were being treated for bone loss. We decided not to initiate therapy soon enough, and implemented an MCS to guide surveillance and treatment.


RESULTS
Four years after implementing the MCS, half of the men were still being treated with ADT and the average treatment length doubled. Significantly more men were being screened, bone loss remained stable, and there was a trend towards decreased SREs. Significantly more men were being treated for bone loss.


CONCLUSIONS
After implementing an MCS we show stable bone mineral density and a trend towards decreased SREs despite doubling of the treatment length. We document significant improvement in our practice pattern.
Department of Urology, Madigan Army Medical Center, Tacoma 98431-1100, USA. dayne.nelson@us.army.mil <dayne.nelson@us.army.mil>
Dayne Matthew
DM
Nelson
Andrew Charles
AC
Peterson
D000368:Aged; D000369:Aged, 80 and over; D000726:Androgen Antagonists / Q000009:adverse effects / Q000627:therapeutic use*; D015519:Bone Density / Q000187:drug effects; D001851:Bone Diseases, Metabolic / Q000139:chemically induced* / Q000188:drug therapy; D002118:Calcium / Q000627:therapeutic use; D003245:Consensus Statements as Topic; D006801:Humans; D008297:Male; D010024:Osteoporosis / Q000139:chemically induced / Q000188:drug therapy; D011471:Prostatic Neoplasms / Q000188:drug therapy*; D013997:Time Factors; D016896:Treatment Outcome; D014807:Vitamin D / Q000627:therapeutic use
D000726:Androgen Antagonists; D014807:Vitamin D; D002118:Calcium