title: Contemporary hormone therapy with LHRH agonists for prostate cancer: avoiding osteoporosis and fracture.
abstract: BACKGROUND
  Prostate cancer is a large clinical burden across Europe. It is, in fact, the most common cancer in males, accounting for more than 92,300 deaths annually throughout the continent. Prostate cancer is androgen-sensitive; thus an androgen deprivation therapy (ADT) is often used for treatment by reducing androgen to castrate levels. Several ADT agents have achieved benefits with effective palliation, but, unfortunately, severe adverse events are frequent. Contemporary ADT (Luteinising Hormone Releasing Hormone agonist - LHRHa injections) can result in side effects that include osteoporosis and fractures, compromising quality of life and survival.
  
  
  METHODS
  In this review we analysed the associated bone toxicity consequent upon contemporary ADT and based on the literature and our own experience we present future perspectives that seek to mitigate this associated toxicity both by development of novel therapies and by better identification and prediction of fracture risk.
  
  
  RESULTS
  Preliminary results indicate that parenteral oestrogen can mitigate associated osteoporotic risk and that CT scans could provide a more accurate indicator of overall bone quality and hence fracture risk.
  
  
  CONCLUSIONS
  As healthcare costs increase globally, cheap and effective alternatives that achieve ADT, but mitigate or avoid such bone toxicities, will be needed. More so, innovative techniques to improve both the measurement and the extent of this toxicity, by assessing bone health and prediction of fracture risk, are also required.
authors.affiliation: Department of Surgery and Cancer, Imperial College, London.
authors.forename: Hannah C P
authors.initials: HC
authors.lastname: Wilson
authors.affiliation: Department of Surgery and Cancer, Imperial College, London.
authors.forename: Syed I A
authors.initials: SI
authors.lastname: Shah
authors.affiliation: Department of Surgery and Cancer, Imperial College, London.
authors.forename: Paul D
authors.initials: PD
authors.lastname: Abel
authors.affiliation: Department of Surgery and Cancer, Imperial College, London.
authors.forename: Patricia
authors.initials: P
authors.lastname: Price
authors.affiliation: Department of Surgery and Cancer, Imperial College, London.
authors.forename: Lesley
authors.initials: L
authors.lastname: Honeyfield
authors.affiliation: Department of Surgery and Cancer, Imperial College, London.
authors.forename: Steve
authors.initials: S
authors.lastname: Edwards
authors.affiliation: Department of Surgery and Cancer, Imperial College, London.
authors.forename: Richard L
authors.initials: RL
authors.lastname: Abel
keywords: androgen deprivation therapy; fracture imaging; luteinising hormone releasing hormone agonist; osteoporosis; prostate cancer