Men with prostate cancer who are being treated with androgen deprivation therapy are at increased risk of osteoporotic fractures, type 2 diabetes, and possibly, cardiovascular events, a new set of management guidelines states.
The guidelines, published in the Medical Journal of
, were developed to guide assessment and management of bone and
metabolic health in men with non-metastatic prostate cancer who are being
treated with androgen deprivation therapy (ADT).
The guidelines have been endorsed by the Endocrine Society
of Australia, the Australian and New Zealand Bone and Mineral Society, and the
Urological Society of Australia and New Zealand.
ADT is the standard first-line therapy for men with
metastatic prostate cancer - cancer that is spreading to other organs - but is
increasingly being used for men with non-metastatic cancer.
Dr Mathis Grossmann, Senior Research Fellow in the
Department of Medicine at Austin Health/Northern Health at the University of Melbourne, and co-authors recommended
counselling patients about possible risk factors before starting treatment, an
individualised, multidisciplinary approach for each patient, and regular
testing for bone mineral density and metabolic risk factors.
Dr Grossmann said that prostate cancer was the most common
solid organ cancer in Australian men, with 20,000 new cases being diagnosed in Australia each
"The prevalence of prostate cancer is increasing because the
population is ageing and prostate-specific antigen testing is occurring more
frequently," Dr Grossmann said.
"This has led to a profound shift towards detecting more
clinically localised, low-risk prostate cancer.
At the same time, the rate of use of ADT in men with
non-metastatic prostate cancer has increased, with an estimated 23,500 men
being treated in Australia
Dr Grossmann said that the expanded use of ADT in
non-palliative treatment mandated a proper risk-benefit assessment in a
The developers of the guidelines called for controlled
trials to better define the risk-benefit ratio of ADT.
"Such information will help to avoid overuse of ADT,
especially for men who have a high baseline risk of fractures and
cardiovascular events but low-risk prostate cancer," they said.
The Medical Journal of Australia
is a publication of
the Australian Medical Association.