Bone Health Care Pathway for Non-metastatic Prostate Cancer Patients on Radiation and Androgen Deprivation Therapy

Isabella Palumbo; Carmelinda Ruggiero; Eleonora Festa; Michelantonio DE Fano; Marta Baroni; Rita Bellavita; Gianluca Ingrosso; Simonetta Saldi; Michele Duranti; Patrizia Mecocci; Alberto Falorni; Cynthia Aristei

doi:10.21873/anticanres.16186

Bone Health Care Pathway for Non-metastatic Prostate Cancer Patients on Radiation and Androgen Deprivation Therapy

Anticancer Res. 2023 Jan;43(1):493-499. doi: 10.21873/anticanres.16186.

Authors

Affiliations

¹ Radiation Oncology Section, University of Perugia and Perugia General Hospital, Perugia, Italy; isabella.palumbo@unipg.it.
² Geriatric Unit, University of Perugia and Perugia General Hospital, Perugia, Italy.
³ Radiation Oncology Section, University of Perugia, Perugia, Italy.
⁴ Internal Medicine and Endocrinological and Metabolic Sciences Section, University of Perugia and Perugia General Hospital, Perugia, Italy.
⁵ Radiation Oncology Division, Perugia General Hospital, Perugia, Italy.
⁶ Radiation Oncology Section, University of Perugia and Perugia General Hospital, Perugia, Italy.
⁷ Radiology Division, Perugia General Hospital, Perugia, Italy.

^# Contributed equally.

PMID: 36585208
DOI: 10.21873/anticanres.16186

Abstract

Background/aim: Survival rates of prostate cancer (PCa) patients have improved considerably as a result of earlier diagnosis and therapies, including radiotherapy (RT) and androgen deprivation therapy (ADT). Patients on ADT develop cancer treatment-induced bone loss (CTIBL) and a high risk of fragility fractures. Bone health (BH) assessment is strongly recommended, together with timely initiation of treatments, to counteract CTIBL and preserve bone strength. Therefore, we decided to develop an interdisciplinary pathway of care (IPC) dedicated to non-metastatic PCa patients on long-term ADT and RT.

Patients and methods: An interdisciplinary team allocated resources to support an IPC to manage patients' CTIBL and prevent fragility fractures. The team provided a diagnostic and therapeutic workflow according to patients' and professional perspectives, consistent with recommendations and healthcare policies. The hospital's quality department certified the IPC, the Ethical Committee approved procedures over the workflow. The Fracture Liaison Service (FLS) standards inspired services and professionals' activities and interactions.

Results: Preliminary data support the feasibility of the IPC from professionals' and patients' perspectives. Median age of the enrolled patients was 75 years, more than a half (58.9%) had low grade osteopenia or normal BMD (T-score ≥-1.5 standard deviation, SD), while 23.5% and 17.6% had osteoporosis and osteopenia, respectively. The IPC meets the requirements of a FLS concerning crucial indicators.

Conclusion: Our IPC was a suitable approach to assure timely identification, assessment, initiation, and monitoring of adherence to anti-fracture treatments among non-metastatic PCa patients on long-term ADT and RT. Further data are required to show its effectiveness on fragility fracture prevention.

Keywords: Non-metastatic prostate cancer; androgen deprivation therapy; cancer treatment-induced bone loss; radiotherapy.

MeSH terms

Aged
Androgen Antagonists / adverse effects
Androgens
Bone Density
Bone Diseases, Metabolic*
Critical Pathways
Fractures, Bone*
Humans
Male
Prostatic Neoplasms* / drug therapy
Prostatic Neoplasms* / pathology

Substances

Androgen Antagonists
Androgens