Bone management in Japanese patients with prostate cancer: hormonal therapy leads to an increase in the FRAX score

e16098 Background: For patients with advanced prostate cancer, long-term treatment of androgen deprivation has been conventionally performed. Among the adverse events such as hormonal therapy, bone fracture due to osteoporosis or metastatsis is one of indispensable events. We assessed the frequency of bone fractures in Japanese patients received hormonal therapy. Methods: Between 2000 and 2010, 1,108 Japanese patients were treated with hormonal therapy including GnRH agonist plus anti-androgens or GnRH agonist alone at Yokohama City University Hospital. Of those patients, 48 patients (4.3%) had bone fractures during their treatment. In this retrospective study, we examined the association of bone fracture with the long-term hormonal therapy by investigating the duration of hormonal therapy, fracture sites, and the occurrence of fracture in castration resistant prostate cancer (CRPC) patients. Results: The median age of the patients with fracture was 77 (60-85) years; the median duration from the start of hormonal therapy to fracture was 29.4 (5.4-110.4) months. Eight patients with CRPC had pathological fractures at bone metastases. With respect of fracture sites, 22 patients (46%) had spinal fractures and 10 patients (21%) had fracture of lower legs. Of 8 CRPC patients, 7 patients had spinal fracture after long-term hormonal therapy (median: 38.6 months, range: 15.7-99.1 months). Conclusions: Japanese patients with prostate cancer treated with hormonal therapy have lower risk for bone fracture compared with those in western countries and USA, and interestingly, it is recognized that vertebral body is vulnerable to fracture in Japanese, especially in CRPC patients treated for long-term hormonal therapy. Because bone fracture in patients with prostate cancer endanger their prognosis, the bone management how to prevent bone fracture is very important during hormonal therapy. For the purpose of it, more detailed analysis in this retrospective study should be required.

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Current status and outcomes of salvage radiotherapy for patients with PSA recurrence after prostatectomy: A JROSG surveillance study.

Journal of Clinical Oncology ◽

10.1200/jco.2013.31.6_suppl.207 ◽

2013 ◽

Vol 31 (6_suppl) ◽

pp. 207-207

Author(s):

Takashi Mizowaki ◽

Manabu Aoki ◽

Katsumasa Nakamura ◽

Atsunori Yorozu ◽

Masaki Kokubo ◽

...

Keyword(s):

Prostate Cancer ◽

Hormonal Therapy ◽

External Beam Radiotherapy ◽

Japanese Patients ◽

Salvage Radiotherapy ◽

Current Status ◽

Prognostic Information ◽

Free Survival ◽

Prostate Bed ◽

Psa Failure

207 Background: Salvage radiotherapy (S-RT) for patients with prostate cancer who developed PSA failure after radical prostatectomy is widely applied. However, current status of this approach in Japan has not been surveyed so far. The aim of this study was to reveal the present conditions and outcomes of S-RT for Japanese patients with biochemically recurrent prostate cancer. Methods: Clinical data of the S-RT was gathered by sending a questionnaire to participating facilities to the Japanese Radiation Oncology Study Group (JROSG). The S-RT was defined as external-beam radiotherapy delivered to the prostate bed to patients with prostate cancer who eventually developed PSA failure, although their PSA value had once reached <0.2 ng/ml after prostatectomy. In addition, the interval between prostatectomy and the S-RT should essentially be six months or longer. PSA failure-free survival (PFFS) and clinical failure-free survival (CFFS) was calculated by the Kaplan-Meier estimation. Results: 371 cases were registered from 38 facilities. Among them, hormonal therapy was combined with S-RT in 151 patients. In 3 cases, chemotherapy was combined before or after the S-RT. The rests of the cases were treated by S-RT alone. However, prognostic information was insufficient in 28 cases, and PSA nadir was >0.2 ng/ml in 3 cases. Therefore, outcome studies were conducted in the remaining 186 cases. The median age was 67 years old. The nadir value of the PSA after prostatectomy and the PSA value at the initiation of S-RT were 0.0135 ng/ml and 0.292 ng/ml, respectively. The median period between prostatectomy and the S-RT was 18.6 months. Median follow-up period was 58 months. The 5-year PFFS and CFFS were 50.1% (95%CI: 42.8 – 57.9) and 90.1% (95%CI: 86.4 – 95.7), respectively. PFFS was significantly superior in patients with PSA values <= 0.3 ng/ml at the initiation of S-RT than those of PSA values > 0.3. (57.5% vs. 40.5%, p = 0.027) Conclusions: In Japan, hormonal therapy was combined with S-RT in about 40% of the cases. The 5-year PFFS and CFFS rates of cases treated by S-RT alone were 50.1% and 90.1%, respectively. A PSA value of 0.3 was significant cut-off point for predicting PFFS.

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