Changes in bone mineral density differ between gonadotrophin-releasing hormone analogue- and surgically castrated men...

The effects of surgical and medical castration on bone mineral density (BMD) were compared in men receiving castration therapy as a result of prostate cancer. A control group of men of similar age was also included in the study.

A total of 28 men with prostatic cancer who had been selected to undergo medical or surgical castration and 10 healthy men with benign urological disorders were followed from baseline observations and BMD was assessed at 3, 6, 12 and 36 months. Serum hormone levels were also assessed.

Orchidectomy and treatment with gonadotrophin-releasing hormone (GnRH) analogues caused an expected rapid decrease in serum testosterone levels, with no difference between these two groups. The mean loss of BMD in the femoral neck measured by means of dual-energy X-ray absorptiometry in surgically castrated men and GnRH-treated men was 0.037 g/cm2 (4.53%; SEM 0.013 g/cm2; p = 0.010) and 0.027 g/cm2 (3.18%; SEM 0.014 g/cm2; p = 0.119), respectively at 12 months, while the controls gained 0.017 g/cm2 (1.26%; SEM 0.013 g/cm2; p = 0.195). In the heel, surgically castrated men lost 9.04% of BMD (p < 0.001), the GnRH-treated men lost 3.58% (p = NS) and the controls gained 1.26% (p = NS).

We found a more pronounced decrease in BMD in men with metastatic prostate cancer who were treated with surgical castration than in those who were treated with GnRH analogues.