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Second-generation hormonotherapy in prostate cancer and bone microenvironment.

Wafa Bouleftour1, Karima Boussoualim2, Sandrine Sotton3

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|May 11, 2021
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Prostate cancer hormone therapies cause significant bone loss, increasing fracture risk in older men. This review examines the impact of newer hormone therapies on bone health in prostate cancer patients.

Keywords:
androgenbone mineral densitydeprivationsecond-generation hormonotherapy

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Area of Science:

  • Oncology
  • Endocrinology
  • Bone Biology

Background:

  • Prostate cancer (Pca) is common in men, with 1 in 8 diagnosed before 75 in France.
  • Androgen deprivation therapies (ADT) are standard Pca treatment but cause significant bone loss and osteoporosis.
  • Newer hormone therapies (abiraterone acetate, enzalutamide, apalutamide, darolutamide) are effective but also inhibit androgen pathways, potentially worsening bone density.

Purpose of the Study:

  • To review the impact of second-generation hormone therapy on the bone microenvironment in prostate cancer patients.
  • To highlight the lack of specific bone health management recommendations for Pca patients on these newer therapies.
  • To address the absence of prospective studies assessing bone mineral density in patients receiving second-generation hormone therapy.

Main Methods:

  • Literature review of existing studies on prostate cancer, androgen deprivation, and bone metabolism.
  • Analysis of the mechanisms by which ADT and newer hormone therapies affect bone remodeling.
  • Synthesis of current knowledge regarding bone microenvironment changes in Pca patients undergoing hormonal treatment.

Main Results:

  • ADT and newer hormone therapies significantly impact bone remodeling by inhibiting androgen synthesis.
  • Older patients and those with pre-existing bone density loss are at higher risk of osteoporosis and fractures.
  • The combined inhibition of androgen pathways by newer therapies may exacerbate bone loss, though specific data is limited.

Conclusions:

  • Second-generation hormone therapies, while effective against prostate cancer, pose a significant risk to bone health.
  • There is an urgent need for prospective studies and specific clinical guidelines for managing bone density in Pca patients on these treatments.
  • Understanding the impact on the bone microenvironment is crucial for preserving quality of life and independence in aging Pca survivors.