陳韋辰、李建儀、裘坤元
臺中榮民總醫院，泌尿部
Real World Experience of Androgen Deprivation Therapy Associated Bone Fracture Risk in Newly Diagnosed Prostate Cancer Patients
Wei-Cheng Chen, Jian-Ri Li, Kun-Yuan Chiu
Department of Urology, Taichung Veteran General Hospital, Taichung, Taiwan
Purpose: Androgen deprivation therapy (ADT) is the standard of care in advanced prostate cancer. We conducted a Taiwan National Health Insurance Research Database (NHIRD) study to evaluate the association between ADT and fracture risk in prostate cancer patient in Taiwan.
Materials and Methods: Between 2005 to 2009, data from Taiwan NHIRD were collected. We separated newly diagnosed prostate cancer patients into injection of gonadotropin-releasing hormone agonists and antagonists group, orchiectomy group, oral antiandrogens group and radical prostatectomy only group. Non-cancer matched control group was also assigned for comparison. Study outcomes were newly onset bone fracture and hospital admissions. T-test, chi-square test, multivariate Cox proportional hazard regression were performed.
Results: Overall, 22517 newly diagnosed prostate cancer patients enrolled. After exclusion, 13321 patients were separated into 5020 subjects in injection group, 1193 subjects in orchiectomy group, 6059 subjects in oral group and 1049 subjects in radical prostatectomy only group. The mean age of the overall study population was 74.4 years. Multi-variant analysis disclosed significant increased risk of fracture in the injection group, orchiectomy group, oral group (HR=1.55, 95% CI 1.36 to 1.76, p<0.001, HR=1.95, 95% CI 1.61 to 2.37, p<0.001, HR=1.37, 95% CI 1.22 to 1.53, p<0.001, respectively). In contrast, decreased fracture risk was noted in radical prostatectomy only group (HR=0.51, 95% CI 0.35 to 0.74, p=0.001). Increased fracture risk was observed with increased treatment duration (p<0.001). Patients receiving osteoporosis medication has decreased fracture risk (HR=0.26, 95% CI 0.19-0.37, p<0.001).
Conclusions: ADT is associated with increased risk of fracture. For patient receiving long-term prostate cancer castration therapy, doctors should always keep this complication in mind and arrange proper monitor and provide osteoporosis medication timely.