Researchers at the University of Texas Medical Branch
at Galveston found that in the five years after prostate
cancer was diagnosed, men taking such drugs had a 20 percent
risk of fracture, versus 13 percent among those not getting
the treatment.
While prostate cancer kills about 30,000 American men
a year, it generally grows slowly, and most patients die
of some other cause before the cancer can kill them.
At the same time, a broken bone can prove lethal. For
elderly people, a serious fracture often starts a downward
spiral of slow-healing infections and other complications,
confinement to a nursing home or hospital bed, and eventually
death. One-third of elderly men who break their hips die
of complications within a year.
"If there's no survival benefit and there's potential
harm, you should consider whether you should put these men
on hormonal deprivation therapy," said Dr. Ronald Morton,
director of urologic oncology at the Cancer Institute of
New Jersey.
The study, led by Dr. Vakahn Shahinian, an assistant professor
of internal medicine, reviewed health records of 50,613
men with prostate cancer, age 66 or older, from national
databases on cancer and Medicare patients. It was reported
in Thursday's New England Journal of Medicine.
The researchers blamed hormone-suppressing drugs for an
estimated 3,000 fractures a year in Americans with prostate
cancer, the second-most common and second-most deadly cancer
among men.
About 40 percent of the 230,000 men diagnosed with prostate
cancer in this country each year get drugs such as Lupron
to suppress production of male hormones like testosterone.
That is because testosterone, which helps build up bone
and muscle, also can induce growth of prostate cancer cells.
Those drugs, when combined with radiation, have been proven
to save lives among men with advanced prostate cancer.
But in recent years, doctors have also been giving hormone-suppressing
drugs to men where there is no clear proof the additional
treatment helps, such as early cases where the cancer has
not spread beyond the prostate gland.
"What doctors should be telling their patients is, `We
don't know that we'll be lengthening your life, but we do
you know that we may be increasing your risk of fracture,'"
said Dr. Durado Brooks, director of prostate cancer for
the American Cancer Society.
Morton and other experts said doctors should also consider
giving drugs such as Fosamax that can slow and sometimes
reverse bone loss.
The study found that among men surviving five years after
their cancer diagnosis, for those getting hormone suppression,
the risk of a fracture requiring hospitalization doubled,
as did the risk of a spine, hip or upper leg fracture, compared
with the group who did not get the treatment.
Morton said doctors generally tell men about the hormone-suppression
therapy's other side effects: loss of muscle mass and strength,
loss of some mental sharpness, and hot flashes. But few
have brought up the fracture risk until recently, he said.
Morton said one weakness of the study is that for unexplained
reasons the group getting the hormone-suppression therapy
had more fractures before their cancer was diagnosed than
the other group. Morton said a study that follows patients
longer, and periodically collects data on bone density,
would be more definitive.
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On the Net: http://www.nejm.org
http://www.cdc.gov/cancer/prostate/index.htm
