Aims
Androgen deprivation therapy (ADT) has deleterious effects on bone health. We sought to determine the frequency of dual x-ray absorptiometry (DXA) scanning in patients commencing adjuvant ADT for treatment of prostate cancer at a large regional cancer centre.
Methods
The electronic medical records of all patients commenced on adjuvant ADT between January 1, 2016 and December 31, 2017 at the Mid-North Coast Cancer Institute, Coffs Harbour were reviewed. Patients commenced on neoadjuvant ADT alone and long-term suppressive ADT for metastatic disease were excluded. The following data were obtained: socio-demographic information, prostate cancer data (date of diagnosis, Gleason score, TMN staging, PSA level pre-ADT, cancer treatment other than ADT), ADT details (start date, duration, type) and DXA results.
Results
A total of 188 men (mean age ± SD, 75.4 ± 7 years) were commenced on adjuvant ADT for a mean ± SD duration of therapy of 23.4 ± 7 months. The majority of men (n=155/188, 82%) were commenced on leuprorelin acetate. While only 26/188 (14%) had a DXA scan performed prior to commencement of ADT, a further 133 (71%) men had a DXA scan at a median of 20 days (interquartile range 7-98) following commencement of ADT. Of the 159 men with DXA readings, 76 (48%) were osteopenic and 38 (24%) were osteoporotic by DXA criteria.
Conclusion
A high level (85%) of DXA scanning in men commencing ADT for prostate cancer can be achieved at a regional centre. The high prevalence (72%) of low bone mass in our unselected cohort underscores the importance of routine DXA scanning as an important first step leading to proactive bone health management during ADT. It would be important to determine if this high level of DXA screening was seen in patients at other regional and metropolitan sites.