Background to and Management of Treatment-Related Bone Loss in Prostate Cancer Alfredo Berruti, 1 Marcello Tucci, 1 Carlo Terrone, 2 Gabriella Gorzegno, 1 Roberto M. Scarpa, 2 Alberto Angeli 3 and Luigi Dogliotti 1 1 Oncologia Medica, Azienda Ospedaliera San Luigi, Orbassano, Italy 2 Urologia, Azienda Ospedaliera San Luigi, Orbassano, Italy 3 Medicina Interne, Azienda Ospedaliera San Luigi, Orbassano, Italy Contents Abstract . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 899 1. Treatment of Prostate Cancer . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 900 2. Bone Loss Induced by Androgen Deprivation in Patients with Prostate Cancer . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 902 3. Clinical Approach and Management of Osteopenia/Osteoporosis Induced by Androgen Deprivation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 904 3.1 General Preventive Measures . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 905 3.2 Antiresorptive Drugs . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 905 3.2.1 Which Patients Should Be Treated? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 907 4. Alternative Forms of Endocrine Therapy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 908 5. Conclusion . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 908 Abstract Prostate cancer is a common disease among older men. Androgen suppression by either orchiectomy or administration of luteinising hormone–releasing hor- mone (LHRH) analogues is the mainstay of treatment. Since the use of prostate- specific antigen (PSA) serum testing has become widespread, however, the timing of endocrine therapy has expanded considerably to include patients with limited involvement of extraprostatic sites and patients presenting an isolated elevation of PSA after radical treatments. These patients are expected to be treated for a long time, since they have a rather low risk of disease progression and there is no recommended time limit for LHRH analogue therapy. The long-term ad- verse effects of androgen deprivation therapy, therefore, deserve more attention than they have received in the past. Osteoporosis represents a special concern for men with prostate cancer receiv- ing androgen deprivation therapy. The rate of bone loss in these men seems to markedly exceed that associated with menopause in women, and fractures occur more frequently than in the healthy elderly male population. Serial bone mineral density (BMD) evaluation could allow the detection of patients with prostate cancer who are at greater risk of osteoporosis and adverse skeletal events after THERAPY IN PRACTICE Drugs Aging 2002; 19 (12): 899-910 1170-229X/02/0012-0899/$25.00/0 © Adis International Limited. All rights reserved.