Many of us believe that the risk developing bone fractures is more common in men who have stage 4 prostate cancer that has developed distant metastasis than those men with stage 4 prostate cancer that do not have distant metastasis. This increased risk, or actually the increase of fractures has significant clinical consequences, such as increased pain and a decreased quality of life.
A study was performed to confirm this assumption by estimating the prevalence of fractures among men diagnosed with stage 4 non-distant metastatic (M0) prostate cancer as opposed to men with stage 4 prostate cancer with distant metastasis (M1). It also evaluated the risk factors associated with developing fractures.
The researchers estimated the prevalence of fractures among men age 66 or older diagnosed with M0 or M1 prostate cancer using data from the U.S. SEER-Medicare datasets between the years of 2000 to 2007. The men were followed through December 2009 or until they were lost to follow up.
Among the 9,826 men with prostate cancer (M1 = 7301; M0 = 2525) who were followed, 12.9% of them experienced a post-diagnosis fracture. The prevalence of fractures was nearly twice as high in men with M1 versus M0 prostate cancer (M1 = 14.7%; M0 = 7.5%).
The median time from diagnosis of M1 prostate cancer to their first fracture was five months and for men with M0 prostate cancer it was 34 months.
Compared to men with no fractures, men who experienced fractures were more likely to be older (20.3% vs. 17.8%), of white/non-Hispanic race (81.1% vs. 75.3%), have well (cancer grade 1) or moderately (cancer grade 2) differentiated tumors (48.7% vs. 41.7%), have a claim of osteoporosis (2.4% vs. 0.6%) or osteoarthritis (9.3% vs. 6.5%) in the year prior to the prostate cancer diagnosis, and to have taken a bone mineral density (BMD) test (13.5% vs. 8.1)
The real surprise was that 92% of men did not receive bone mineral density (BMD) testing at any time post diagnosis despite the fact that 67% of the men had been on a hormone treatment (ADT).
For men with M1 prostate cancer the prevalence of fractures is higher and the time to having a fracture is substantially shorter than in men with M0 prostate cancer.
Additionally, most men with prostate cancer do not receive BMD testing. A significant need remains to monitor bone health and treat fractures, particularly among men with M1 prostate cancer.
J Clin Oncol 32, 2014 (suppl 4); Abdulla M. Abdulhalim, Ebere Onukwugha, Corinne Woods, Yi Qian, Jorge Arellano, Arun Balakumaran, C. Daniel Mullins, Arif Hussain
Joel T. Nowak, M.A., M.S.W.