Managing ADT-Associated Skeletal-Related Events

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The initiation of androgen deprivation therapy (ADT) for patients with prostate cancer can result in major side effects, including osteoporosis or bone thinning and a multitude of other bone complications. Now more than ever, urologists are responsible for managing these skeletal-related events (SREs).

Daniel R. Saltzstein, MD, explains that urologists are very familiar with the side effects associated with ADT. To help manage these concerns, many urologists advise their patients to make lifestyle changes, such as exercising, avoiding smoking and alcohol, and instituting supplements of vitamin D and calcium. Saltzstein explains that treating SREs is gaining support among the urology community as more information becomes available on the severity and frequency of these events.

Bryan A. Mehlhaff, MD, notes that his institution automatically refers every patients beginning ADT to a bone health clinic. In addition to calcium and vitamin D, Mehlhaff stresses the importance of a DXA scan, to measure bone density. On average, he adds, women, as they go through menopause, experience a 1% to 1.5% loss in bone every year. With ADT, men can lose as much as 4% a year, which is ongoing year after year.

In addition to lifestyle changes, in 2011 the FDA approved Prolia (denosumab) as a treatment to increase bone mass in patients at high risk for fracture receiving ADT. As a result, both Saltzstein and Mehlhaff have incorporated Prolia into their practices.