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Journal of Clinical Oncology, Vol 25, No 22 (August 1), 2007: pp. 3385 © 2007 American Society of Clinical Oncology. DOI: 10.1200/JCO.2007.12.3125
Patient Quality of Life Safeguarding: The Primary Aim in Nonmetastatic Prostate Cancer PatientsDepartment of Urology, University of Florence, Italy To the Editor: It was with great interest that we read Michaelson et al's1 article in the Journal of Clinical Oncology concerning the role of a single treatment with zolendronic acid to prevent gonadotropin-releasing hormone (GnRH) agonist-induced bone loss in men with nonmetastatic prostate cancer. In this well-set-out study, which showed that a single dose of zolendronic acid (4 mg once in 12 months) significantly increases bone mineral density (BMD) and durably suppresses biochemical markers of bone turnover, the authors highlighted a most important feature of nonmetastatic prostate cancer treatment (ie, the need for patient quality of life [QoL] safeguarding). Therefore, in patients affected by nonmetastatic prostate cancer, the preservation of patient QoL is an essential target because of the fact that this neoplasm often has nonaggressive biologic and clinical behavior.2 However, we would like to make an additional consideration regarding their study. The authors enrolled 44 patients (22 treated and 22 placebo), who had undergone GnRH agonist throughout the study with a different duration of prior GnRH agonist treatment of 21 ± 17 months for the zoledronic acid group and 12 ± 16 months for the placebo group. The authors, however, when explaining their study limitations, state that BMD decreases at a steady rate regardless of the duration of past GnRH agonist exposure, as reported by Lee et al.3 We would like to highlight the fact that a more rapid mineral bone mass reduction is associated with initial serum testosterone decreasing to castrate levels, due to a higher bone turnover, as reported by Greenspan et al.4 This aspect is crucial and well known in the bone mineral mass loss related to postmenopausal hormonal changes.5 Consequently, the question is since BMD reduction prophylaxis with a single dose of zolendronic acid is really useful in nonmetastatic prostate cancer patient QoL safeguarding, can it be useful to select the best time for administering this kind of treatment? On the basis of this well-presented study, we think that the fact should be stressed that early administration of zolendronic acid should be suggested in nonmetastatic prostate cancer patients treated with GnRH agonist, particularly to reduce the costs related to fracture due to GnRH agonist-induced osteoporosis. AUTHORS' DISCLOSURES OF POTENTIAL CONFLICTS OF INTEREST The author(s) indicated no potential conflicts of interest. REFERENCES
1. Michaelson MD, Kaufman DS, Lee H, et al: Randomized controlled trial of annual zoledronic acid to prevent gonadotropin-releasing hormone agonist-induced bone loss in men with prostate cancer. J Clin Oncol 25:1038-1042, 2007 2. Bill-Axelson A, Holmberg L, Ruutu M, Häggman M, et al: Radical prostatectomy versus watchful waiting in early prostate cancer. N Engl J Med 352:1977-1984, 2005 3. Lee H, McGovern K, Finkelstein JS, et al: Changes in bone mineral density and body composition during initial and long-term gonadotropin–releasing hormone agonist treatment for prostate carcinoma. Cancer 104:1633-1637, 2005[CrossRef][Medline] 4. Greenspan SL, Coates P, Sereika SM, et al: Bone loss after initiation of androgen deprivation therapy in patients with prostate cancer. J Clin Endocrinol Metab 90:6410-6417, 2005 5. Raisz LG: Pathogenesis of osteoporosis: Concepts, conflicts, and prospects. J Clin Invest 115:3318-3325, 2005[CrossRef][Medline] Related Reply
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Copyright © 2007 by the American Society of Clinical Oncology, Online ISSN: 1527-7755. Print ISSN: 0732-183X
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