AUA 2017: Trends In Management Of Bone Health In Men With Metastatic Prostate Cancer: Analysis From The Surveillance, Epidemiology, And End Results Medicare Database

Boston, MA ( Bone loss and fracture are known risks of androgen-deprivation therapy (ADT), particularly among patients with bone metastases. Bisphophonates and Denusomab (bone therapy, BT) are commonly used to promote bone health. These drugs improve bone mineral density, decrease risk of skeletal related events but do not have an impact on overall survival. According to National Comprehensive Cancer Network (NCCN) guidelines, BT Is indicated for men with metastatic castrate resistant prostate cancer (mCRCP), and should be considered for men with metastatic prostate cancer (mCP) who are at high risk of fracture. Dr. Boysen presented his study aiming to analyze trends in utilization of BT in these patients and assess the factors associated with receiving BT.

The Surveillance, Epidemiology, and End Results (SEER) Medicare database was analyzed during the years 2004-2011 for all relevant patients above age 65. A total of 2563 men met the inclusion criteria. BT was administered to 431 (16.8%) patients overall with 315 receiving Denosumab and 116 receiving bisphosphonates. Among men with mCRPC, 31.4% received BT. Utilization of BT increased significantly during the study period, from 5.9% in 2004 to 35.2% in 2011 (p<0.01). On multivariate analysis, men had increased odds of receiving BT if year of diagnosis was later than 2008 or an oncologist was involved in their care. Decreased odds of BT occurred if patients received care in a less urban area. On multivariate analysis, age 80-85 and diagnosis year later than 2010 were associated with increased odds of BT. Adverse events related to BT were rare, with osteonecrosis of the jaw occurring in <11 patients (<2.6%) and hypocalcemia in 34 (8.0%).

Dr. Boysen concluded that utilization of BT among men with mCP is increasing, though the overall usage of these medications remains low. Among men with mCRCP, only 31.4% received bone health treatments in accordance with NCCN guidelines. As novel treatments expand the role of urologists in management of mCRCP, careful consideration of appropriate management of bone health must not be overlooked.

Presented by: William R. Boysen, Chicago, IL

Written By: Hanan Goldberg, MD, Urologic Oncology Fellow (SUO), University of Toronto, Princess Margaret Cancer Centre

Twitter: @Goldberghanan

at the 2017 AUA Annual Meeting - May 12 - 16, 2017 – Boston, Massachusetts, USA