ADT Shown to Increase Fracture Risk

ALL FORMS OF androgen deprivation therapy (ADT) for prostate cancer are significantly associated with an increased risk for bone fracture, according to a recent population-based study published in PLoS ONE The risk is highest among men who undergo orchiectomy.

An analysis of 2001-2008 data from the Taiwan National Health Insurance Research Database showed that patients who received injection formulations of ADT (gonadotropin-releasing hormone agonists and antagonists) had a 55% increased risk of bone fracture compared with a matched group of control patients without cancer after adjusting for multiple variables. Men who underwent orchiectomy and those who took oral antiandrogens had a 95% and 37% increased risk, respectively.

Patients who underwent only radical prostatectomy (RP) had a significant 49% decreased risk of fracture. Those who received osteoporosis medications had a significant 74% decreased risk.

The study also demonstrated that older age and various comorbidities, including stroke, heart failure, and pulmonary and renal disease, significantly increased the risk of fracture in men with prostate cancer. Stroke, heart failure, pulmonary disease, and renal disease increased the risk of fracture by 15%, 24%, 22%, and 33%, respectively.

“For patients receiving long-term prostate cancer castration therapy, doctors should always keep this complication in mind and arrange proper monitoring and provide timely osteoporosis medication,” Wei-Cheng Chen, MD, of Taichung Veterans General Hospital in Taichung, Taiwan, and colleagues concluded. ■

Stone Treatment in Kidney Grafts Characterized

ANTEGRADE treatment approaches may yield the highest stone-free rates for patients with de novo nephrolithiasis in kidney grafts, according to new study findings.

In a systematic review of 37 retrospective studies, investigators identified 553 patients with de novo stones in the transplanted kidney. Of the 612 procedures, 20 were antegrade ureteroscopy, 154 retrograde ureteroscopy, 118 percutaneous nephrolithotomy (PCNL), 25 open surgery, 155 extracorporeal shock wave lithotripsy (ESWL), and 140 surveillance/ medical treatment. The stone-free rate at 3 months was 96% with open surgery, 95% with antegrade ureteroscopy, 86% with PCNL, 81% with retrograde ureteroscopy, and 75% with ESWL, Alberto Breda, MD, of University Autonoma of Barcelona in Spain, and colleagues reported in European Urology Focus.

“As opposed to the management of nephrolithiasis in native kidney, an antegrade approach should be considered more in renal transplant patients,” they wrote. Study findings support a minimum of annual imaging of the renal graft, they noted.

The mean stone size on diagnosis was 11 mm. ■