Side effects of hormone therapy may be worse than believed

The adverse side effects of hormone therapy in prostate cancer patients may be more severe and may manifest sooner than many believe, according to two separate studies discussed here yesterday.

Martin G. Sanda, MD, director of the Prostate Care Center at Beth Israel Deaconess Medical Center and Harvard Medical School in Boston, looked at neoadjuvant hormone therapy (NHT) before radiation therapy and found significant losses of vitality and sexual function that now can be attributed directly to hormone therapy and that began within the first 2 months of treatment. These losses may be sufficient to raise benefit-risk questions.

Similarly, Christopher Ryan, MD, assistant professor of medicine at the Oregon Health and Science University, Portland, found that hormone therapy is associated with significant bone loss that appears early in treatment.

"Two things were unexpected. One was how early they [side-effects] appeared; the second was how common they were," Dr. Sanda told Urology Times.

Dr. Ryan acquired bone mineral density readings at the femoral neck, hip, and spine of 120 prostate cancer patients without bone metastases in a multicenter study of androgen deprivation therapy (ADT) plus zoledronic acid (Zometa) or placebo. All patients had been treated with ADT for less than a year (median, 3 months). Significant bone loss occurred at all three bone sites and was associated with the duration of treatment.

"Up to two-thirds of patients receiving ADT for less than 12 months had either osteopenia or osteoporosis as defined by T-scores used for women," Dr. Ryan told Urology Times, explaining that the women's scale was used because standards of T-score deviations for men have yet to be determined by consensus.

He noted that a significant portion of the osteopenia and osteoporosis might be attributed to aging. The mean age of patients in the cohort was 72 years.