Urologists lack confidence in treating androgen deprivation therapy bone effects

Washington-Urologists seem to lack the confidence to screen for bone-related side effects in men with prostate cancer who are treated with androgen-deprivation therapy (ADT), according to the results of an electronic survey.

Two-thirds (66%) of respondents to the survey rated their level of confidence in screening for bone-related adverse effects in prostate cancer patients treated with ADT as a "4" on a 1 (not at all confident) to 7 (extremely confident) scale, and 27% rated their confidence as "3" or worse.

The findings indicate that continuing medical education curricula on bone health management should target urologists, said first author Pamela Ellsworth, MD, who presented the results of an online survey developed with Health Wellness Education Partners and posted on UroToday at the AUA annual meeting in Washington.

"Older men may have underlying conditions that may predispose them to having problems with bone health," said Dr. Ellsworth, associate professor of urology and surgery, Brown University, Providence, RI. "Thus, it is important to be aware of that and to screen before starting them on ADT, but also to realize the impact of ADT so you can prevent and protect against bone loss."

Urologists unfamiliar with drugs' mechanisms

The five-question survey evaluating bone health screening and knowledge of prevention and treatment strategies in prostate cancer patients at risk for skeletal-related events was distributed electronically to approximately 16,000 urologists; 356 responses were received.

In addition to lacking confidence in screening for bone-related side effects, the urologists indicated that they lacked familiarity in the mechanism of action for current and emerging agents for the prevention and treatment of bone loss. Fifty-one percent rated themselves at "4" or worse on familiarity with the mechanism of bisphosphonates, and two-thirds (67%) rated themselves as "4" or worse on familiarity of mechanisms of emerging agents.

"Furthermore, they're not aware of the underlying risk factors that may contribute to bone loss in men that don't have prostate cancer," Dr. Ellsworth said.

Some 202 of 279 respondents reported using dual energy x-ray absorptiometry scans to assess the risk of skeletal-related events in ADT recipients, 139 of 179 used formation markers, and 55 of 279 used the World Health Organization fracture risk assessment tool (FRAX).

"The bottom line is we need to think about bone loss and bone health in older men, and we need to be proactive in terms of evaluating and treating it in men on ADT for prostate cancer," Dr. Ellsworth said.