背景:前列腺癌(PCa)治疗与对骨骼健康(BH)和身体组成的有害影响有关。然而,关于这些问题的证据是有限和矛盾的。这一共识,基于德尔菲法,提供有关PCa中BH管理的进一步指导。
方法:2023年5月,由一组具有PCa和BH专业知识的肿瘤学家和内分泌学家进行了一项由37个问题和74个陈述组成的调查。2023年6月,67名选定的意大利专家,属于意大利科学学会意大利医学肿瘤学协会和意大利泌尿外科肿瘤学研究网络(Meet-URO),通过电子邮件邀请完成它,以5分制对他们与每项声明的一致性强度进行评级。≥75%的协议将该声明定义为接受。
结果:在非转移性激素敏感性PCa中,专家组一致认为,单用雄激素剥夺治疗(ADT)意味着足够的骨折风险,因此需要使用骨靶向药物(BTA)进行抗骨折治疗以预防癌症治疗诱导的骨丢失(CTIBL)(79%).因此,对于接受短期ADT(<6个月)的患者的BTA治疗未达成共识(48%).所有接受转移性激素敏感性PCa积极治疗的患者(75%),非转移性去势抵抗性PCa(89%)和无骨转移的转移性去势抵抗性PCa(mCRPC)(84%)应按照CTIBL预防的剂量和方案接受BTA治疗.所有患有骨转移的mCRPC患者均应接受BTA治疗,以减少骨骼相关事件(94%)。在所有设置中,小组分析了治疗和检查的类型和时间,以进行BH监测。专家小组同意这些患者的肌肉减少性肥胖的风险较高及其与骨脆性的相关性。
结论:这一共识突出了缺乏重大共识的领域,如非转移性激素敏感前列腺癌患者接受短期ADT。在前瞻性临床试验中评估这些问题以及识别骨丢失的早期生物标志物尤其紧迫。
BACKGROUND: Prostate cancer (PCa) treatments are associated with a detrimental impact on bone health (BH) and body composition. However, the evidence on these issues is limited and contradictory. This
consensus, based on the Delphi method, provides further guidance on BH management in PCa.
METHODS: In May 2023, a survey made up of 37 questions and 74 statements was developed by a group of oncologists and endocrinologists with expertise in PCa and BH. In June 2023, 67 selected Italian experts, belonging to the Italian scientific societies Italian Association of Medical Oncology and Italian Network for Research in Urologic-Oncology (Meet-URO), were invited by e-mail to complete it, rating their strength of agreement with each statement on a 5-point scale. An agreement ≥75% defined the statement as accepted.
RESULTS: In non-metastatic hormone-sensitive PCa, the panel agreed that androgen deprivation therapy (ADT) alone implies sufficient fracture risk to warrant antifracture therapy with bone-targeting agents (BTAs) for cancer treatment-induced bone loss (CTIBL) prevention (79%). Therefore, no
consensus was reached (48%) for the treatment with BTAs of patients receiving short-term ADT (<6 months). All patients receiving active treatment for metastatic hormone-sensitive PCa (75%), non-metastatic castration-resistant PCa (89%) and metastatic castration-resistant PCa (mCRPC) without bone metastases (84%) should be treated with BTAs at the doses and schedule for CTIBL prevention. All mCRPC patients with bone metastasis should be treated with BTAs to reduce skeletal-related events (94%). In all settings, the panel analyzed the type and timing of treatments and examinations to carry out for BH monitoring. The panel agreed on the higher risk of sarcopenic obesity of these patients and its correlation with bone fragility.
CONCLUSIONS: This
consensus highlights areas lacking major agreement, like non-metastatic hormone-sensitive prostate cancer patients undergoing short-term ADT. Evaluation of these issues in prospective clinical trials and identification of early biomarkers of bone loss are particularly urgent.