The onset of skeletal complications in hormone refractory prostate cancer patients is not influenced by the duration of androgen deprivation therapy

Background: Skeletal complications frequently complicate the natural history of prostate cancer with metastatic bone disease. Androgen deprivation therapy (ADT), the mainstay of therapy for advanced prostate cancer, induces osteoporosis and may cause adverse skeletal related events (SRE) irrespective of disease progression in bone. SRE, however, are relatively uncommon until the tumor is responsive to ADT but they are more frequent when the tumor become hormone refractory. The relative contribution of ADT in predisposing SRE in hormone refractory stage is totally unknown. Methods: From July 1990 to September 2003, 205 prostate cancer patients with hormone refractory disease were treated and followed in our Institution. Eighty-three of them (41.0%) underwent SRE defined as vertebra collapses (20.0%), bone fractures (12.7%), spinal cord compression (8.0%). SRE occurred before hormone refractoriness in 8 patients (3.9%). Results: Hormone refractory patients destined to undergo SRE had at baseline conditions greater bone pain (p=0.002), greater values of serum bone alkaline phosphatase (p 6 bone lesions (p=0.01). Median duration of ADT (range) was 22.9 months (1.1–138.) in hormone refractory patients destined to undergo SRE and 25.9 months (1.0–211) in hormone refractory patients who did not develop SRE (p=n.s.). Conclusions: the occurence of SRE in hormone refractory prostate cancer with metastatic bone disease is significantly influenced by tumor load in bone, levels of bone turnover markers, but not by the duration of androgen deprivation therap