BACKGROUND
Prostate cancer as a urological malignancy has the highest incidence of bone metastases. Bone metastasis in cancer prostate causes some of the most distressing symptoms.
OBJECTIVES
The present research was undertaken to study the trends of prostate cancer patients presenting to one of the largest tertiary center in north India. It was also done to intervene early and prevent skeletal related events.
Design, Setting, and Participants
Prospective observational time bound study carried out in the Department of Urology from Jan 2015 to Dec 2016. Total of 80 patients were included. Base level bone health was assessed by Dual Energy X-ray Absorptiometry scans (DEXA) and measured by T-score at spine, femur neck, total femur and radius bone. Patient with metastatic bone disease were started on Inj Zolendronic Acid (ZA) and changes in their BMD were measured during follow up. Changes in pain score were assessed on visual pain analogue score (VAS).
Outcomes measurement and Statistical Analysis:
T score at baseline and after 6 months of therapy was compared using Wilcoxon Signed Ranks Test. Bone health of patients on Androgen Deprivation Therapy (ADT) but could not take Injection ZA were compared with those who were on ADT and monthly Injection ZA using the Mann Whitney test.
Results and Limitations
The demography and baseline characteristics of the patient are summarized in TABLE 1. Most common age of presentation in our series was between 60-70 years. More than 80% of patients presented with voiding symptoms, followed by bony pain and hematuria in 14 and 1 patient respectively. All but 2 patients had a hard nodular prostate on digital rectal examination. Another interesting finding to note was that more than 50% of patients had a serum PSA of more than 100ng/ml.
TRUS biopsy revealed high grade disease (Gleason > 7) in 65% of cases with Gleason 5+4 being the most common histological pattern. (Table 2) Bone scan was positive in > 3/4th of the patients presenting to us and most common bone involved was spine in 94% cases. On BMD evaluation, osteoporosis( T score < -2.5) was found in 64% of patients while osteopenia (T score -1 to -2.5) in another 30%. As most of the patients were already metastatic at the time of presentation, most common treatment modality used in our patients was hormone therapy in the form of bilateral orchidectomy (75%) cases and LHRH antagonist/agonist in around 20% of the cases. T score was found to increase significantly in patients on Injection ZA therapy (Figure 1) and pain scores decreased significantly at 6 months follow up.(Figure 2)
TABLE 1
PARAMETERS
|
NUMBER OF PATIENTS
|
PERCENTAGE
|
AGE DISTRIBUTION
|
|
|
41-50
|
6
|
7.5
|
51-60
|
9
|
11.25
|
61-70
|
45
|
56.25
|
71-80
|
18
|
22.5
|
>80
|
2
|
2.5
|
|
|
|
GEOGRAPHICAL DISTRIBUTION
|
URBAN
|
50
|
62.5
|
RURAL
|
30
|
37.5
|
|
|
|
PRESENTING SYMPTOMS
|
VOIDING LUTS
|
65
|
81.25
|
BONY PAIN
|
14
|
17.5
|
HEMATURIA
|
1
|
1.25
|
|
|
|
DIGITAL RECTAL EXAMINATION
|
HARD NODULAR PROSTATE
|
78
|
97.5
|
FIRM SMOOTH PROSTATE
|
2
|
2.5
|
|
|
|
PROSTATE SIZE (CC)
|
|
|
20-40
|
29
|
36.25
|
40-60
|
20
|
25
|
60-80
|
18
|
22.5
|
81-100
|
3
|
3.75
|
>100
|
10
|
12.5
|
|
|
|
SERUM PSA
|
|
|
0-100
|
34
|
42.5
|
>100
|
46
|
57.5
|
Conclusion
In this article we have analysed the trend of cancer prostate in patients presenting to us and have catered to their bone health as well. Injection ZA improves the bone health status of the patients both objectively and subjectively as assessed by changes in DEXA Scan and pain scores respectively. This is probably the first study from India of its kind.