Advertisement

Clinical & Experimental Metastasis

, Volume 18, Issue 5, pp 385–390 | Cite as

Dual X-ray absorptiometry detects disease- and treatment-related alterations of bone density in prostate cancer patients

  • Gillian L. Smith
  • Alan P. Doherty
  • Linda M. Banks
  • Jane Dutton
  • Iain W. Hanham
  • Timothy J. Christmas
  • Richard J. Epstein
Article

Abstract

Metastatic bone disease is an important clinical problem which has proven difficult to study because of a lack of noninvasive investigative modalities. Here we show that dual-energy X-ray absorptiometry (DXA) scanning provides clinically useful information about the status of metastatic bone lesions in cancer patients undergoing palliative treatment. In the study group of 21 patients, a significant increase in metastatic bone mineral density (BMD) was confirmed in prostate (n=14) relative to breast (n=7) cancer patients. With respect to the prostate cancer cohort, further increases in lesional BMD were evident in all evaluable patients in whom biochemical progression occurred; conversely, lesional BMD declined in patients who had a partial response to therapy. BMD of uninvolved bone decreased with all types of androgen-deprivation therapy regardless of whether patients responded or relapsed. We conclude that BMD changes in both lesional and uninvolved bone are readily detectable in metastatic prostate cancer, and propose that DXA scanning represents a promising new approach to monitoring the natural history and therapeutic course of this disease.

bone density bone metastasis dual X-ray absorptiometry prostate-specific antigen prostatic neoplasms 

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. 1.
    Belliveau RE, Spencer RP. Incidence and sites of bone lesions detected by 99mTc-polyphosphate scans in patients with tumors. Cancer 1975; 36: 359–63.PubMedCrossRefGoogle Scholar
  2. 2.
    Cook G, Watson F. Events in the natural history of prostate cancer: using salvage curves, mean age distributions and contingency coefficients. J Urol 1968; 96: 87–96.Google Scholar
  3. 3.
    Hayward JL, Carbone PP, Heuson JC et al. Assessment of response to therapy in advanced breast cancer. Cancer 1977; 3: 1389–94.Google Scholar
  4. 4.
    Coleman RE. Evaluation of bone disease in breast cancer. Breast 1994; 3: 73–8.CrossRefGoogle Scholar
  5. 5.
    Nguyen-Pamart M, Bonneterre J, Hecquet B. Urinary excretion of deoxypyridinoline in patients with breast cancer. Anticancer Res 1995; 15(4): 1601–3.PubMedGoogle Scholar
  6. 6.
    Delmas PD, Fontana A. Bone loss induced by cancer treatment and its management. Eur J Cancer 1998; 34: 260–2.PubMedCrossRefGoogle Scholar
  7. 7.
    Hauschka PV, Manrakos AE, Iafrati MD et al. Growth factors in bone matrix. Isolation of multiple types of affinity chromatography on heparin sepharose. J Biol Chem 1986; 261: 12665–74.PubMedGoogle Scholar
  8. 8.
    Diel IJ, Solomayer E-F, Costa SD et al. Reduction in new metastases in breast cancer with adjuvant clodronate treatment. N Engl J Med 1998; 339(6): 357–63.PubMedCrossRefGoogle Scholar
  9. 9.
    McGrath SA, Diamond T. Osteoporosis as a complication of orchiectomy in 2 elderly men with prostatic cancer. J Urol 1995; 154: 535–6.PubMedCrossRefGoogle Scholar
  10. 10.
    Townsend MF, Sanders WH, Northway RO et al. Bone fractures associated with luteinizing hormone-releasing hormone agonists used in the treatment of prostate carcinoma. Cancer 1997; 79: 545–50.PubMedCrossRefGoogle Scholar
  11. 11.
    Bruning PF, Pit MJ, de Jong-Bakker M et al. Bone mineral density after adjuvant chemotherapy for premenopausal breast cancer. Br J Cancer 1990; 61: 308–310.PubMedGoogle Scholar
  12. 12.
    Powles TJ, Hickish T, Kanis JA et al. Effect of tamoxifen on bone mineral density measured by dual energy X-ray absorptiometry in healthy premenopausal and postmenopausal women. J Clin Oncol 1996; 14: 78–84.PubMedGoogle Scholar
  13. 13.
    Love RR, Mazess RB, Barden HS, al e. Effects of tamoxifen on bone mineral density in postmenopausal women with breast cancer. N Engl J Med 1992; 326: 852–6.PubMedCrossRefGoogle Scholar
  14. 14.
    Rodan GA. Introduction to bone biology. Bone 1992; 13 (Suppl 1): S3–S6.PubMedCrossRefGoogle Scholar
  15. 15.
    Wahner HW, Fogelman I. The Evaluation of Osteoporosis. Dual X-Ray Absorptiometry in Clinical Practice. London: Martin Dunitz 1994.Google Scholar
  16. 16.
    Banks LM. Dual energy X-ray absorptiometry (DXA). In Grainger RG, Allison DJ (eds) Diagnostic Radiology-a Textbook for Radiologists, 3rd ed. London: Churchill Livingstone 1997; 125–36.Google Scholar
  17. 17.
    Kroger H, Laituieu K. Bone mineral density measured by dual energy X-ray absorptiometry in normal men. Eur J Clin Nutr 1992; 22: 454–60.Google Scholar
  18. 18.
    Krall EA, Dawson-Hughes B, Hirst K et al. Bone mineral density and biochemical markers of bone turnover in healthy elderly men and women. J Gerontol 1997; 52A: M61–M67.Google Scholar
  19. 19.
    Burgher H, van Daele PLA, Algra D et al. The association between age and bone mineral density in men and women aged 55 years and over. The Rotterdam study. J Bone Miner Res 1994; 25: 1–13.CrossRefGoogle Scholar
  20. 20.
    Hayward JL, Rubens RD, Carbone PP. Assessment of response to therapy in advanced breast cancer. Br J Cancer 1977; 35: 292–8.PubMedGoogle Scholar
  21. 21.
    Shapiro CL, Keating J, Angell JE et al. Monitoring therapeutic response in skeletal metastases using dual-energy X-ray absorptiometry: A prospective feasability study in breast cancer patients. Cancer Invest 1999; 17: 566–74.PubMedCrossRefGoogle Scholar
  22. 22.
    Tyrell CJ, Blake GM, Iversen P et al. 'Casodex' may preserve bone mineral density of patients with advanced prostate cancer. BJU Int BJU Intl 2000; 86 (Suppl 3): 220–1.Google Scholar
  23. 23.
    Group MRCPCWPI. Immediate versus deferred treatment for advanced prostate cancer: Initial results of the Medical Research Council trial. Br J Urol 1998; 79(2): 235–46.Google Scholar
  24. 24.
    Scher HI, Kelly WMK, Zhang Z-F et al. Post-therapy serum prostate-specific antigen level and survival in patients with androgenindependent prostate cancer. J Natl Cancer Inst 1999; 91: 244–51.PubMedCrossRefGoogle Scholar
  25. 25.
    Schwartz LH, LaTrenta LR, Bonaccio E, Kelly WK, Scher HI, Panicek DM. Small cell and anaplastic prostate cancer: Correlation between CT findings and prostate-specific antigen level. Radiology 1998; 208: 735–8.PubMedGoogle Scholar
  26. 26.
    Sabbatini P, Larson SM, Kremer A, Zhang ZF, Sun m, Yeung H, et al. Prognostic significance of extent of disease in bone in patients with androgen-independent prostate cancer. J Clin Oncol 1999; 17: 948–57.PubMedGoogle Scholar
  27. 27.
    Pollen JJ, Witzkun KF, Ashburn WL. The flare phenomenon on radionuclide bone scan in metastatic prostate cancer. Am J Radiother 1984; 142: 773–6.Google Scholar
  28. 28.
    Rossleigh MA, Lovegrove FTA, Reynolds PM, Byrne MJ, Whitney BP. The assessment of response to therapy of bone metastases in breast cancer. Aust NZ J Med 1984; 14: 19–22.Google Scholar
  29. 29.
    Coleman RE, Rubens RD, Fogelman I. The bone scan flare following systemic treatment for bone metastases. J Nucl Med 1988; 29: 1354–9.PubMedGoogle Scholar
  30. 30.
    Yuh WT, Zacher CK, Barloon TJ, Sato Y, Sickels WJ, Hawes DR. Vertebral compression fractures: A distinction between benign and malignant causes with MR imaging. Radiology 1989; 172: 215–8.PubMedGoogle Scholar
  31. 31.
    Jones AL, Williams MP, Powles TJ, et al. Magnetic resonance imaging in the detection of skeletal metastases in patients with breast cancer. Br J Cancer 1990; 62: 296–8.PubMedGoogle Scholar
  32. 32.
    Coleman RE. Monitoring of bone metastases. Eur J Cancer 1998; 34(2): 252–9.PubMedCrossRefGoogle Scholar

Copyright information

© Kluwer Academic Publishers 2000

Authors and Affiliations

  • Gillian L. Smith
    • 1
  • Alan P. Doherty
    • 2
  • Linda M. Banks
    • 3
  • Jane Dutton
    • 4
  • Iain W. Hanham
    • 5
  • Timothy J. Christmas
    • 6
  • Richard J. Epstein
    • 7
  1. 1.Metabolic Medicine, UrologyImperial College School of MedicineSingapore
  2. 2.Urology, Medical OncologyImperial College School of MedicineSingapore
  3. 3.ImagingImperial College School of MedicineSingapore
  4. 4.Department of RadiologyImperial College School of MedicineSingapore
  5. 5.RadiotherapyImperial College School of MedicineSingapore
  6. 6.UrologyImperial College School of MedicineSingapore
  7. 7.Metabolic Medicine, Imperial School of MedicineNational Cancer CentreSingapore

Personalised recommendations