Tuesday, December 6, 2022

Bone Density Test For Prostate Cancer

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Genetic Testing For Some Men With Prostate Cancer

Prostate cancer and bone density

Some doctors now recommend that some men with prostate cancer be tested to look for certain inherited gene changes. This includes men in whom a family cancer syndrome is suspected, as well as men with prostate cancer that has certain high-risk features or that has spread to other parts of the body. Talk to your doctor about the possible pros, cons, and limitations of such testing.

Bone Density Evaluation For Patients With Prostate Cancer And Receiving Androgen Deprivation Therapy

Not Applicable
Description

Patients determined as having prostate cancer who are currently starting or undergoing androgen deprivation therapy , for an anticipated period of 12 months or greater and who receive an initial bone density evaluation. The bone density evaluation must be prior to the start of ADT or within 3 months of the start of ADT.

Initial Population

Male patients with a qualifying encounter in the measurement period AND with a diagnosis of prostate cancer AND with an order for ADT or an active medication of ADT with an intent for treatment greater than or equal to 12 months during the measurement period

Denominator

None

Numerator

Patients with a bone density evaluation within the two years prior to the start of or less than three months after the start of ADT treatment

Numerator Exclusions

Patient refused recommendation for a bone density evaluation after the start of ADT therapy

Measure Steward

A higher score indicates better quality

Guidance

In order to capture the practitioner’s intent of androgen deprivation therapy for a period of 12 months or greater, SNOMEDCT 456381000124102 which is Injection of leuprolide acetate for twelve month period is the correct code.

This eCQM is a patient-based measure.

This version of the eCQM uses QDM version 5.5. Please refer to the eCQI resource center for more information on the QDM.

MIPS Quality ID
CMS645v4

Bone Loss And Cancer Treatment

Low testosterone levels in the blood can cause bone loss. The hormone treatments for prostate cancer aim to lower the amount of testosterone or block its action.

Hormone treatments include:

  • drug treatments including goserelin , leuprorelin , decapeptyl
  • surgery to remove your testicles

Bone loss is a common side effect. But how much bone loss you might have varies from person to person. The spine is most likely to be affected.

Not all hormone treatments cause bone loss, for example the drug bicalutamide doesn’t.

Your nurse or doctor will tell you if they think you might be at risk of bone loss and in particular problems with your spine.

Contact them urgently if you have:

  • any changes in sensation such as numbness, tingling
  • have pain that doesnt go away or gets worse
  • have any changes to opening your bowels or passing urine.

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Bone Mineral Density Testing Rates Still Low Among Men Receiving Adt For Prostate Cancer

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Rates of bone mineral density testing among men with prostate cancer undergoing androgen deprivation therapy have risen since 2000 but remain low, according to study results published in Journal of the National Comprehensive Cancer Network.

Men who are older, those with metastatic disease and residents of rural areas appeared less likely to receive testing, researchers found. They noted that further efforts may be needed to emphasize the importance of bone mineral density testing in prostate cancer guidelines.

Although we expected BMD testing rates to be fairly low given the prior literature, we were somewhat surprised that they didnt go up more in recent years,Alice Dragomir, MSc, PhD, associate professor in the department of surgery at McGill University in Canada, said in a press release. Bone density testing helps doctors evaluate fracture risk and identify which patients would benefit from additional monitoring and interventions like lifestyle change or medications.

ADT is a cornerstone of treatment for advanced prostate cancer however, it accelerates the loss of BMD, according to study background. This leads to increased risk for osteoporosis and fracture.

Among these men, 3,910 underwent BMD testing.

Receipt of BMD testing from 6 months before to 12 months after ADT initiation served as the studys primary outcome.

What You Need To Know About Prostate Cancer And Osteoporosis

Medical Tests in your 60s and Up

About 1 in 9 men in the United States, roughly 11%, will be diagnosed with prostate cancer in his lifetime, according to the American Cancer Society.

After skin cancer, prostate cancer is the second most common cancer in males, and mostly occurs in men 65 and older. While the disease can be successfully treated in many cases, cancer therapies may lead to weakened bones, a condition known as osteoporosis. This article discusses what prostate cancer is, the risks for osteoporosis after treatment, and ways to prevent and manage osteoporosis.

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Bone Mineral Density Screening Among Men With Prostate Cancer: A Missed Opportunity

Prostate cancer is the most common cancer among men in the United States and the second leading cause of cancer death. The use of androgen-deprivation therapy , which reduce male hormone levels, or prevent them from reaching the prostate cancer cells, prolongs survival and improves quality of life, and is used in close to 50 percent of all men with prostate cancer.

Because ADT is associated with a decrease in bone mineral density and an increase in fractures, the American College of Physicians recommends bone mineral density screening for all men who are being treated with ADT.

Unfortunately, a recent report from a national database of cancer care, the Surveillance, Epidemiology and End Results and Medicare data, found that less than 15 percent of men on ADT are being screened. Elderly men and African American men were the least likely to be screened. These statistics are particularly worrisome because there are several effective medications that can delay or even reverse the loss of bone mineral density.

Men with prostate cancer patients who are receiving ADT should ask their physician if screening with DEXA scans is right for them.

Compliance With Ethical Standards

Salma El Badri and Abdulazeez Salawu declare no conflict of interest. Janet Brown reports grants and personal fees from Amgen, Novartis, and Bayer and personal fees from BMS, Daiichi-Sankyo, Ipsen, Sandoz, and Merck, Sharp, Dome, outside the submitted work.

This article does not contain any studies with human or animal subjects performed by any of the authors.

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Positron Emission Tomography Scan

A PET scan is similar to a bone scan, in that a slightly radioactive substance is injected into the blood, which can then be detected with a special camera. But PET scans use different tracers that collect mainly in cancer cells. The most common tracer for standard PET scans is FDG, which is a type of sugar. Unfortunately, this type of PET scan isnt very useful in finding prostate cancer cells in the body.

However, newer tracers, such as fluciclovine F18, sodium fluoride F18, and choline C11, have been found to be better at detecting prostate cancer cells.

Other newer tracers, such as Ga 68 PSMA-11, 18F-DCFPyl , and Ga 68 gozetotide , attach to prostate-specific membrane antigen , a protein that is often found in large amounts on prostate cancer cells. Tests using these types of tracers are sometimes referred to as PSMA PET scans.

These newer types of PET scans are most often used if its not clear if prostate cancer has spread. For example, one of these tests might be done if the results of a bone scan arent clear, or if a man has a rising PSA level after initial treatment but its not clear where the cancer is in the body. PSMA PET scans can also be used to help determine if the cancer can be treated with a radiopharmaceutical that targets PSMA.

Doctors are still learning about the best ways to use these newer types of PET scans, and some of them might not be available yet in all imaging centers.

Calcium And Vitamin D

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Adults should generally have 700mg of calcium a day. People with osteoporosis should aim for 1000mg a day.

Dairy products contain calcium. Some foods have added calcium. Check food labels to see how much calcium they contain. Milk substitutes such as soya or rice milk do not contain as much calcium as dairy products.

You can also get calcium from:

  • green vegetables
  • soya products including tofu
  • bread and foods made from flour

Calcium supplements are available. Dietitians recommend that you do not have more than a total of 1500mg of calcium. This total calcium could come from your diet or a combination of diet and supplements. Too much calcium can cause tummy pain and diarrhoea.

Your body needs vitamin D to absorb calcium. Sunlight helps the body to make vitamin D. A daily short walk in natural sunlight makes enough vitamin D for most people. It is also found in margarine, oily fish and egg yolks. You should eat most foods in moderation.

Your GP can refer to a dietitian to check that your diet has enough calcium and vitamin D to keep your bones healthy.

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Biopsy During Surgery To Treat Prostate Cancer

If there is more than a very small chance that the cancer might have spread , the surgeon may remove lymph nodes in the pelvis during the same operation as the removal of the prostate, which is known as a radical prostatectomy .

The lymph nodes and the prostate are then sent to the lab to be looked at. The lab results are usually available several days after surgery.

Dexa Bone Density Scan

DEXA scans are used to measure bone mineral density. This information can help us determine your likelihood for bone fractures and osteoporosis, and see if cancer has spread to your bones.

Short for dual-energy X-ray absorption, DEXA scans are a quick and painless way to measure bone mineral density. During the scan, you will lie on a table for 15 to 20 minutes while your entire skeleton or specific points on your body are scanned. After the scan, youll be given results based on two different scores: your T-score and your Z-score.

A T-score is the difference between your bone density and that of an average healthy person. This score helps us determine your risk of breaking a bone. A Z-score is the amount of bone you have compared to people of the same age, race and gender as you. If your Z-score is too high or too low, you may need more testing.

After your DEXA scan, your doctor will talk to you about your scores and what they mean for your ongoing treatment.

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Prevention And Treatment Of Ctibl

Systemic anticancer therapies as well as bone-targeted agents such as zoledronic acid, denosumab and radium-223 have proven effective for the prevention of skeletal-related events from prostate cancer bone metastases and this has been the subject of previous extensive review and is beyond the remit of this article. With improved survival of patients living with bone-metastatic prostate cancer however, the impact of CTIBL continues to grow and is gaining recognition. Several strategies have therefore been evaluated to prevent and treat CTIBL.

Pelvic Lymph Node Radiotherapy And Androgen Deprivation Therapy Augment Progression

Phase 3 Assessment of the Automated Bone Scan Index as a Prognostic ...

In-Depth : This cohort study included 54 953 men diagnosed with prostate cancer between 2005-2015 who initiated treatment with ADT. Data on DXA screening from 12 months prior to 6 months after initial ADT claim was collected from the SEER and TCR Medicare-linked databases. Overall, 4362 men received DXA screening, where the screening rate increased from 6.8% in 2005 to 8.4% in 2015. Screening rates were lower in individuals who were single , non-Hispanic Black , from small urban areas and areas with lower education levels , and receiving nonsteroidal androgens . After initial ADT, 9365 patients developed fractures, where the median time to first fracture was 31 months . Among men without previous fractures before ADT, DXA screening was not associated with fracture risk at any site but was associated with a decreased risk of major fractures .

Image: PD

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Use In Men Who Might Have Prostate Cancer

The PSA blood test is used mainly to screen for prostate cancer in men without symptoms. Its also one of the first tests done in men who have symptoms that might be caused by prostate cancer.

PSA in the blood is measured in units called nanograms per milliliter . The chance of having prostate cancer goes up as the PSA level goes up, but there is no set cutoff point that can tell for sure if a man does or doesnt have prostate cancer. Many doctors use a PSA cutoff point of 4 ng/mL or higher when deciding if a man might need further testing, while others might recommend it starting at a lower level, such as 2.5 or 3.

  • Most men without prostate cancer have PSA levels under 4 ng/mL of blood. Still, a level below 4 is not a guarantee that a man doesnt have cancer.
  • Men with a PSA level between 4 and 10 have about a 1 in 4 chance of having prostate cancer.
  • If the PSA is more than 10, the chance of having prostate cancer is over 50%.

If your PSA level is high, you might need further tests to look for prostate cancer.

To learn more about how the PSA test is used to look for cancer, including factors that can affect PSA levels, special types of PSA tests, and what the next steps might be if you have an abnormal PSA level, see Screening Tests for Prostate Cancer.

Effects Of Zol 5mg On Incident Vertebral Fracture

Incident vertebral fractures were identified in 8 of 42 patients at 12months after the start of ADT . The effect of ZOL 5mg in combination with ADT on incident vertebral fractures was evaluated by a logistic regression analysis . The logistic regression analysis with adjusting for the age, BMI, and percentage change in LS-BMD showed that the administration of ZOL 5mg was not significantly associated with the occurrence of incident vertebral fractures .

Table 3 Association between ZOL 5mg and presence of incident VFs evaluated by a logistic regression analysis

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Cancer Treatmentinduced Bone Loss

The role of sex steroids on bone homeostasis has been extensively studied and, in recent years, the development of mouse models with global and cell-specific deletions in Oestrogen and Androgen Receptors has evolved our understanding of this role . Androgen receptor signalling in osteoblasts is responsible for the protective effects of androgens on trabecular bone mass, leading to a decrease in osteoclast numbers and bone resorption. Oestrogens, produced via aromatization of androgens in males, protect against endocortical resorption, at least in part, via ER signalling in mesenchymal/stromal cells . Oestrogens play an important role in regulating the RANKL/RANK/OPG pathway, which influences osteoclast activity and has important therapeutic implications . Collective evidence from several interventional and observational human studies supports the theory that oestrogen plays a much more significant role in regulating bone metabolism in men than testosterone .

Mechanistic role of androgen deprivation therapy

Lymph Node Biopsy As A Separate Procedure

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A lymph node biopsy is rarely done as a separate procedure. Its sometimes used when a radical prostatectomy isnt planned , but when its still important to know if the lymph nodes contain cancer.

Most often, this is done as a needle biopsy. To do this, the doctor uses an image to guide a long, hollow needle through the skin in the lower abdomen and into an enlarged node. The skin is numbed with local anesthesia before the needle is inserted to take a small tissue sample. The sample is then sent to the lab and looked at for cancer cells.

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Measurement Of Biochemical Values

The serum levels of N-terminal telopeptide of type I collagen , C-terminal telopeptides of type I collagen , intact parathyroid hormone , prostate-specific antigen , and testosterone were measured before breakfast at the time BMD was measured. The intra-assay coefficients of variation for NTx and ICTP were less than 10 and 8% respectively. In addition, common laboratory blood and serum data, including hemoglobin , albumin , lactate dehydrogenase , alkaline phosphatase , Ca, P, and glucose levels, were determined using a multichannel autoanalyzer .

Osteoporosis Risks After Prostate Cancer Treatment

While osteoporosis is often considered a condition that affects women, men can also develop it. Male osteoporosis is becoming more common due to prostate cancer therapies that put men at a greater risk for bone loss. The cancer treatments below may contribute to the development of osteoporosis:

  • Chemotherapy: Chemotherapy is a way to treat cancer with drugs that destroy cancer cells. In some cases, chemotherapy kills the tumor. In other instances, chemo shrinks it or reduces cancer symptoms.
  • Hormone Therapy: Testosterone is the primary male sex hormone, and it plays a strong role in the development of the male reproductive system. Its also responsible for hair growth, sex drive, and other normal body functions. Since testosterone can fuel prostate cancer growth, men are often treated with hormone therapy to reduce testosterone levels in the body. This treatment is called androgen deprivation therapy , or androgen suppression therapy . Men typically receive hormone therapy in conjunction with other prostate cancer treatments, depending on the severity of the disease.

Although cancer treatments can lead to bone loss, osteoporosis, and fractures, not all men treated for prostate cancer will develop the complication. Osteoporosis can be prevented and managed through lifestyle and medications.

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