Testosterone recovery and changes in bone mineral density after stopping long-term luteinizing hormone-releasing hormone analogue therapy in osteoporotic patients with prostate cancer

Authors


Robin Weston, Wirral NHS Trust, Urology, Liverpool, UK.
e-mail: robin.weston1@btopenworld.com

Abstract

OBJECTIVE

To investigate the rate of testosterone recovery and changes in bone mineral density in patients found to be osteoporotic while receiving luteinizing hormone-releasing hormone (LHRH) analogues after changing to antiandrogen monotherapy in an attempt to reduce further demineralization.

PATIENTS AND METHODS

Fifteen patients receiving LHRH analogue therapy for ≥ 1 year were identified as osteoporotic by distal forearm dual X-ray densitometry. They were then converted to antiandrogen monotherapy, and prostate specific-antigen (PSA) and total testosterone monitored at 3-monthly intervals. The forearm densitometry was repeated at 1 year.

RESULTS

All patients had some testosterone recovery; the mean (range) duration to initial detectable testosterone was 12.8 (6–22) months. Six patients had a normal testosterone level after a mean of 17.5 (14–30) months. In the year after stopping LHRH analogue therapy the mean bone mineral density (t-score) decreased by 7.2%.

CONCLUSIONS

Osteoporotic patients, after stopping LHRH analogues, continue to have suppressed levels of testosterone which have a detrimental effect on bone mineral density. We therefore would not advocate conversion to antiandrogen monotherapy to improve bone density, and suggest alternative therapeutic intervention e.g. bisphosphonate therapy, for these patients.

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