Author/Editor		Jagodič, Klemen; Korošec Jagodič, Helena
Title		Rak prostate in zdravje kosti
Type		članek
Source		In: Metastatska bolezen kostnine Celje : Splošna in učna bolnišnica
Publication year		2013
Volume		str. 96-104
Language		slv
Abstract		Uvod: rak prostate je najpogostejši malignom moških. Malignom prostate značilno zaseva v kost in kostni zasevki se pojavijo pri 70 % bolnikov z napredovalo boleznijo. Poleg zasevkov je lahko kost pri bolniku z rakom prostate prizadeta tudi zaradi androgene deprivacije (kastracije), ki vodi v pospešeno izgubo kostne mase in razvoj osteoporoze. Razprava: hipogonadizem kot posledica androgene deprivacije pospeši izgubo kostne mase in izguba kostnine je kumulativna. Izguba lahko privede do osteoporoze in večjega rizika zlomov. Zlomi kosti so v negativno [!] korelaciji s pričakovanim preživetjem bolnikov z malignomom prostate. Bolniki z vrednostjo PSA > 20ng/ml imajo večji riziko kostnih zasevkov. Bolniki s kostnimi zasevki imajo večjo verjetnost skeletnih dogodkov. Tudi patološki zlomi negativno korelirajo s preživetjem bolnikov z malignomom prostate. Pri preprečevanju razvoja osteoporoze svetujemo redno fizično aktivnost, dodatek kalcija in D vitamina ter omejen vnos alkohola in prenehanje kajenja. O osteoporozi govorimo, ko je mineralna kostna gostota bolnika > 2.5 standardne deviacije pod referenčno vrednostjo. Denosumab ter različni bisfosfonati so pokazali pozitiven učinek pri zdravljenju osteoporoze zaradi adnrogene [!] deprivacije pri bolnikih z ne metastatskim malignomom prostate. Pri bolnikih z malignomom prostate in kostnimi zasevki le denosumab in zoledronska kislina signifikantno zmanjšata verjetnost skeletnih dogodkov. Pri zdravljenju je potrebno dodajati kalcij in D vitamin. Stranski učinki zdravljenja so večina nenevarni. Zaključek: denosumab in bisfosfonati preprečijo oziroma podaljšajo čas do nastanka skeletnih zapletov zaradi osteoporoze in kostnih zasevkov pri bolniku z malignomom prostate.Background: prostate cancer (PC) is the most common cancer in men. The skeleton is the preferred site for the disease`s spread and 70% of men with advanced PC will have metastatic bone disease (MBD). However, in patient with PC bone can be affected also by androgen deprivation therapy (ADT) witch increases bone mineral resorbtion and turnover resulting in a significant loss of trabecular bone mass, leading to osteoporosis. Discussion: Hypogonadism induced by ADT accelerates bone loss and decreases of bone mineral density (BMD) are cumulative. This may lead to osteoporosis and increased risk of bone fractures. However skeletal fractures in patients with PC are negatively correlated with overall survival. Patients with PA with PSA levels > 20ng/ml are at great risk for bone metastases. Patients with MDB are at high risk for developing skeletal related events (SRE). Also pathological fractures correlate with reduced survival in PC patients with MBD. Adjunctive to specific antiopsteoporotic [!] therapies a regular exercise program, daily calcium and D vitamin intakes and avoidance of tobacco and excess alcohol intake are recommended. Osteoporosis is diagnosed when BMD is 2.5 standard deviation below a relevance mean. Denusomab and different bisphosphonates (BP)showed benefit in preventing bone loss in patients with non metastatic PC with osteoporosis due to ADT. In patients with MBD only denusomab and zoledronic acid demonstrated significant reduction in skeletal morbidity (reduction in SRE) and bone pain. Calcium and D vitamin should be supplemented. Common adverse events are acute phase reactions and flu like symptoms (fever, myalgia, arthralgia) generally manageable with paracetamol. Uncommon adverse events are renal toxicity and osteonecrosis of the jaw (ONJ). Conclusion: Denusomab and BP reduce and delay skeletal morbidity and resulting complications of osteoporosis and skeletal morbidity due to MDP.
Descriptors		Prostatic neoplasms Osteoporosis Prostata, novotvorbe Osteoporoza Therapy