# Multiple or More Severe Grade Prevalent Vertebral Fractures Are Associated with Higher All-Cause Mortality in Men with Nonmetastatic Prostate Cancer Receiving Androgen Deprivation Therapy

## TL;DR

Men with nonmetastatic prostate cancer who have multiple or severe vertebral fractures before starting hormone therapy face higher risk of death.

## Contribution

This study shows that pre-treatment vertebral fracture severity predicts mortality in prostate cancer patients undergoing ADT.

## Key findings

- Multiple vertebral fractures were linked to higher all-cause mortality in prostate cancer patients.
- High-grade vertebral fractures, as assessed by the SQ method, were significant predictors of reduced survival.
- Adjusting for age and cancer stage confirmed the strong association between fracture severity and mortality.

## Abstract

Androgen deprivation therapy (ADT) is an established effective treatment for patients with nonmetastatic prostate cancer. However, cancer treatment-induced bone loss (CTIBL) and the associated increase in fractures are recognized as significant complications that affect patient prognosis. Current guidelines for CTIBL management recommend a bone health assessment prior to initiating ADT, which includes the identification of prevalent vertebral fractures (PVFs). While fractures occurring after ADT have been reported to be associated with reduced overall survival, the relationship between PVFs before initiating ADT and actual prognosis remains unclear. This study investigates the impact of the presence and severity of PVFs on overall survival in patients with nonmetastatic prostate cancer undergoing ADT. Additionally, it provides valuable insights into the clinical usefulness of spine health assessment before initiating ADT.

Background/Objectives: Prognostic information for nonmetastatic prostate cancer (nmPC) patients with prevalent vertebral fractures (PVFs) is very limited. Vertebral fractures can impair physical function, limit activities of daily living, and decrease quality of life. Prevention of vertebral fractures may be important to improve patient prognosis. This study aims to investigate the impact of the presence and severity of PVFs on overall survival in patients with nmPC undergoing androgen deprivation therapy (ADT). Methods: A total of 275 men (median age: 73 years) with nmPC who underwent ADT were studied retrospectively. The median observation period was 55 months. Variables included age, body mass index, T classification, N classification, Gleason score, and pretreatment serum prostate-specific antigen levels. PVF was diagnosed from the sagittal computed tomography images of Th1 to L5 before initiating ADT, and the severity was determined by the number of PVFs and the Semiquantitative (SQ) method. Hazard ratios and 95% confidence intervals for overall survival were calculated using the Cox proportional hazards model. Results: During the observation period, 30 patients died from all causes. Multivariate Cox regression analysis identified multiple PVFs and high-grade PVFs, as determined by the SQ method, as significant predictors of overall survival. The analysis utilized two adjustment models: one adjusted for age only and the other adjusted for age, Gleason score, and clinical T stage. Conclusions: Multiple PVFs and high-grade PVF determined by the SQ method prior to ADT initiation were associated with higher all-cause mortality in nmPC patients treated with ADT.