Prostate cancer patients need PCPs for complete care

Although some men receiving androgen deprivation therapy for advanced prostate cancer receive bone mineral density testing, it is not routine. A new study found it is significantly more likely to occur when the men were being cared for by both a urologist and a primary care physician.

Androgen deprivation therapy, which is common and effective for advanced prostate cancer, can cause significant bone thinning in men on long-term treatment. Androgen deprivation therapy cuts off the production of testosterone by the male testes, which prolongs the life of men with prostate cancer, often by years. However, the therapy can cause osteoporosis, which increases the risk of fractures. Available treatments can help to reduce the extent of osteoporosis. Practice guidelines have recommended bone mineral density testing since 2002, but it does not seem to be carried out frequently enough.

To determine current levels of testing, a research team examined the medical records of over 80,000 men with prostate cancer in a Medicare claims database between 1996 and 2008. Though they found that the levels of bone mineral density testing had increased over those years, just over 11% of the men had received a test for osteoporosis in the last year studied.

“The absolute rates of bone mineral density testing remain low, but are higher in men who have a primary care physician involved in their care,” stated the authors chronicling their study, Vahakn Shahinian, MD, and Yong-Fang Kuo, PhD, from the Universities of Michigan and Texas, respectively. Levels of testing were lowest in men being cared for by just a urologist alone.

The authors emphasized that bone care is not within the usual remit of most urologists and thus its diagnosis and management may be outside their comfort zone. This is not just urologists, as breast and colorectal cancer patients also tend to fare better when a primary care physician is involved in addition to their oncologist.

Primary care physicians should remain involved in the care of men with prostate cancer, as indicated by this study. Additionally, urologists need to be more aware of the risk to bones. Men starting androgen deprivation therapy need to know to ask about the test. The study was published in the Journal of General Internal Medicine (2013; doi: 10.1007/s11606-013-2477-2).
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