Quantitative ultrasound of the calcaneus (QUS): A valuable tool in the identification of patients with non-metastatic prostate cancer requiring screening for osteoporosis

B B Nieuwkamer; J P M Vrouwe; P M Willemse; M P J Nicolai; R F M Bevers; R C M Pelger; N A T Hamdy; S Osanto

doi:10.1016/j.bonr.2023.101679

Quantitative ultrasound of the calcaneus (QUS): A valuable tool in the identification of patients with non-metastatic prostate cancer requiring screening for osteoporosis

Bone Rep. 2023 Apr 17:18:101679. doi: 10.1016/j.bonr.2023.101679. eCollection 2023 Jun.

Authors

B B Nieuwkamer^{1

2}, J P M Vrouwe^{1

3}, P M Willemse⁴, M P J Nicolai^{5

6}, R F M Bevers⁵, R C M Pelger⁵, N A T Hamdy⁷, S Osanto¹

Affiliations

¹ Department of Medical Oncology, Leiden University Medical Center (LUMC), Albinusdreef 2, 2333 ZA Leiden, the Netherlands.
² Department of Urology, Reinier de Graaf Hospital (RdGG), Reinier de Graafweg 5, 2625 AD Delft, the Netherlands.
³ Centre for Human Drug Research (CHDR), Zernikedreef 8, 2333 CL Leiden, the Netherlands.
⁴ Department of Urology, University Medical Center Utrecht (UMCU), Heidelberglaan 100, 3584 CX Utrecht, the Netherlands.
⁵ Department of Urology, Leiden University Medical Center (LUMC), Albinusdreef 2, 2333 ZA Leiden, the Netherlands.
⁶ Department of Urology, Netherlands Cancer Institute, Plesmanlaan 121, 1066 CX Amsterdam, the Netherlands.
⁷ Department of Medicine, Division of Endocrinology and Center for Bone Quality, Leiden University Medical Center, Albinusdreef 2, 2333 ZA Leiden, the Netherlands.

Abstract

Non-metastatic prostate cancer (PCa) patients are at increased risk for osteoporosis and fractures mainly due to androgen deprivation therapy (ADT)-associated hypogonadism, but this remains largely underdiagnosed and untreated. In this study, we examine the value of pre-screening calcaneal QUS in identifying patients who should be referred for screening for osteoporosis using dual-energy X-Ray absorptiometry (DXA). In a single-center retrospective cross-sectional cohort study, we analysed data on DXA and calcaneal QUS measurements systematically collected between 2011 and 2013 in all non-metastatic PCa patients attending our Uro-Oncological Clinic at the Leiden University Medical Center. Receiver operating characteristic curves were used to assess the positive (PPV) and negative (NPV) predictive values of QUS T-scores of 0, -1.0, and - 1.8 in identifying DXA-diagnosed osteoporosis (T-scores ≤ - 2.5 and ≤ -2) at lumbar spine and/or femoral neck. Complete sets of data were available in 256 patients, median age 70.9 (53.6-89.5) years; 93.0 % had received local treatment, 84.4 % with additional ADT. Prevalence of osteoporosis and osteopenia was respectively 10.5 % and 53 %. Mean QUS T-score was -0.54 ± 1.58. Whereas PPV at any QUS T-score was <25 %, precluding the use of QUS as surrogate for DXA in screening for osteoporosis, QUS T-scores of -1.0 to 0.0 had a NPV of ≥94.5 % for DXA T-scores ≤ 2.5 and ≤ -2 at any site, confidently identifying patients least likely to have osteoporosis, thereby significantly reducing the number of patients requiring DXA screening for diagnosing osteoporosis by up to two-third. Osteoporosis screening is a significant unmet need in non-metastatic prostate cancer patients treated with ADT, and QUS may represent a valuable alternative pre-screening strategy to overcome logistics, time demands, and economic barriers encountered with current strategies for osteoporosis screening in these patients.

Summary: Osteoporosis and associated increased fracture risk are common in non-metastatic prostate carcinoma, mainly due to androgen deprivation therapy, but these often remain underdiagnosed and untreated. We demonstrate that QUS is a safe, less costly pre-screen tool that reduces by up to two-third the number of patients requiring referral for DXA for osteoporosis screening.

Keywords: Androgen deprivation therapy; Dual-energy X-ray absorptiometry (DXA); Osteoporosis; Prostate cancer; Quantitative ultrasonography (QUS); ROC analysis.