Background: Prostate cancer (PCa) is associated with high skeletal morbidity especially vertebral compression fractures (VCF) occurring on bone loss. We aimed to characterize benign (bVCF) versus malignant VCF (mVCF), in PCa patients who underwent vertebroplasty, and describe respective populations.
Methods: An observational retrospective study was conducted in two French cancer centers. Characterization of VCF was made using a composite criterion (bone scan, CT scan, MRI +/- bone biopsy).
Results: From 2008 to 2016, 100 patients, mean age 73.5 (45-94) and 128 VCFs were reported: 66 (52%) mVCF and 62 (48%) bVCF. Among bVCF, 17 (27%) occured in bone metastatic patients. Among mVCF, 28 (42%) of bone metastases were purely osteolytic and 38 (58%) with osteolytic component. Regarding bVCF, continuous androgen deprivation therapy and high doses of corticosteroids (> 6 months, ≥7.5 mg/day prednisone equivalent) were given in respectively 85% and 24% of cases. Dual X-ray Absorptiometry was performed in 13% of pts. Vitamin D supplementation was prescribed in 38% of patients.
Conclusion: These data suggest the necessary prevention of bVCF even in patients with bone metastases with consequences on patient management, while studies for bone targeted agents approval used skeletal related events with no definition of the cause, i.e. benign or malignant. Occurrence of bVCF is a rising concern since these pts are experiencing longer survival. Malignant VCF were mostly with osteolytic component, which constitutes one feature of rising dedifferentiated phenotype. Vertebroplasty may play a major role in these newly defined populations.