Bicalutamide Monotherapy Versus Leuprolide Monotherapy for Prostate Cancer: Effects on Bone Mineral Density and Body Composition
Abstract
Purpose: Gonadotropin-releasing hormone agonists decrease bone mineral density, lean mass, and muscle size and increase fat mass in men with prostate cancer. Less is known about the effects of bicalutamide monotherapy on bone mineral density and body composition. Patients and Methods: In a 12-month, open-label study, we randomly assigned 52 men with prostate cancer and no bone metastases to receive either leuprolide or bicalutamide (150 mg by mouth daily). Bone mineral density and body composition were measured by dual energy x-ray absorptiometry and quantitative computed tomography. Results: Mean (± standard error) bone mineral density of the posterior-anterior lumbar spine decreased by 2.5% ± 0.5% in the leuprolide group and increased by 2.5 ± 0.5 in the bicalutamide group from baseline to 12 months (P < .001). Mean changes in bone mineral density of the total body, total hip, femoral neck, and trabecular bone of the lumbar spine also differed significantly between groups (P ≤ .003 for each comparison). Fat mass increased by 11.1% ± 1.3% in the leuprolide group and by 6.4% ± 1.1% in the bicalutamide group (P = .01). Changes in lean mass, muscle size, and muscle strength were similar between the groups. Breast tenderness and enlargement were more common in the bicalutamide group than in the leuprolide group. Fatigue, loss of sexual interest, and vasomotor flushing were less common in the bicalutamide group than in the leuprolide group. Conclusion: In men with prostate cancer, bicalutamide monotherapy increases bone mineral density, lessens fat accumulation, and has fewer bothersome side effects than treatment with a gonadotropin-releasing hormone agonist.
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In a 12-month open-label trial, prostate cancer patients treated with leuprolide monotherapy had an 11.2% increase in whole body fat mass, and those treated with bicalutamide monotherapy had a 6.4% increase.
“In a 12 month open label trial, Smith et al. reported that patients treated with bicalutamide or leuprolide (a GnRH agonist) monotherapies exhibited an increase in whole body fat mass of 11.2% for leuprolide and 6.4% for bicalutamide.”
From The role of the androgen receptor in the pathogenesis of obesity and its utility as a target for obesity treatments (2022) · cites this paper as [119]
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- Authors
- Smith, M. R., Goode, M., Zietman, A. L., McGovern, F. J., Lee, H., & Finkelstein, J. S.
- Affiliations
- Massachusetts General Hospital (US)
- Venue
- Journal of Clinical Oncology
- Published
- 2004-07-01
- Volume
- 22
- Issue
- 13
- Pages
- 2546-2553
- ISSN
- 0732-183X (ISSN-L)
- 1527-7755
- OpenAlex
- W2158397011
- Cited by
- 188
- References
- 47
- Citations by year
- 2026: 3 · 2024: 4 · 2023: 5 · 2022: 5 · 2021: 3 · 2020: 5 · 2019: 6 · 2018: 9 · 2017: 8 · 2016: 8 · 2015: 11 · 2014: 18 · 2013: 13 · 2012: 8
- FWCI
- 9.67
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Journal of Clinical Oncology (publishedVersion)
- PubMed (publishedVersion)
- Funders
- Massachusetts General Hospital
- National Cancer Institute (R21 CA10353-01)
- National Institute of Diabetes and Digestive and Kidney Diseases (K24DK02759, K24DK002759)
- National Center for Research Resources (M01RR001066, RR-1066)
- NIH Clinical Center
- Topics
- Health Sciences › Medicine › Pulmonary and Respiratory Medicine › Prostate Cancer Treatment and Research
- Health Sciences › Medicine › Oncology › Bone health and treatments
- Health Sciences › Medicine › Physiology › Nutrition and Health in Aging
- Keywords
- prostate cancer, bicalutamide, leuprolide, bone mineral density, body composition, fat mass, lean body mass, GnRH agonist, androgen deprivation therapy, adverse effects, breast tenderness
- MeSH terms
- Aged, Anilides, Antineoplastic Agents, Body Composition, Humans, Male, Middle Aged, Nitriles, Prostatic Neoplasms, Tosyl Compounds, Bone Density, Leuprolide, Treatment Outcome, Antineoplastic Agents, Hormonal
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