PITTSBURGH, March 29, 2007 Androgen deprivation therapy (ADT) has become a valuable weapon in the fight against prostate cancer. As enhanced screening tools detect the cancer in its earliest stages, an increasing number of men who are otherwise healthy are receiving the therapy. However, the growing prevalence of ADT may be cause for concern. In this months issue of the Journal of Urology, researchers from the University of Pittsburgh School of Dental Medicine report that prostate cancer patients receiving ADT are three times as likely to show signs of periodontal, or gum disease, as patients who do not receive the therapy.
Earlier research demonstrated links between ADT and osteoporosis and other types of bone loss in men, but this work is the first to explore ADTs relationship with periodontal disease, which itself has been connected to a variety of other conditions.
People with periodontal disease are at greater risk for numerous negative health outcomes, said Pouran Famili, D.M.D., M.P.H., Ph.D., professor and interim chair of the department of periodontics at the University of Pittsburgh School of Dental Medicine and lead author of the study. If we can identify populations who are more likely to develop periodontal disease, as we have in this research, we may be able to target early interventions to groups like ADT recipients.
In the study, 68 prostate cancer patients who were, on average, nearly 70 years old and had received ADT for an average of 18 months, received standard screenings for various symptoms of periodontal disease, which occurs when the inner layers of gum and bone pull away from the teeth. That process creates pockets that give toxic bacteria the opportunity to attack and destroy the underlying bone and can ultimately result in tooth loss.
Of the study participants, 41 received ADT for an average of 18 months, and periodontal disease was evident in 80 percent of those men. Conversely, only four percent of the men who did not receive ADT had periodontal disease. When adjusted for other factors that also may influence the development of periodontal disease, such as age and smoking behaviors, the statistical relationship between ADT and periodontal disease remained significant, with ADT recipients three times as likely to have periodontal disease as the men who did not undergo the therapy.
Urologists and oncologists, in particular, should heed these findings and refer their patients for periodontal screening early in the course of their ADT, said Dr. Famili, who also noted that such a referral is standard for other at-risk populations, such as transplant patients. As the majority of these men were quite conscientious about their oral hygiene, the need for early intervention by a dental care provider is paramount. It could prevent the need for more extensive treatment down the road.
While this research has important implications for ADT patients and their risks for periodontal disease, it does have limitations, due to its relatively small sample size and cross-sectional nature. As such, further investigation involving larger populations and longitudinal data is warranted.
This research was supported by the Osteoporosis Prevention and Treatment Center at the University of Pittsburgh, which receives funding from the National Institutes of Health and the General Clinical Research Center of the University of Pittsburgh Medical Center. Other study investigators include Jane Cauley, Dr.P.H., of the University of Pittsburgh Graduate School of Public Health, and Susan Greenspan, M.D., of the University of Pittsburgh School of Medicine.