Gene/Protein Disease Symptom Drug Enzyme Compound
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Query: UMLS:C0376358 (prostate cancer)
 59,338 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

There have been recent concerns of atypical non-spinal fractures in patients with osteoporosis who are on long-term bisphosphonate therapy. These fractures are less commonly reported in cancer patients on zoledronic acid therapy, where it is used in higher doses as compared to patients with osteoporosis. We report the case of a 70-year-old man with non-metastatic prostate cancer who was on androgen deprivation therapy following bilateral orchiectomy. He was on bone protection with intravenous zoledronic acid 4 mg monthly for a period of two years. He presented with spontaneous acute right mid-thigh pain. Radiograph of the right femur showed an atypical femoral shaft fracture, which was treated with intramedullary nailing and teriparatide. This case report raises concerns of atypical fractures in cancer patients who receive high doses of zoledronic acid. Patients receiving bisphosphonates who present with thigh or groin pain must undergo radiographic examination of the femur to rule out atypical femoral fractures.
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PMID:Atypical femoral shaft fracture in a patient with non-metastatic prostate cancer on zoledronic acid therapy: effect of therapy or coincidence? 2243 5

There are very few cases of radiation-induced femoral head necrosis described in the literature, therefore, this case will add new knowledge and highlights important aspects in the diagnosis and management of this uncommon condition. Our patient was 74 years old and presented with left hip and groin pain for 8 months, with no previous history of trauma or osteoarthritis. However, he had been treated for metastatic prostate cancer, to the pelvis and roof of the left acetabulum, with androgen ablation, and radiotherapy 5 years before presentation. Examination of the left hip revealed painful movements, but no restriction in the range of motion. Initial X-rays did not show any abnormalities, but MRI scan revealed a suspicious lesion in the roof of the left acetabulum, with no indication of secondary weakening of the femoral neck. The patient was therefore referred to the oncologists to consider radiotherapy, but they were not convinced it was metastatic, because he had no new urinary symptoms, and the PSA remained normal throughout this period. He was subsequently referred for a bone scan to look for possible secondary lesions (from the prostate gland), but this did not reveal any abnormal increased uptake. Three months later, he was reviewed in the clinic with a repeat X-ray of the pelvis which revealed complete destruction of the left femoral head and the acetabular roof, but CT-guided biopsy revealed no evidence of malignancy in the left hip. However, in view of the persistent pain and radiological evidence of left hip destruction, the patient had left Total Hip Replacement (THR), and excellent post-operative recovery. He mobilised fully, and was discharged on day five. Histology of the femoral head and hip capsule, revealed no evidence of metastasis from the prostate cancer, but confirmed osteonecrosis of the femoral head, presumably caused by the previous radiotherapy. MRI of the spine was clear and he was discharged to the oncologists and urologists for follow up.
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PMID:Radiation-induced femoral head necrosis. 2337 87