The Effect of Androgen Deprivation Therapy on Periodontal Disease in Men With Prostate Cancer

Purpose

We tested the hypothesis that men undergoing androgen deprivation therapy as treatment for prostate cancer are at greater risk for periodontitis and tooth loss.

Materials and Methods

A total of 81 men with a mean age of 68.5 years who had prostate cancer were consecutively recruited among 325 enrolled in an academic osteoporosis study. Of these men 68 were eligible to participate in the research. The prevalence of periodontal disease in 41 men with prostate cancer undergoing androgen deprivation for a mean of 1.5 years was compared to that in 27 with prostate cancer not undergoing androgen deprivation, who served as controls. The prevalence of periodontal disease was examined in relation to bone mineral density in men with prostate cancer with and without androgen deprivation therapy. A periodontist (PF) blinded to androgen deprivation status recorded probing depth, clinical attachment level, bleeding, plaque scores, gingival recession, missing teeth and calculus. Logistic regression models were used to test the association between androgen deprivation therapy and periodontal disease. Linear regression models were used to assess the association between periodontal disease and bone mineral density in the 2 groups with prostate cancer (treated/untreated). We adjusted for variables known to influence periodontal disease, including patient age, race, smoking and periodontal disease history.

Results

The prevalence of periodontal disease was 80.5% in men on androgen deprivation therapy compared with 3.7% in those not on androgen deprivation therapy (OR 3.33, 95% CI 1.07–10.35). Men on androgen deprivation therapy had significantly greater probing depth and higher plaque scores (p <0.001 and <0.09, respectively). A total of 81 men (76.9%) completed bone mineral density examinations. There was no relationship between bone mineral density and periodontal disease.

Conclusions

Men with prostate cancer undergoing androgen deprivation therapy were more likely to have periodontal disease than men not on androgen deprivation therapy. If confirmed in larger studies, this observation could have important public health implications, given the increasing use of androgen deprivation therapy to treat prostate cancer.

Key Words: prostate, prostatic neoplasms, osteoporosis, periodontal diseases, androgen antagonists

Abbreviations and Acronyms: ADT, androgen deprivation therapy, BMD, bone mineral density