Physicians prescribing androgen-deprivation therapy for their patients with advanced prostate cancer should also order a lateral thoracolumbar x-ray exam. This helps identify men at risk of treatment-induced fracture, according to an article published in the August issue of the Journal of Urology.
Androgen-deprivation therapy is known to significantly increase the incidence of long bone fractures, and existing osteoporotic compression fractures are good predictors of future treatment-induced fractures. A thoracolumbar x-ray exam performed before commencement of hormone therapy will allow for a baseline comparison in patients who experience subsequent back pain. It can also function as a warning to modify or postpone the therapy for men identified as having vertebral fragility fractures (J Urol, August 2011, Vol. 186:2, pp. 474-481).
These fractures are often undetected by physicians and underreported by radiologists, according to author Dr. Nigel Parr, a consultant urologist at the Wirral University Teaching Hospital in Wirral, U.K., and colleagues. They conducted a retrospective audit of the results from standard hospital reporting of 202 patients who had the spinal x-ray exam performed before starting androgen-deprivation therapy. The patients were 49 to 89 years of age, with a mean age of 73.
Using the Eastell method of classification, which recognizes three types of vertebral deformities, a radiologist reviewed the radiographs of the patients and determined that 191 (94.6%) had at least one type of fracture. By comparison, according to the medical records, only 152 (72.4%) of these men had fractures.
The authors suggested that vertebral fractures are being overlooked because the criteria for consistently diagnosing osteoporotic compression fractures are not as precise as they are for hip fractures. They also suggested that there is a lack of standardization in radiologists' interpretation of vertebral fractures, especially if attention was being focused on identifying possible metastases rather than prior fractures.
They recommended that radiologists should adopt a standardized approach to the reporting of vertebral fractures. This could lead to better communication with clinicians and improve the care of patients about to start hormone therapies and also any patients with osteoporosis.
![Examples of ultrasound findings and techniques. (A) Images in a 39-year-old male patient with a mass in the left thigh. The mass is heterogeneous on the B-mode US image (compared with the patient in D) and showed increased microvascularity (superb microvascular imaging [SMI]) and shear-wave elastography (SWE) values. Undifferentiated pleomorphic sarcoma was diagnosed at biopsy (with pleomorphic rhabdomyosarcoma in surgical specimen). (B) Images in an 18-year-old male patient with a mass in the left leg. The mass is hypoechoic on the B-mode image, with no other findings suggestive of malignancy. The lesion is in contact with the cortex of the tibia, which is slightly irregular. CT revealed a doubtful anteromedial tibial erosion. The microvascular study demonstrated high vascularization, suggestive of malignancy. Periosteal Ewing sarcoma was diagnosed with both histologic and immunohistochemical confirmation. (C) Images in a 69-year-old female patient with a lump growing on the outside of the left leg. Multiple SWE examinations were performed (please note the high values obtained in the measurements, whereas the color map highlights the stiffness relative to adjacent tissues). SMI showed areas of increased vascularization to target for sampling. Undifferentiated spindle cell sarcoma was diagnosed at biopsy, with residual leiomyosarcoma in the surgical specimen after neoadjuvant therapy. (D) Images in a 56-year-old female patient with a mass in the right thigh. The mass is heterogeneous at both B-mode ultrasound (similar to patient A) and MRI (coronal T2-weighted spectral attenuated inversion recovery [SPAIR]; T1-weighted pre-contrast and postcontrast imaging), which even shows uptake after the administration of paramagnetic contrast material, which is traditionally suggestive of malignancy. Low values at SMI and elastography are suggestive of benignity. Spindle cell lipoma was diagnosed at biopsy, with atypical spindle cell lipomatous tumor in the surgical specimen.](https://img.auntminnieeurope.com/mindful/smg/workspaces/default/uploads/2026/08/images-radiol250278fig2.APCFLSvX6p.jpg?auto=format%2Ccompress&fit=crop&h=100&q=70&w=100)
![Examples of ultrasound findings and techniques. (A) Images in a 39-year-old male patient with a mass in the left thigh. The mass is heterogeneous on the B-mode US image (compared with the patient in D) and showed increased microvascularity (superb microvascular imaging [SMI]) and shear-wave elastography (SWE) values. Undifferentiated pleomorphic sarcoma was diagnosed at biopsy (with pleomorphic rhabdomyosarcoma in surgical specimen). (B) Images in an 18-year-old male patient with a mass in the left leg. The mass is hypoechoic on the B-mode image, with no other findings suggestive of malignancy. The lesion is in contact with the cortex of the tibia, which is slightly irregular. CT revealed a doubtful anteromedial tibial erosion. The microvascular study demonstrated high vascularization, suggestive of malignancy. Periosteal Ewing sarcoma was diagnosed with both histologic and immunohistochemical confirmation. (C) Images in a 69-year-old female patient with a lump growing on the outside of the left leg. Multiple SWE examinations were performed (please note the high values obtained in the measurements, whereas the color map highlights the stiffness relative to adjacent tissues). SMI showed areas of increased vascularization to target for sampling. Undifferentiated spindle cell sarcoma was diagnosed at biopsy, with residual leiomyosarcoma in the surgical specimen after neoadjuvant therapy. (D) Images in a 56-year-old female patient with a mass in the right thigh. The mass is heterogeneous at both B-mode ultrasound (similar to patient A) and MRI (coronal T2-weighted spectral attenuated inversion recovery [SPAIR]; T1-weighted pre-contrast and postcontrast imaging), which even shows uptake after the administration of paramagnetic contrast material, which is traditionally suggestive of malignancy. Low values at SMI and elastography are suggestive of benignity. Spindle cell lipoma was diagnosed at biopsy, with atypical spindle cell lipomatous tumor in the surgical specimen.](https://img.auntminnieeurope.com/mindful/smg/workspaces/default/uploads/2026/08/images-radiol250278fig2.APCFLSvX6p.jpg?auto=format%2Ccompress&dpr=2&fit=crop&h=167&q=70&w=250)
