World J Mens Health.  2020 Apr;38(2):151-163. 10.5534/wjmh.190044.

Bone Health Issues in Patients with Prostate Cancer: An Evidence-Based Review

• Walz S
• Maas M
• Stenzl A
• Todenhöfer T

• KMID: 2471822
• DOI: http://doi.org/10.5534/wjmh.190044

Abstract

Bone health in prostate cancer patients represents a prerequisite for acceptable quality of life and optimal outcome of this disease. The major threat for bone health in prostate cancer displays cancer treatment induced bone loss as well as the development of bone metastases. In recent years, several new pharmaceuticals targeting bone metabolism such as denosumab or androgen pathway targeting drugs (abiraterone acetate and enzalutamide) have been approved for the treatment of progressive disease aiming to interrupt the vicious circle of bone metastasis and aberrant bone resorption. This development raised the awareness of the pivotal role of bone health in prostate cancer and introduced (symptomatic) skeletal related events as an important end point in recent clinical trials. Bone targeted drugs have become standard of care in patients with metastatic castration resistant prostate cancer, their role in metastatic hormone sensitive prostate cancer has been discussed controversely. In oligometastatic prostate cancer patients several promising approaches in metastasis directed therapy, including conventional surgery, stereotactic ablative radiation and image-guided single-fraction robotic stereotactic radiosurgery (CyberKnife®) were launched but are not in routine clinical use until now caused by sparse clinical evidence.

Keyword

Bone; Bone loss; Bone-targeted therapy; Cancer treatment induced bone loss; Metastasis; Prostatic neoplasms

MeSH Terms

Bone Resorption
Castration
Denosumab
Humans
Metabolism
Neoplasm Metastasis
Prostate*
Prostatic Neoplasms*
Quality of Life
Radiosurgery
Standard of Care
Denosumab

Figure

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  Fig. 1 Cancer treatment induced bone loss management in prostate cancer (PC). PC patients receiving androgen deprivation therapy (ADT) or cytotoxic agents should be monitored according to the flowchart mentioned above after initial evaluation. BMI: body mass index, BMD: bone mineral density, CRPC: castration resistant prostate cancer. Modified from article of Coleman et al (Ann Oncol 2014;25 Suppl 3:iii124-37) [80] with original copyright holder's permission.

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