Guidelines:Prostate cancer/Management/Locally advanced and metastatic/Bisphosphonates
Bone is the most frequent site for metastases from prostate cancer. It has been estimated that 85% of men with advanced prostate cancer, particularly when the disease is not controlled by androgen deprivation therapy, will have bony metastases. These metastases lead to bone pain, pathological fractures, spinal cord compression and in rare instances, disturbances in serum calcium levels sufficient to produce symptoms. This composite of bone complications associated with cancer has been encompassed by the term ‘skeletal related events’ (SRE). Bisphosphonates have been shown to be effective in reducing the incidence of SREs in myeloma and breast cancer.
This section examines the evidence for the use of bisphosphonates in the prevention of SRE and bone pain control in men with metastatic prostate cancer.
There are two points regarding bisphosphonates and prostate cancer worth clarifying. First, the use of bisphosphonates to prevent prostate cancer associated SREs is distinct from discussions about the management of osteoporosis induced by therapies used to treat prostate cancer. Namely, androgen deprivation can lead to a decrease in bone mineral density and in some cases, osteoporotic crush fractures. The relevance of this is paramount in the adjuvant setting, and the dosing and schedules of bisphosphonates are far lower than the doses for prevention of SREs. This matter is not addressed in this review. The second point to appreciate when reviewing the following dataset is that bisphosphonates have vastly different potencies. This variability probably leads to the heterogeneity in the outcomes and contributes to the limitations of the recommendations based on the current dataset.
- What is the evidence for the use of bisphosphonates in the prevention of skeletal events?
- What is the evidence for the use of bisphosphonates in the treatment of bone pain?
Issues requiring more clinical research study Clinical question considered, but for which no evidence was found during systematic review
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