Optimal Bone Health Management Strategies in Patients with Prostate Cancer

Overview

Journal Indian J Urol

Specialty Urology

Date 2013 Aug 20

PMID 23956508

Citations 4

Authors

Gagan Prakash

Gagan Gautam

Affiliations

Soon will be listed here.

Abstract

Bone health is affected in patients with prostate cancer, both by the disease and its treatment. Metastases to bone leads to pain, fractures, and spinal cord compression; bone loss due to androgen deprivation therapy (ADT) leads to osteoporosis and its complications. Both these scenarios are a major cause of morbidity and adversely affect the quality of life of these patients. Maintaining an optimum bone health throughout the natural course of prostate cancer is an important aspect in the management of this disease. An understanding of the complex interplay between osteoclasts, osteoblasts, receptor activator of nuclear factor κB (RANK), and various other tyrosine kinases involved in the pathophysiology of bone metastases is essential. Zoledronic acid (ZA), an intravenously administered bisphosphonate, and Denosumab, a subcutaneously administered inhibitor of nuclear factor B ligand (RANKL), have already been approved by Food and Drug Administration (FDA) for their use in treatment of bone metastases. This article discusses the pathophysiology of bone metastases and bone loss due to ADT in prostate cancer, role of biomarkers, newer modalities of imaging, World Health Organization (WHO)/FRAX nomogram in evaluation of these patients, utility of currently available drugs and evidence supporting their use, and newer therapeutic agents like alpha-emitting Radium-223, endothelin-A receptor antagonists (Atrasentan and Zibotentan) and the proto-oncogene tyrosine-protein kinase (SRC) inhibitor, Dasatinib.

Citing Articles

A prospective longitudinal study to evaluate bone health, implication of FRAX tool and impact on quality of life (FACT-P) in advanced prostate cancer patients.

Sharma A, Garg G, Sadasukhi N, Sadasukhi T, Gupta H, Gupta M Am J Clin Exp Urol. 2021; 9(3):211-220.

PMID: 34327260 PMC: 8303024.

Implications of the Fracture Risk Assessment Algorithm for the assessment and improvement of bone health in patients with prostate cancer: A comprehensive review.

Sharma A, Sinha R, Singh V, Garg G, Agarwal S, Pandey S Turk J Urol. 2019; 45(4):245-253.

PMID: 30817274 PMC: 6619849. DOI: 10.5152/tud.2019.11736.

Recent advances in bone-targeted therapies of metastatic prostate cancer.

Deng X, He G, Liu J, Luo F, Peng X, Tang S Cancer Treat Rev. 2014; 40(6):730-8.

PMID: 24767837 PMC: 4042838. DOI: 10.1016/j.ctrv.2014.04.003.

The osteoblastic and osteoclastic interactions in spinal metastases secondary to prostate cancer.

Dushyanthen S, Cossigny D, Quan G Cancer Growth Metastasis. 2014; 6:61-80.

PMID: 24665208 PMC: 3941153. DOI: 10.4137/CGM.S12769.

References

Saad F, Gleason D, Murray R, Tchekmedyian S, Venner P, Lacombe L . A randomized, placebo-controlled trial of zoledronic acid in patients with hormone-refractory metastatic prostate carcinoma. J Natl Cancer Inst. 2002; 94(19):1458-68. DOI: 10.1093/jnci/94.19.1458. View

Kanis J, Johansson H, Johnell O, Oden A, De Laet C, Eisman J . Alcohol intake as a risk factor for fracture. Osteoporos Int. 2004; 16(7):737-42. DOI: 10.1007/s00198-004-1734-y. View

Dearnaley D, Mason M, Parmar M, Sanders K, Sydes M . Adjuvant therapy with oral sodium clodronate in locally advanced and metastatic prostate cancer: long-term overall survival results from the MRC PR04 and PR05 randomised controlled trials. Lancet Oncol. 2009; 10(9):872-6. PMC: 2748902. DOI: 10.1016/S1470-2045(09)70201-3. View

Smith M, Lee W, Brandman J, Wang Q, Botteman M, Pashos C . Gonadotropin-releasing hormone agonists and fracture risk: a claims-based cohort study of men with nonmetastatic prostate cancer. J Clin Oncol. 2005; 23(31):7897-903. DOI: 10.1200/JCO.2004.00.6908. View

Johnell O, Kanis J, Oden A, Johansson H, De Laet C, Delmas P . Predictive value of BMD for hip and other fractures. J Bone Miner Res. 2005; 20(7):1185-94. DOI: 10.1359/JBMR.050304. View

Agarawal J, Swangsilpa T, van der Linden Y, Rades D, Jeremic B, Hoskin P . The role of external beam radiotherapy in the management of bone metastases. Clin Oncol (R Coll Radiol). 2006; 18(10):747-60. DOI: 10.1016/j.clon.2006.09.007. View

Schirrmeister H, Glatting G, Hetzel J, Nussle K, Arslandemir C, Buck A . Prospective evaluation of the clinical value of planar bone scans, SPECT, and (18)F-labeled NaF PET in newly diagnosed lung cancer. J Nucl Med. 2001; 42(12):1800-4. View

Kanis J, Johnell O, Oden A, Johansson H, De Laet C, Eisman J . Smoking and fracture risk: a meta-analysis. Osteoporos Int. 2004; 16(2):155-62. DOI: 10.1007/s00198-004-1640-3. View

Xia W, Unger P, Miller L, Nelson J, Gelman I . The Src-suppressed C kinase substrate, SSeCKS, is a potential metastasis inhibitor in prostate cancer. Cancer Res. 2001; 61(14):5644-51. View

10.

Nelson J, Hedican S, George D, Reddi A, Piantadosi S, Eisenberger M . Identification of endothelin-1 in the pathophysiology of metastatic adenocarcinoma of the prostate. Nat Med. 1995; 1(9):944-9. DOI: 10.1038/nm0995-944. View

11.

Hoff A, Toth B, Altundag K, Johnson M, Warneke C, Hu M . Frequency and risk factors associated with osteonecrosis of the jaw in cancer patients treated with intravenous bisphosphonates. J Bone Miner Res. 2008; 23(6):826-36. PMC: 2677083. DOI: 10.1359/jbmr.080205. View

12.

Kattapuram S, Khurana J, Scott J, El-Khoury G . Negative scintigraphy with positive magnetic resonance imaging in bone metastases. Skeletal Radiol. 1990; 19(2):113-6. DOI: 10.1007/BF00197616. View

13.

Qaseem A, Snow V, Shekelle P, Hopkins Jr R, Forciea M, Owens D . Screening for osteoporosis in men: a clinical practice guideline from the American College of Physicians. Ann Intern Med. 2008; 148(9):680-4. DOI: 10.7326/0003-4819-148-9-200805060-00008. View

14.

Kanis J, Johansson H, Oden A, Johnell O, De Laet C, Eisman J . A family history of fracture and fracture risk: a meta-analysis. Bone. 2004; 35(5):1029-37. DOI: 10.1016/j.bone.2004.06.017. View

15.

Watts N . Clinical utility of biochemical markers of bone remodeling. Clin Chem. 1999; 45(8 Pt 2):1359-68. View

16.

Diamond T, Higano C, Smith M, Guise T, Singer F . Osteoporosis in men with prostate carcinoma receiving androgen-deprivation therapy: recommendations for diagnosis and therapies. Cancer. 2004; 100(5):892-9. DOI: 10.1002/cncr.20056. View

17.

Briganti A, Passoni N, Ferrari M, Capitanio U, Suardi N, Gallina A . When to perform bone scan in patients with newly diagnosed prostate cancer: external validation of the currently available guidelines and proposal of a novel risk stratification tool. Eur Urol. 2009; 57(4):551-8. DOI: 10.1016/j.eururo.2009.12.023. View

18.

Smith M, Morton R, Barnette K, Sieber P, Malkowicz S, Rodriguez D . Toremifene to reduce fracture risk in men receiving androgen deprivation therapy for prostate cancer. J Urol. 2010; 184(4):1316-21. PMC: 3047407. DOI: 10.1016/j.juro.2010.06.022. View

19.

Fizazi K, Carducci M, Smith M, Damiao R, Brown J, Karsh L . Denosumab versus zoledronic acid for treatment of bone metastases in men with castration-resistant prostate cancer: a randomised, double-blind study. Lancet. 2011; 377(9768):813-22. PMC: 3090685. DOI: 10.1016/S0140-6736(10)62344-6. View

20.

Bae D, Stein B . The diagnosis and treatment of osteoporosis in men on androgen deprivation therapy for advanced carcinoma of the prostate. J Urol. 2004; 172(6 Pt 1):2137-44. DOI: 10.1097/01.ju.0000141515.67372.e5. View