Harnessing the Potential of Therapeutic Agents to Safeguard Bone Health in Prostate Cancer

Overview

Journal Prostate Cancer Prostatic Dis

Specialties Oncology
Urology

Date 2018 Jul 11

PMID 29988100

Citations 7

Authors

Kurt Miller

Gunther G Steger

Daniela Niepel

Diana Luftner

Affiliations

Soon will be listed here.

Abstract

Background: Patients with prostate cancer are at risk of impaired bone health. Prostate cancer has a propensity to metastasize to bone, after which patients are at risk of skeletal-related events (SREs). These complications are associated with increased mortality, substantial pain, and reduced quality of life. Patients are also at risk of bone loss due to androgen deprivation therapy (ADT), which can be compounded in elderly patients with reduced bone density. It is essential, therefore, that aspects of bone health and therapies able to prevent the occurrence of SREs are considered throughout the clinical course of prostate cancer.

Methods: We reviewed the literature regarding the molecular mechanisms underpinning bone lesion formation, the modes of action of therapies that prevent SREs, and the efficacy and safety of these therapies in patients with hormone-sensitive or castration-resistant prostate cancer (CRPC).

Results: Therapies such as denosumab (a RANKL inhibitor) and zoledronic acid (a bisphosphonate) were indicated for prevention of SREs. Radium-223 dichloride also has proven efficacy in delaying symptomatic SREs, as well as in improving overall survival through effects on bone metastases. Before development of bone metastases, low-dose denosumab may also be used for treatment of ADT-associated bone loss. Denosumab may also have the potential to delay bone metastases development in patients with CRPC, although this is not currently an approved indication. The safety profile of therapies to prevent SREs should be considered. This review consolidates the available evidence on use of denosumab and bisphosphonates in prostate cancer, differentiated by hormone-sensitive and castration-resistant disease.

Conclusions: There is convincing evidence to support the use of denosumab and bisphosphonates to maintain bone health in patients with prostate cancer. Clinicians should be mindful of the adverse event risk profile of these therapies.

Citing Articles

Risk Factors for Medication-Related Osteonecrosis of the Jaw-A Binomial Analysis of Data of Cancer Patients from Craiova and Constanta Treated with Zoledronic Acid.

Ciobanu G, Camen A, Ionescu M, Vlad D, Munteanu C, Gheorghita M J Clin Med. 2023; 12(11).

PMID: 37297941 PMC: 10253558. DOI: 10.3390/jcm12113747.

How zoledronic acid improves osteoporosis by acting on osteoclasts.

Wang B, Zhan Y, Yan L, Hao D Front Pharmacol. 2022; 13:961941.

PMID: 36091799 PMC: 9452720. DOI: 10.3389/fphar.2022.961941.

Metastatic Spread in Prostate Cancer Patients Influencing Radiotherapy Response.

Klusa D, Lohaus F, Furesi G, Rauner M, Benesova M, Krause M Front Oncol. 2021; 10:627379.

PMID: 33747899 PMC: 7971112. DOI: 10.3389/fonc.2020.627379.

Bone health effects of androgen-deprivation therapy and androgen receptor inhibitors in patients with nonmetastatic castration-resistant prostate cancer.

Hussain A, Tripathi A, Pieczonka C, Cope D, McNatty A, Logothetis C Prostate Cancer Prostatic Dis. 2020; 24(2):290-300.

PMID: 33028943 PMC: 8134041. DOI: 10.1038/s41391-020-00296-y.

Cannabinoid receptor 2‑selective agonist JWH015 attenuates bone cancer pain through the amelioration of impaired autophagy flux induced by inflammatory mediators in the spinal cord.

Mao Y, Huang Y, Zhang Y, Wang C, Wu H, Tian X Mol Med Rep. 2019; 20(6):5100-5110.

PMID: 31661120 PMC: 6854597. DOI: 10.3892/mmr.2019.10772.

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