Bone health and bone-targeted therapies for prostate cancer

Prostate Cancer : Prostate cancer is cancer that occurs in a man's prostate a small walnut-shaped gland that produces the seminal fluid that nourishes and transports sperm. Prostate cancer is one of the most common types of cancer in men.

In 23 September 2016, Bone health and bone-targeted therapies for prostate cancer issued of Program in Evidence-based Care.

Question 1

Can therapeutic interventions reduce osteoporosis-related outcomes in men with prostate cancer receiving androgen deprivation therapy (ADT)?

Recommendation 1

For men with prostate cancer at high risk of fracture (with or without bone metastases) receiving ADT, denosumab at the osteoporosis-indicated dosage should be considered to reduce the risk of fracture. In situations or jurisdictions where denosumab is contraindicated or not available, a bisphosphonate is a reasonable option.

Question 2

Can therapeutic interventions prevent bone metastases in men with prostate cancer?

Recommendation 2a

In men with high-risk localized prostate cancer, bisphosphonates are not recommended to reduce the risk of first bone metastasis.

Recommendation 2b

In men with nonmetastatic castration-resistant prostate cancer (CRPC), denosumab at the bone metastasis-indicated dosage is not recommended to reduce the risk of first bone metastasis.

Question 3

Can bone-targeted therapies reduce the incidence of skeletal-related events (SREs), reduce pain, or improve quality of life in men with prostate cancer metastatic to bone?

Recommendation 3a

In men with metastatic CRPC (mCRPC), either zoledronic acid (ZA) (minimally symptomatic or asymptomatic disease) or denosumab (disease independent of symptoms) (both at bone metastasis-indicated dosages) is recommended for preventing or delaying SREs. Insufficient evidence exists to make a recommendation with respect to men with castration-sensitive prostate cancer and bone metastasis.

Recommendation 3b

In men with symptomatic mCRPC and bone pain, radium (Ra)-223 should be considered for reducing symptomatic skeletal events and improving health-related quality of life.

Recommendation 3c

In men with mCRPC and bone pain, radiopharmaceuticals or intravenous (IV) bisphosphonates may be considered for pain palliation.

Question 4

Can bone-targeted therapies improve overall survival in men with established prostate cancer and bone metastases?

Recommendation 4

In men with symptomatic mCRPC, Ra-223 is recommended to extend overall survival.

Refer to Table 1-1 in the original guideline document for recommended dosages of medications.

You can read the full Guideline by clicking on the link :

Alibhai S, Zukotynski K, Walker-Dilks C, Emmenegger U, Finelli A, Morgan S, Hotte S, Winquist E, Genitourinary Cancer Disease Site Group. Bone health and bone-targeted therapies for prostate cancer. Toronto (ON): Cancer Care Ontario (CCO); 2016 Sep 23. 123 p. (Program in Evidence-based Care Guideline; no. 3-14v2). [130 references]