New recommendations released to preserve bone health in patients with prostate cancer


Researchers from the Cancer Care Ontario Genitourinary Cancer Disease Site Group have released treatment guidelines for bone health and bone-targeted therapies for prostate cancer, published in Clinical Oncology (published online February 4, 2017; doi: 10.1016/j.clon.2017.01.007).


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Clinicians offer many different drugs and supplements for improving bone health or outcomes in patients with prostate cancer with bone metastases. However, standard of care therapies for patients with varying prior treatments and degrees of prostate cancer could help clinicians recommend optimal treatments courses.

S M H Alibhai, Department of Medicine, University of Toronto (Canada), and colleagues conducted a systematic review with the intent of proposing recommendations with respect to bone health and bone-targeted therapies for men with prostate cancer. Researchers utilized Medline, Embase, and the Cochrane Library to analyze systematic reviews and randomized controlled trials from inception to 2016 involving therapies to improve bone health or outcomes such as skeletal-related events, pain, and quality of life. Therapies included in the review were medications, supplements or lifestyle modifications alone or in combination compared with placebo, no treatment, and other agents. Androgen receptor targeted agents and chemotherapeutic agents were excluded from the review. Resulting recommendations were approved by internal and external review groups.

Researchers recommend that patients with prostate cancer undergoing androgen deprivation therapy receive baseline bone mineral density testing. Patients undergoing androgen deprivation therapy with an increased risk of bone fracture should receive denosumab to reduce such risk. Bisphosphonates are effective options for improving bone mineral density, but their effects in decreasing bone fracture risk are inconclusive.

Denosumab and zoledronic acid are recommended for preventing skeletal-related events in patients with metastatic castration-resistant prostate cancer. Additionally, radium-223 is recommended for reducing symptomatic skeletal events and prolonging survival in such patients.

The systematic review yielded inconclusive evidence to recommend any medication for preventing development of first-bone metastasis.

Researchers concluded that these recommendations “represent a standard of care that is feasible to implement, with outcomes valued by clinicians and patients.”