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Multidisciplinary management of bone complications in prostate cancer and optimizing outcomes of bisphosphonate therapy

Abstract

Prostate cancer is the second most common cancer diagnosed in men worldwide and, although advances in treatment options have extended the overall survival of these patients, bone health issues remain a challenge throughout the continuum of care. Patients with prostate cancer are at high risk of skeletal complications from bone metastases and bone loss induced by cancer treatments, such as androgen-deprivation therapy. The preservation of skeletal health might require the cooperation of urologists, oncologists, pain specialists, and other physicians specializing in the treatment of prostate cancer. Complications resulting from bone loss and bone metastases can result in increased risk of fracture and death. Implementation of a multidisciplinary approach for the management of bone health can, therefore, provide clinically meaningful benefits to patients with skeletal complications. The early diagnosis and treatment of bone loss and bone metastases with bisphosphonates are critical for the maintenance of skeletal wellness and prevention of bone complications in patients with prostate cancer.

Key Points

  • Bone health issues remain a challenge throughout the continuum of care in patients with prostate cancer

  • The early diagnosis and treatment with bisphosphonates of bone loss and bone metastases in patients with prostate cancer are critical to maintain skeletal wellness and prevent bone complications

  • Although the use of biomarkers of bone metabolism, imaging techniques, and adjuvant therapies for the diagnosis and treatment of skeletal complications are being developed, risk-assessment tools are needed for the identification of patients with prostate cancer who are at an increased risk of skeletal disease

  • The cooperation of urologists, medical oncologists, radiation oncologists, and other specialists to ensure that bone health is monitored and treated throughout the course of disease progression can optimize outcomes

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Figure 1: Time course of increasing fracture risk among patients with prostate cancer and types of therapies to treat cancer and related complications
Figure 2: Identifying and treating bone loss in men with prostate cancer
Figure 3: The proportion of patients in treatment and control groups with each type of second on-study SRE at 15 months

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Acknowledgements

We acknowledge the assistance of Carol Sledz in the editorial preparation of this manuscript before submission.

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Correspondence to Fred Saad.

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Competing interests

F Saad has received funding for clinical research from Novartis Pharmaceuticals Corporation and Sanofi Aventis and has participated in such advisory boards.

CN Sternberg has participated in Novartis Pharmaceuticals Corporation and Sanofi Aventis advisory boards.

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Saad, F., Sternberg, C. Multidisciplinary management of bone complications in prostate cancer and optimizing outcomes of bisphosphonate therapy. Nat Rev Urol 4 (Suppl 1), S3–S13 (2007). https://doi.org/10.1038/ncpuro0727

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