Role of bisphosphonates in prostate cancer

To investigate the role of bisphosphonates in the long-term supportive care of patients with prostate cancer, an emerging medical challenge. Although the success of current therapeutic options has extended the survival of patients with prostate cancer, they often develop skeletal morbidity from disease and treatment-related effects that undermine skeletal integrity.

Studies were identified through MEDLINE searches, review of bibliographies of relevant articles, and review of abstracts from scientific meetings.

Low bone mass is prevalent in patients in early stages of prostate cancer, although the reasons for this correlation are unknown. Furthermore, androgen deprivation therapy (ADT) by either pharmaceutical (including hormonal) or surgical castration causes significant decreases in bone mineral density. Pamidronate has been shown to prevent bone loss, whereas zoledronic acid has been shown to increase bone mass in men undergoing ADT. Finally, zoledronic acid is the only bisphosphonate that has demonstrated efficacy in reducing objectively measurable skeletal complications in patients with bone metastases secondary to prostate cancer.

Bisphosphonates, zoledronic acid in particular, have potent activities against osteoclasts, which affect bone integrity. Zoledronic acid has now become an additional option that can provide benefits to patients with prostate cancer throughout the course of their disease.