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Bone Health and Bone-targeted Therapies for Prostate Cancer: a Programme in Evidence-based Care - Cancer Care Ontario
S M H Alibhai1, K Zukotynski2, C Walker-Dilks3
1Department of Medicine, University Health Network, University of Toronto, Toronto, Ontario, Canada.
Aims:
To make recommendations with respect to bone health and bone-targeted therapies in men with prostate cancer.
Materials And Methods:
A systematic review was carried out by searching MEDLINE, EMBASE and the Cochrane Library from inception to January 2016. Systematic reviews and randomised-controlled trials were considered for inclusion if they involved therapies directed at improving bone health or outcomes such as skeletal-related events, pain and quality of life in patients with prostate cancer either with or without metastases to bone. Therapies included medications, supplements or lifestyle modifications alone or in combination and were compared with placebo, no treatment or other agents. Disease-targeted agents such as androgen receptor-targeted and chemotherapeutic agents were excluded. Recommendations were reviewed by internal and external review groups.
Results:
In men with prostate cancer receiving androgen deprivation therapy, baseline bone mineral density testing is encouraged. Denosumab should be considered for reducing the risk of fracture in men on androgen deprivation therapy with an increased fracture risk. Bisphosphonates were effective in improving bone mineral density, but the effect on fracture was inconclusive. No medication is recommended to prevent the development of first bone metastasis. Denosumab and zoledronic acid are recommended for preventing or delaying skeletal-related events in men with metastatic castration-resistant prostate cancer. Radium-223 is recommended for reducing symptomatic skeletal events and prolonging survival in men with symptomatic metastatic castration-resistant prostate cancer.
Conclusions:
The recommendations represent a current standard of care that is feasible to implement, with outcomes valued by clinicians and patients.
Insights
Recommendations for prostate cancer bone health include bone density testing for men on androgen deprivation therapy. Denosumab can reduce fracture risk, while bisphosphonates improve bone density, but fracture data is inconclusive.
Area of Science:
- Oncology
- Bone Metabolism
- Prostate Cancer Therapeutics
Background:
- Prostate cancer treatment, particularly androgen deprivation therapy (ADT), can negatively impact bone health.
- Men with prostate cancer are at increased risk for fractures and skeletal-related events (SREs).
- Optimizing bone health is crucial for improving quality of life in prostate cancer patients.
Purpose of the Study:
- To provide evidence-based recommendations for managing bone health in men with prostate cancer.
- To evaluate the efficacy of various bone-targeted therapies in preventing fractures and SREs.
- To guide clinical practice regarding bone health interventions for prostate cancer patients.
Main Methods:
- A systematic review of MEDLINE, EMBASE, and the Cochrane Library was conducted up to January 2016.
- Included studies were systematic reviews and randomized-controlled trials on therapies for bone health in prostate cancer patients.
- Exclusion criteria included disease-targeted agents like androgen receptor-targeted and chemotherapeutic agents.
Main Results:
- Baseline bone mineral density testing is recommended for men on ADT.
- Denosumab is recommended to reduce fracture risk in men on ADT with elevated fracture risk.
- Denosumab and zoledronic acid are recommended for preventing SREs in metastatic castration-resistant prostate cancer (mCRPC).
- Radium-223 is recommended for symptomatic mCRPC to reduce skeletal events and prolong survival.
Conclusions:
- The developed recommendations represent a feasible standard of care.
- These recommendations address outcomes highly valued by both clinicians and patients.
- Implementing these guidelines can optimize bone health management in prostate cancer care.
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