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Updated: Sep 5, 2025
A Bioluminescent and Fluorescent Orthotopic Syngeneic Murine Model of Androgen-dependent and Castration-resistant Prostate Cancer
Published on: March 6, 2018
Real-world use of bone modifying agents in metastatic, castration-resistant prostate cancer
Aaron P Mitchell1,2, Akriti Mishra Meza3, Katherine S Panageas3
1Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, USA. mitchea2@mskcc.org.
Background:
Bone modifying agents (BMAs) prevent skeletal related events among patients with metastatic, castration-resistant prostate cancer (mCRPC) involving bone and prevent osteoporotic fractures among patients at high risk. BMA utilization for patients with mCRPC has not been well quantified.
Methods:
We used linked SEER registry and Medicare claims data. We included men diagnosed with stage IV prostate adenocarcinoma during 2007-2015, aged > = 66 at diagnosis, with sufficient continuous enrollment in Medicare Parts A, B, and D, who received androgen deprivation therapy. We limited to those who subsequently received a CRPC-defining treatment (CDT). We identified patients with evidence of bone metastasis using claims. Our primary outcome was receipt of a BMA (zoledronic acid or denosumab) within 180 days of initiating CDT.
Results:
Among 1292 included patients, 1034 (80%) had bone metastasis. BMA use within 180 days of initiating CDT was higher among patients with bone metastases than those without (705/1034 [68%] vs 56/258 [22%]). Among patients without bone metastasis, those with high osteoporotic fracture risk were more likely than those without to receive a BMA (OR = 2.48, 95% CI: 1.17, 5.29); however, only 26% of patients with high fracture risk received a BMA. Among patients who received BMAs, most (62%) first initiated them >90 days before initiating CDT.
Conclusions:
Two-thirds of patients with mCRPC and bone metastases received BMAs within 180 days after initiating CDT. A greater proportion of patients without bone metastasis may warrant BMA therapy for osteoporotic fracture prevention. Some patients with bone metastasis may be able to delay BMA initiation until CRPC.
Insights
Bone modifying agents (BMAs) are used for prostate cancer patients with bone metastases. Two-thirds of patients with metastatic, castration-resistant prostate cancer (mCRPC) received BMAs, but some without bone metastasis also benefit.
Area of Science:
- Oncology
- Pharmacology
- Geriatric Medicine
Background:
- Bone modifying agents (BMAs) are crucial for managing skeletal events in metastatic, castration-resistant prostate cancer (mCRPC) and preventing osteoporotic fractures.
- Quantifying BMA utilization in mCRPC patients is essential for understanding treatment patterns.
Purpose of the Study:
- To quantify the utilization of bone modifying agents (BMAs) in patients with metastatic, castration-resistant prostate cancer (mCRPC).
- To assess BMA use based on the presence of bone metastasis and osteoporotic fracture risk.
Main Methods:
- Utilized linked SEER registry and Medicare claims data for men diagnosed with stage IV prostate adenocarcinoma (2007-2015), aged >= 66.
- Included patients receiving androgen deprivation therapy and subsequently a castration-resistance defining treatment (CDT), with identified bone metastasis via claims.
- Primary outcome: receipt of a BMA (zoledronic acid or denosumab) within 180 days of initiating CDT.
Main Results:
- Of 1292 patients, 1034 (80%) had bone metastasis. BMA use within 180 days of CDT initiation was higher in patients with bone metastases (68%) than without (22%).
- Among patients without bone metastasis, high osteoporotic fracture risk increased BMA likelihood (OR=2.48), yet only 26% with high risk received a BMA.
- Most patients receiving BMAs initiated them over 90 days before CDT (62%).
Conclusions:
- Approximately two-thirds of mCRPC patients with bone metastases received BMAs within 180 days of CDT initiation.
- Patients without bone metastasis but with high fracture risk may benefit from BMAs, indicating a potential gap in current utilization.
- Timing of BMA initiation can be flexible; some patients with bone metastasis may delay initiation until CRPC treatment begins.
