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Bone-Targeted Therapy: Rationale and Current Status

  • Chapter
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Management of Castration Resistant Prostate Cancer

Part of the book series: Current Clinical Urology ((CCU))

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Abstract

Bone metastases are common in metastatic castration-resistant prostate cancer (mCRPC) and may lead to skeletal-related events (SREs) such as pathologic fracture, the requirement of surgery or radiation to bone or spinal cord compression. SREs are associated with pain, loss of function, and decreased survival. Therefore, preventing SREs is a key consideration in the treatment of mCRPC. Osteoclast-targeted agents such as the bisphosphonate zoledronic acid and the monoclonal antibody denosumab reduce the incidence of SREs in mCRPC. Skeletal complications are also common to non-metastatic prostate cancer as androgen deprivation therapy (ADT) associated loss of bone mineral density (BMD) increases the risk of osteoporotic fragility fractures. A number of agents improve ADT-induced BMD loss in non-metastatic prostate cancer, but only denosumab has been shown to decrease fracture risk. Beyond osteoclast-targeted agents, the radiopharmaceutical agent radium-223 is a bone-targeted agent that delays skeletal events and improves survival in mCRPC. While osteoclast-targeted agents are generally well tolerated a number of adverse events associated with bisphosphonates and denosumab are sufficiently common to warrant attention. This chapter addresses the skeletal complications common to advanced prostate cancer and discusses the therapeutics available to prevent them.

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Authors and Affiliations

  1. Department of Medical Oncology, Montefiore Medical Center, the Albert Einstein College of Medicine, 111 E 210th Street, Bronx, NY, 10467, USA

    Benjamin A. Gartrell MD

  2. Division of Urology, University of Montreal Hospital Center, 1058 St. Denis, Montreal, QC, Canada, H2X 3J4

    Fred Saad MD, FRCS (Professor and Chief, Director of Urologic Oncology, U of M Endowed Chair in Prostate Cancer)

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  1. Benjamin A. Gartrell MD
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Correspondence to Fred Saad MD, FRCS .

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  1. Department of Surgery, University of Montreal Hospital Center, Montreal, Québec, Canada

    Fred Saad

  2. Department of Oncology, The Johns Hopkins University, Baltimore, Maryland, USA

    Mario A. Eisenberger

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Gartrell, B.A., Saad, F. (2014). Bone-Targeted Therapy: Rationale and Current Status. In: Saad, F., Eisenberger, M. (eds) Management of Castration Resistant Prostate Cancer. Current Clinical Urology. Humana Press, New York, NY. https://doi.org/10.1007/978-1-4939-1176-9_10

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