Bisphosphonates in the management of prostate carcinoma metastatic to the skeleton.
BACKGROUND
Prostate carcinoma metastasizes frequently to the skeleton, causing significant morbidity, particularly severe bone pain. Metastatic lesions typically are osteosclerotic, but there is experimental, histologic, and biochemical evidence of increased bone resorption. Furthermore, bone resorption rates appear to correlate with bone pain. These observations provide the rationale for the use of bisphosphonates in the management of patients with prostate carcinoma and skeletal metastases.


METHODS
The authors reviewed the literature and current findings on the use of biphosphonates in the management of patients with prostate carcinoma metastatic to the skeleton.


RESULTS
Compared with the large number of studies with bisphosphonates in predominantly osteolytic bone disease, there have been relatively few (mostly uncontrolled) studies in patients with prostate carcinoma. Apart from the lack of appropriate experimental models, the osteoblastic nature of the metastases and the low incidence of objectively assessed endpoints of treatment (e.g., hypercalcemia, pathologic fractures) have delayed developments. Available data, however, strongly suggest that potent bisphosphonates are efficacious in reducing skeletal morbidity in patients with prostate carcinoma.


CONCLUSIONS
For the optimal management of patients with skeletal metastases from prostate carcinoma with bisphosphonates their mode of administration, the dose and duration of treatment need to be evaluated. Better understanding of the cellular and molecular mechanisms underlying bone metastases can lead to the design of improved treatment protocols with potent bisphosphonates.
Papapoulos
S E
SE
Department of Endocrinology and Metabolic Diseases, Leiden University Medical Center, The Netherlands.
Hamdy
N A
NA
van der Pluijm
G
G
D001859:Bone Neoplasms / Q000188:drug therapy* / Q000556:secondary*; D001862:Bone Resorption / Q000188:drug therapy; D004164:Diphosphonates / Q000627:therapeutic use*; D006801:Humans; D008297:Male; D010146:Pain / Q000188:drug therapy; D010166:Palliative Care; D011471:Prostatic Neoplasms / Q000188:drug therapy*
D004164:Diphosphonates