title: Factors that predict the development of bone metastases due to prostate cancer: Recommendations for follow-up and therapeutic options.
abstract: BACKGROUND
  Prostate cancer is a public health problem in Spain and in the Western world. Bone involvement, associated to significant morbidity, is practically constant in the advanced stages of the disease. This work aims to review the prognostic factors used in the usual clinical practice that predict the development of bone metastases and to analyze the follow-up and treatment option in these patient profiles.
  We performed a review of the literature on the useful factors in the context of therapy with intention to cure. We included the classical clinical values in the diagnosis (PSA, clinical stage, Gleason score on the biopsy) pathological factors (pT stage, margins, bladder invasion, tumor volume, lymph node involvement) and PSA kinetics in their different contexts and the histological and molecular parameters.
  
  
  RESULTS
  The tumor differentiation "Gleason" score and PSA are the most important predictive factors in the prediction of bone metastases in patients with intention to cure. Kinetic factors such as PSA doubling time (TDPSA) < 8 months or PSA > 10 ng/ml in the case of castration-resistant prostate cancer (CPRC), are predictive factors for the development of metastasis. Zoledronic acid and denosumab have demonstrated their effectiveness for the treatment of bone disease in randomized studies.
  
  
  CONCLUSIONS
  There are predictive factors within the usual clinical practice that make it possible to recognize the "patient at risk" to develop bone metastatic disease. The currently available treatments, zoledronic acid or denosumab, can help us in the management of the patient at risk of developing metastasis or metastatic patient, increasing the quality of life and decreasing skeletal events.
authors.affiliation: Departamento de Urología, Hospital Universitario 12 de Octubre, Madrid, España. Electronic address: arantolin@yahoo.es.
authors.forename: A
authors.initials: A
authors.lastname: Rodríguez-Antolín
authors.affiliation: Departamento de Urología, Complexo Hospitalario Hospital A Coruña Juan Canalejo, A Coruña, España.
authors.forename: F
authors.initials: F
authors.lastname: Gómez-Veiga
authors.affiliation: Departamento de Urología, Hospital Puerta del Mar, Cádiz, España.
authors.forename: J K
authors.initials: JK
authors.lastname: Alvarez-Osorio
authors.affiliation: Departamento de Urología, Hospital Universitario Puerta de Hierro, Madrid, España.
authors.forename: J
authors.initials: J
authors.lastname: Carballido-Rodriguez
authors.affiliation: Departamento de Urología, Fundació Puigvert, Barcelona, España.
authors.forename: J
authors.initials: J
authors.lastname: Palou-Redorta
authors.affiliation: Departamento de Urología, Instituto Valenciano de Oncología, Valencia, España.
authors.forename: E
authors.initials: E
authors.lastname: Solsona-Narbón
authors.affiliation: Departamento de Urología, Hospital Virgen de la Macarena, Sevilla, España.
authors.forename: E
authors.initials: E
authors.lastname: Sánchez-Sánchez
authors.affiliation: Departamento de Urología, Hospital de Basurto, Bilbao, España.
authors.forename: M
authors.initials: M
authors.lastname: Unda
mesh_terms: D001859:Bone Neoplasms / Q000556:secondary* / Q000628:therapy*; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D017410:Practice Guidelines as Topic; D011379:Prognosis; D011471:Prostatic Neoplasms / Q000473:pathology* / Q000628:therapy*
keywords: Bone metastasis; Cáncer de próstata; Enfermedad local; Factores pronósticos; Follow-up; Hormone therapy; Hormonoterapia; Local disease; Metástasis óseas; Prognostic factors; Prostate cancer; Seguimiento