title: Treatment of bone metastases in urologic malignancies.
abstract: The skeletal system is the most common site of metastatic cancer spread. Bone metastases are often associated with severe morbidity, pain and functional impairment. Timely diagnosis and proper treatment may decrease morbidity, improve quality of life and in some cases even improve survival. External beam radiotherapy may effectively give pain relief in patients with painful bone metastases. In bone metastases from castration-resistant prostate cancer or urothelial bladder cancer, treatment with zoledronic acid or denosumab may reduce skeletal-related events. In contrast to castration-resistant prostate cancer, in patients with bone metastases from bladder cancer such treatment may even improve survival. On the other hand, the efficacy of these agents is questionable in patients with bone involvement from metastatic renal cell carcinoma or germ cell tumors. When bisphosphonates or denosumab are considered in such cases, the potential benefits of treatment should be critically weighed against the risk of side effects. In germ cell tumors, bone metastases may be cured by cisplatin-based chemotherapy, however, there are only limited data on the specific management of residual disease. Oligometastases may be treated by stereotactic radiotherapy or--especially in patients with renal cell carcinoma--by surgical resection and endoprosthetic replacement. Limited data are available on the management of bone involvement in germ cell tumors. Decisions on the resection or local radiotherapy of residual disease should be individualized considering the overall response and the feasibility and risks of resection.
authors.affiliation: Department of Urology, University Hospital 'Carl Gustav Carus', Technische Universität Dresden, Germany.
authors.forename: Michael
authors.initials: M
authors.lastname: Froehner
authors.forename: Tobias
authors.initials: T
authors.lastname: Hölscher
authors.forename: Oliver W
authors.initials: OW
authors.lastname: Hakenberg
authors.forename: Manfred P
authors.initials: MP
authors.lastname: Wirth
mesh_terms: D061067:Antibodies, Monoclonal, Humanized / Q000627:therapeutic use; D050071:Bone Density Conservation Agents / Q000627:therapeutic use; D001859:Bone Neoplasms / Q000556:secondary* / Q000628:therapy*; D002292:Carcinoma, Renal Cell / Q000473:pathology / Q000628:therapy; D002945:Cisplatin / Q000627:therapeutic use; D000069448:Denosumab; D004164:Diphosphonates / Q000737:chemistry / Q000627:therapeutic use; D006801:Humans; D007093:Imidazoles / Q000627:therapeutic use; D008297:Male; D009362:Neoplasm Metastasis; D009373:Neoplasms, Germ Cell and Embryonal / Q000473:pathology / Q000628:therapy; D011471:Prostatic Neoplasms / Q000473:pathology / Q000628:therapy; D011788:Quality of Life; D016634:Radiosurgery; D016896:Treatment Outcome; D001749:Urinary Bladder Neoplasms / Q000473:pathology / Q000628:therapy; D014571:Urologic Neoplasms / Q000473:pathology* / Q000628:therapy*; D000077211:Zoledronic Acid
chemical_list: D061067:Antibodies, Monoclonal, Humanized; D050071:Bone Density Conservation Agents; D004164:Diphosphonates; D007093:Imidazoles; D000069448:Denosumab; D000077211:Zoledronic Acid; D002945:Cisplatin