title: Pathologic fracture in patients with metastatic prostate cancer.
abstract: OBJECTIVE
  This review will describe the management of patients with prostate cancer and bone metastases with a particular emphasis on recent advances in this area.
  
  
  RESULTS
  Two osteoclast-targeted agents have been shown to decrease the incidence of skeletal-related events in patients with metastatic castration-resistant prostate cancer (mCRPC) and bone metastases. These agents are the bisphosphonate zoledronic acid and the monoclonal antibody denosumab. Recent advances in the field include the approval of several agents shown to extend survival in mCRPC. Among these agents, the androgen-pathway inhibitors, abiraterone and enzalutamide, are shown to decrease the incidence of skeletal-related events, whereas the radiopharmaceutical radium-223 is shown to reduce the incidence of symptomatic skeletal event. Cabozantinib, an agent in development, has shown encouraging activity in patients with mCRPC and bone metastases; definitive phase III trials of this agent are underway. Phase III metastasis-prevention trials are also underway in nonmetastatic CRPC.
  
  
  CONCLUSIONS
  Osteoclast-targeted agents reduce skeletal-related events in mCRPC. Disease-modifying agents also reduce the skeletal morbidity associated with mCRPC. Multiple agents are now available to reduce the skeletal morbidity of prostate cancer, whereas agents in development may provide additional options in the future.
authors.affiliation: aDepartment of Medical Oncology, Montefiore Medical Center, Albert Einstein College of Medicine, New York, USA bCentre Hospitalier de I'Université de Montréal, Hôpital Notre-Dame, Montreal, Canada.
authors.forename: Benjamin A
authors.initials: BA
authors.lastname: Gartrell
authors.forename: Fred
authors.initials: F
authors.lastname: Saad
mesh_terms: D000736:Androstenes / Q000627:therapeutic use; D000813:Anilides / Q000627:therapeutic use; D061067:Antibodies, Monoclonal, Humanized / Q000627:therapeutic use; D000970:Antineoplastic Agents / Q000627:therapeutic use*; D001549:Benzamides; D050071:Bone Density Conservation Agents / Q000627:therapeutic use*; D001859:Bone Neoplasms / Q000188:drug therapy / Q000556:secondary*; D000069448:Denosumab; D004164:Diphosphonates / Q000627:therapeutic use; D005598:Fractures, Spontaneous / Q000517:prevention & control*; D006801:Humans; D007093:Imidazoles / Q000627:therapeutic use; D008297:Male; D009570:Nitriles; D010669:Phenylthiohydantoin / Q000031:analogs & derivatives / Q000627:therapeutic use; D011471:Prostatic Neoplasms / Q000473:pathology; D064129:Prostatic Neoplasms, Castration-Resistant / Q000473:pathology*; D011725:Pyridines / Q000627:therapeutic use; D011868:Radioisotopes; D011883:Radium; D000077211:Zoledronic Acid
chemical_list: D000736:Androstenes; D000813:Anilides; D061067:Antibodies, Monoclonal, Humanized; D000970:Antineoplastic Agents; D001549:Benzamides; D050071:Bone Density Conservation Agents; D004164:Diphosphonates; D007093:Imidazoles; D009570:Nitriles; D011725:Pyridines; D011868:Radioisotopes; C558660:cabozantinib; D010669:Phenylthiohydantoin; D000069448:Denosumab; D000077211:Zoledronic Acid; C540278:enzalutamide; C089740:abiraterone; C581106:radium Ra 223 dichloride; D011883:Radium