title: Targeting bone metabolism in patients with advanced prostate cancer: current options and controversies.
abstract: Maintaining bone health remains a clinical challenge in patients with prostate cancer (PC) who are at risk of developing metastatic bone disease and increased bone loss due to hormone ablation therapy. In patients with cancer-treatment induced bone loss (CTIBL), antiresorptive agents have been shown to improve bone mineral density (BMD) and to reduce the risk of fractures. For patients with bone metastases, both zoledronic acid and denosumab delay skeletal related events (SREs) in the castration resistant stage of disease. Novel agents targeting the Wnt inhibitors dickkopf-1 and sclerostin are currently under investigation for the treatment of osteoporosis and malignant bone disease. New antineoplastic drugs such as abiraterone, enzalutamide, and Radium-223 are capable of further delaying SREs in patients with advanced PC. The benefit of antiresorptive treatment for patients with castration sensitive PC appears to be limited. Recent trials on the use of zoledronic acid for the prevention of bone metastases failed to be successful, whereas denosumab delayed the occurrence of bone metastases by a median of 4.1 months. Currently, the use of antiresorptive drugs to prevent bone metastases still remains a field of controversies and further trials are needed to identify patient subgroups that may profit from early therapy.
authors: Department of Urology, University Hospital, Hoppe-Seyler-Straße 3, 72076 Tübingen, Germany ; Vancouver Prostate Centre, University of British Columbia, 2660 Oak Street, Vancouver, BC, Canada V6H 3Z6.
authors: Tilman
authors: T
authors: Todenhöfer
authors: Department of Urology, University Hospital, Hoppe-Seyler-Straße 3, 72076 Tübingen, Germany.
authors: Arnulf
authors: 0000-0003-4207-9928
authors: A
authors: Stenzl
authors: Department of Medicine III, Technische Universität Dresden Medical Center, Fetscherstraße 74, 01307 Dresden, Germany.
authors: Lorenz C
authors: LC
authors: Hofbauer
authors: Department of Medicine III, Technische Universität Dresden Medical Center, Fetscherstraße 74, 01307 Dresden, Germany.
authors: Tilman D
authors: TD
authors: Rachner