Key clinical point: Bone loss may occur in up to 90% of prostate cancer patients with advanced disease and has been shown to impact quality of life in approximately 80% of metastatic prostate cancer patients.

Major finding: Bone targeting agents (BTAs) such as the bisphosphonate zoledronic acid and the receptor activator of nuclear factor kappa-B (RANK) ligand inhibitor denosumab, are approved for preventing skeletal-related events, but new evidence suggests that the combination of BTAs and abiraterone acetate, enzalutamide and the radiopharmaceutical radium-223 could yield improved clinical outcomes and survival.

Study details: The data come from a literature review focusing on the mechanisms of bone metastasis in prostate cancer.

Disclosures: The study received no external funding. The researchers had no financial conflicts to disclose.

Commentary

“Bone metastases occur in the vast majority of patients afflicted with prostate cancer and are associated with significant morbidity. Numerous studies of bone-targeted agents (BTAs), such as zoledronic acid and denosumab, alone or in the setting of additional prostate cancer treatments, have been conducted. The review by Mollica et al. highlights the key studies in this area. BTAs have not been associated with significant clinical benefits in patients with metastatic castrate-sensitive prostate cancer, but BTAs are effective and approved to prevent skeletal-related events in metastatic castrate-resistant prostate cancer. While BTAs have not been associated with a definitive improvement in overall survival, further studies are needed to determine if particular BTAs and treatment regimens (i.e., abiraterone acetate, androgen deprivation, androgen receptor blockade) may work together better than other combinations in patients with prostate cancer in order to improve outcomes.”

Mark Klein, MD