Bone metastases in advanced prostate cancer: Management
- A Oliver Sartor, MD
A Oliver Sartor, MD
- Laborde Professor for Cancer Research
- Medical Director, Tulane Cancer Center
- Depts. of Medicine and Urology
- Tulane Medical School
- Steven J DiBiase, MD
Steven J DiBiase, MD
- Professor of Radiation Oncology
- Tulane University School of Medicine
- Medical Director, Department of Radiation Oncology
- Tulane Cancer Center
- Section Editors
- Nicholas Vogelzang, MD
Nicholas Vogelzang, MD
- Section Editor — Prostate Cancer
- Professor of Medicine
- University of Nevada School of Medicine
- US Oncology Research
- W Robert Lee, MD, MS, MEd
W Robert Lee, MD, MS, MEd
- Section Editor — Prostate Cancer
- Professor of Radiation Oncology
- Duke University Medical Center
- Jerome P Richie, MD, FACS
Jerome P Richie, MD, FACS
- Section Editor — Cancer of the Urethra, Penis, and Ureter; Urologic Surgery; Prostate Cancer
- Elliott Carr Cutler Professor of Surgery
- Harvard Medical School
The clinical manifestations of prostate cancer at diagnosis have changed substantially since the introduction of prostate-specific antigen (PSA) screening. Although a higher percentage of men have localized disease at presentation, metastatic prostate cancer remains an important clinical problem in terms of the number of men with advanced disease and its impact on quality of life, and as a cause of mortality.
Osteoblastic lesions in bone are the most common site of metastasis. These frequently are symptomatic and can cause pain, debility, and functional impairment. The treatment of bone metastases in men with prostate cancer is palliative. The goals of treatment are to improve survival, relieve pain, improve mobility, and prevent complications (eg, pathologic fractures, epidural spinal cord compression).
The management of bone metastases in men with advanced prostate cancer is reviewed here. Treatment can include treatments directed specifically against the cancer-involving bone, osteoclast inhibition to prevent complications from osseous involvement, and systemic therapy directed against the cancer.
The clinical presentation and evaluation of bone metastases and the overall approach to the management of men with advanced prostate cancer are discussed separately. (See "Overview of the epidemiology, clinical presentation, diagnosis, and management of adult patients with bone metastasis" and "Bone metastases in advanced prostate cancer: Clinical manifestations and diagnosis" and "Overview of the treatment of disseminated castration-sensitive prostate cancer".)
TREATMENT OF PATIENTS WITH SYMPTOMATIC BONE METASTASES
External beam radiation therapy — External beam radiation therapy (RT) is the treatment of choice for men with castration-resistant prostate cancer and bone pain that is limited to one or a limited number of sites. External beam RT is discussed separately. (See "Radiation therapy for the management of painful bone metastases".)
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- TREATMENT OF PATIENTS WITH SYMPTOMATIC BONE METASTASES
- External beam radiation therapy
- Bone-targeted radiopharmaceuticals
- - Radium-223
- Radium-223 based combinations
- - Beta emitting radiopharmaceuticals
- Focused ultrasound
- Systemic anticancer therapy
- PREVENTION OF BONE METASTASIS COMPLICATIONS
- Osteoclast inhibition
- - Prevention of skeletal-related events due to bone metastases
- Castration-resistant disease
- - Bisphosphonates
- - Denosumab
- Castration-sensitive disease
- - Prevention of ADT-related bone loss
- - Prevention or delay of bone metastases
- - Calcium and vitamin D
- - Side effects
- SUMMARY AND RECOMMENDATIONS