©TheCanadian Journal ofUrology™: International Supplement, April 2014
Address correspondence to Dr. Bertrand Tombal, Service
d’Urologie, Cliniques universitaires Saint Luc, Avenue
Hippocrate, 10, B-1200Brussels, Belgium
Practical guide tobonehealth in the spectrum
of advancedprostate cancer
ValentinaButoescu,MD, BertrandTombal,MD
Cliniquesuniversitaires Saint-Luc, Institut deRechercheCliniqueUniversité catholiquedeLouvain, Brussels, Belgium
BUTOESCUV, TOMBALB. Practical guide tobone
health in thespectrumof advancedprostatecancer.
Can JUrol
2014;21(Suppl 1):84-92.
Introduction:
In the advanced stage of prostate cancer,
bone is consistently the first and, later on, the dominant
extra-nodalmetastatic site. Bonemetastases account for
most of prostate cancer’smorbidity.
Materialsandmethods:
Wehaveperformeda literature
review using the MEDLINE database for publications
on: 1) bone metastases (androgen deprivation therapy);
2) cancer treatment induce bone loss; 3) skeletal related
events; 4) denosumab; 5) zoledronic acid.
Results:
Prostate cancer cells disrupt the normal bone
remodelingprocess, invade theskeletal environment, and
ultimately weaken the bone structure. This may result
in skeletal complications, also known as skeletal related
events (SREs), including pain, fractures, spinal cord
compressions requiring surgery, radiotherapy or change
in anti-cancer treatments. SREs negatively impact
quality-of-lifeandsurvival andrepresentamajorcost for
thehealthcaresystem. Thebonemetastasesconundrum is
further aggravatedby the fact that androgendeprivation
therapy (ADT), the reference systemic treatment of
advanced prostate cancer, profoundly affects the skeletal
integrityaswell. ADTaccelerates thephysiological bone
resorption, leading toosteoporosisand fragility fractures.
Conclusion:
The concept of “bone health” or “skeletal
heath”refers to thediagnostic,prevention, and treatment
of cancer treatment induced bone loss (CTIBL) and
metastasis,andtheirrespectivecomplications,osteoporotic
fractures andSREs.
KeyWords:
prostatecancer, androgendeprivation
therapy, osteoporosis, skeletal related events,
bisphosphonates, denosumab
spinalcordcompression. Registrationauthoritieshave
aggregated thesecomplicationsandcoined the termof
skeletal-relatedevents (SREs),mostly for thepurpose
ofproperevaluationofnewpharmacologicalentities.
6
SREsarecommon inall“osteotropic”cancers, suchas
breast, prostate, and lung cancer.
In breast and prostate cancer, skeletal integrity is
alsocompromisedbyhormonal treatments,androgen
deprivation therapy (ADT) inprostatecancerpatients.
ADT increases bone resorption and is a known risk
factor for osteoporosis andosteoporotic fractures.
The concept of “bone health” or “skeletal heath”
refers to thediagnostic,primaryandpharmacological
prevention,and treatmentofcancer treatment induced
bone loss (CTIBL)andmetastasis,and theirrespective
complications, osteoporotic fracturesandSREs. Bone
health is a major issue in prostate cancer because it
impactsqualityanddurationof lifeof thepatients. The
Introduction
Advanced prostate cancer is characterized by a
very high tropism to bone.
1,2
Less than 10% of men
diagnosed with prostate cancer will ultimately die
of the disease.
3
In those progressing to lethal stage
prostate cancer, the skeleton is the first metastatic
extra-nodal landingsite in80%ofpatientsand,overall,
90% of patients will have bone metastases.
4,5
The
metastatic tissue replaces the normal bone marrow
content, leading to anemia. But more importantly,
metastasesalter thenormalboneremodelingprocesses
and invade the surrounding structures, resulting
in complications such as pathologic fractures, pain,
84
